The journey to full practice authority (FPA) for nurse practitioners (NPs) in Massachusetts reached its peak on January 1, 2021, when Governor Charlie Baker signed FPA for Massachusetts NPs into law. This journey began more than 10 years earlier, when a dedicated group of volunteers decided to start comprehensive advocacy work to bring the idea of FPA for Massachusetts NPs to fruition.  

Stephanie Ahmed, DNP, NP-BC, joined the legislative committee for the Massachusetts Coalition of Nurse Practitioners (MCNP) in 2009; she now serves as the organization’s director of state legislative policy. Dr Ahmed discussed Massachusetts’ journey to full practice authority with the Clinical Advisor, and offered advice to NPs who practice in restricted states and seek to lobby for FPA legislation.

Dr Ahmed and fellow volunteers had to write and file legislation 4 times, working tirelessly as a group for more than a decade leading up to this year’s legislation. “We initially had a lot of education to do [within the state government] and help people understand [NPs] and what we do,” she said.


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Dr Ahmed and her team identified key stakeholders who could help advance their cause, including lawmakers, professional organizations, and patients. The group also lobbied with physician colleagues who supported the cause.

“We had a lot of opposition from professional physician organizations, but by and large we received support from the general public, AARP, and other key groups in Massachusetts that were lobbying for healthcare reform,” Dr Ahmed said.

Advocates cited peer-reviewed studies as proof to indicate that care delivered by NPs is equal to or exceeds that of a physician. “We knew the true story of the outcomes and care we delivered,” Dr Ahmed said. “We felt that there was a need in the state that had not been addressed, although it had been identified.”

The need identified in Massachusetts, as well as many other states, is to reduce patient wait times. Dr Ahmed explained that scarcity of providers can cause delays for patients — an issue inconvenient at best, and lethal at worst.

“Access to care is no longer a rural phenomenon, and it is important that we advance this legislation across the country,” she stated. Dr Ahmed noted that especially during the COVID-19 pandemic, NPs can help fill gaps in access to care to strengthen the nation’s public health system.

Uniformity of practice was another motivator for advocates; scope of practice for a physician does not vary state by state, but for NPs, moving to another state could result in added restrictions. Dr Ahmed noted that there will be a lack of consistency as FPA legislation passes or fails in each state, and stressed the importance of obtaining FPA for NPs across the country so that the ability to fill prescriptions and practice independently becomes standard.

During the decade in which the group of volunteers advocated for FPA in Massachusetts, Dr Ahmed served twice as the president of MCNP. The process instilled in her a strong commitment to perseverance; she stated that though the process was lengthy and tedious, it became easier as she learned from her experience.

“Had I known when I was sitting with a group of people and said ‘let’s file this legislation’ that it would take 10 years, that would [have been] very daunting,” she said. But was it worth it, and would she encourage NPs in other states to do the same? For Dr Ahmed, the answer is a resounding yes.

“One, it’s the right thing to do for patients. Two, it’s the right thing to do for nursing practice,” she stated.