In the long struggle to gain full practice authority (FPA), nurse practitioners (NPs) can point to notable advances in the last few years. Now, patients in more than half of the states, the District of Columbia, and two U.S. territories have full, direct healthcare access from NPs.
In April 2022, New York and Kansas granted FPA to NPs. That brings to 26 the number of states where NPs can practice to the top of their license without restriction. In this article, we’ll look at how that progress was made, the impact of COVID, and how newly proposed federal legislation would strengthen NP practice. But first, let’s have a look at what FPA means.
“Full practice authority is essentially that the nurse practitioner can practice to the full extent of their education and training,” says April N. Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, president of the American Association of Nurse Practitioners (AANP). “Nurse practitioners are trained to evaluate patients, make diagnoses, order and interpret tests, prescribe medications, coordinate care, and educate. We are educated and trained to do these things,” says Kapu.
In the past few years, the pace has “really picked up as we have seen more and more states move to full practice authority,” according to Kapu. She notes that four states moved to full practice authority through the pandemic: Delaware and Massachusetts in 2021 and New York and Kansas in 2022. “It’s because we demonstrate our commitment to quality and equitable care and ensuring care is provided in all communities.”
In states that have moved to full practice authority, “we’ve seen improved patient care outcomes. We’ve seen an increase in the workforce. We’ve seen an increase in nurse practitioners working in historically underserved urban and rural areas,” Kapu says.
COVID and Care
While devastating, COVID helped bring to light the high-quality care that NPs provide and boosted efforts to gain FPA. In some states where NPs worked under less than full practice authority, the governors signed executive orders waiving various restrictions, notes Kapu.
“That’s where we saw the opportunity for nurse practitioners to continue providing care. They provided very high-quality care. They were able to provide more accessible care. As you saw throughout the pandemic, they were in communities and churches, going door to door, seeing patients in their homes, and doing everything they did in the hospital and the ICUs. So we demonstrated that continued quality of care. And that is what quickened the momentum during the pandemic; the executive orders provided that opportunity,” Kapu says.
In Ohio, a reduced practice state, an emergency authorization during COVID allowed NPs to deliver care via telehealth, notes Evelyn Duffy, DNP, AGPCNP-BC, APRN-NP. However, she notes that NPs can still practice via telehealth, and that ability is no longer contingent on emergency authorization. Based in Cleveland, Duffy is an NP in the University Hospitals Geriatric Medical Group and a professor at the Frances Payne Bolton School of Nursing.
An NP since 1981, Duffy notes that “we’ve come a long way in Ohio. We got full prescriptive authority at the end of the 1990s.”
However, like all Ohio NPs, Duffy needs a collaborative agreement with a doctor. “Ohio is in the reduced practice category,” she notes. “Not a lot obstructs me from doing what I want. The only thing that gets in the way is having to make that collaborative arrangement.”
Kapu stresses the need to get out the message that laws limiting NP practice need to be revised. Laws need to be updated to “allow NPs to practice to the extent of their education and training, not beyond that, but to the extent of their education and training, as they are very capable of doing and have decades and decades of evidence demonstrating their quality-of-care outcomes. So it’s getting that message out that all we have to do is update those laws. It’s no cost or delay and can be put into place, and you would see much-increased access.”
Kapu points to Arizona as an example of what may happen for states that grant FPA. Arizona, she notes, moved to FPA in 2001. Five years later, the NP workforce doubled, and rural areas saw a 70% increase in NPs.
On the federal level, new legislation, the Improving Care and Access to Nurses (ICAN) Act, was introduced in September in the House of Representatives. Supported by the AANP and other major nursing organizations, the act would update Medicare and Medicaid to enable advanced practice nurses to practice to the top of their education and clinical training, according to a press release from the American Nurses Association.
Although getting FPA in all states has taken a little longer than wanted, “we have momentum,” says Kapu. “I believe we’ll get there, especially with the increasing access to care needs that we’re seeing in the United States today.”
Fayetteville State University’s (FSU) School of Nursing launched a statewide initiative to train more Sexual Assault Nurse Examiners (SANEs).
FSU is the first HBCU in the country to host a SANE training program at its nursing school, thanks to a $1.5 million appropriation from the state of North Carolina. Right now, there are fewer than 100 SANEs certified across the state of North Carolina, even though they are the best people to care for sexual assault victims and to collect forensic evidence.
“The state of North Carolina recognizes the need not only for a higher number of these specially trained nurses across the state but also a more diverse pool of these professionals to help make survivors feel more comfortable during an already traumatic time,” says Dr. Sheila Cannon, associate dean of FSU’s School of Nursing. “Fayetteville State University is in a unique position to fulfill those needs.”
FSU’s SANE program aims to train 20 specially qualified nurses per semester, including the summer, to reach 60 per year.
“This program emphasizes two of Fayetteville State University’s core missions, to prepare our students for success in their careers and to serve our community,” says FSU Chancellor Darrell T. Allison. “As much as we wish they weren’t needed, there is a shortage of these specially trained nurses in our state and community. Thanks to the exceptional training our current nursing students receive at our university, the state trusted us with the responsibility of filling that need. I have no doubt our faculty, and content experts are up to the task.”
Beyond SANE training, a SANE nurse certification requires a candidate to have at least two years of nursing experience, complete dozens of hours of training and clinical work, and pass a written exam by the International Association of Forensic Nurses.
“Many nurses in the state have had some training either in a classroom or through the hospital, but they don’t have the full credential,” says Cannon. “A SANE nurse needs to know more than just how to collect DNA evidence. They are also trained to know where to look for injuries, how to ask delicate questions, and how to interact with survivors as they process what happened to them.”
FSU’s nursing school aims to grow and sustain the program to address a void in specialized nursing care, particularly in underserved and underrepresented communities.
Structural and interpersonal racism is blocking aspiring midwives of color from joining the workforce at a critical time for the health of pregnant and birthing people.
The U.S. has alarming disparities in maternal health that will likely intensify following the erosion of reproductive health access in states across the country. Midwifery care and care from providers who share a racial and cultural identity with their patients are proven to improve outcomes for parents and babies. Yet an overwhelming majority of midwives in the U.S. identify as white.
People also frequently cited the lack of midwives of color to teach and mentor them. Barriers to becoming a midwife were greater among people with lower levels of income or education.
This survey of aspiring midwives of color across the U.S. is the first study exploring a wide range of barriers to entering midwifery education.
“Aspiring midwives of color are motivated to provide care in their communities to counteract the effects of racism on maternal and infant health,” says Renee Mehra, Ph.D., ACTIONS postdoctoral fellow and first author on the paper. “We need them in the workforce, yet the cost of midwifery education and the lack of racial and ethnic diversity in the profession are standing in their way.”
“We must act now to train, diversify and deploy a midwifery workforce that can tackle the persistent maternal morbidity and mortality that disproportionately plagues Black and marginalized people in the USA today,” says midwife Jennie Joseph, Founder and President of Commmonsense Childbirth.
The structural and interpersonal racism that impacts people’s ability to become midwives also motivated them to want to provide this care. The strongest motivating factors in the study were providing racially concordant care in their communities, reducing racial health disparities, and their own prior experiences of discrimination in healthcare settings.
To help aspiring midwives of color meet their goals, the researchers suggest solutions including providing funding for students of color for tuition and other living costs, creating a pipeline for midwives of color by enrolling more students of color, and supporting and hiring more teachers of color, and opening more midwifery schools, especially in Historically Black Colleges and Universities.
For the second year in North America, WaterWipes has awarded a Pure Foundation Fund, which awards the department of the winning healthcare provider $9,000, as well as a 6-month supply of WaterWipes.
According to a statement from WaterWipes, the Pure Foundation Fund “recognizes the outstanding work of healthcare heroes who have made a difference in the lives of parents and babies in their pregnancy, birth, and postnatal journey.
Out of the 266 healthcare providers nominated, Alessandra Chung, a nurse for the Southcentral Foundation as a home-visiting nurse with the Nutaqusiivik program (part of the Nurse Family Partnership) in Anchorage, Alaska, won. She and the program serve Alaska Native and American Indian families living in Anchorage and the surrounding communities. In addition to an award plaque, Chung receives a $100 Visa gift card and flowers.
Chung took time to answer Daily Nurse’s questions about being this year’s award winner and how the money and wipes will help her work.
What did it feel like when you learned you won the WaterWipes Pure Foundation Award? Did you expect it?
It was a complete surprise; I had no idea my coworker, Sarah Swanland had nominated me! I was finishing my maternity leave, so it was terrific news to share with my colleagues once I returned to work. After learning more about this incredible program, I felt excited and honored to be selected.
I’m incredibly grateful and honored to be recognized by the Pure Foundation Fund. I love the team of nurses I work with and hold them in such high regard. I think any of them could have been the winner, so I am honored that Sarah thought of me.
What type of work do you do? How long have you been doing it? For what community? Why do you enjoy it?
I have been a nurse for 15 years and have been a part of Southcentral Foundation’s Nutaqsiivik Nurse Family Partnership for the last four. The Nutaqusiivik program is a voluntary nurse home-visiting program working with Alaska Native and American Indian families from pregnancy until the child is two-years-old.
The program’s overall goals are to improve pregnancy outcomes and child health and development. Still, what I love most is uncovering each mom’s heart’s desire for their children and encouraging them to become the parents they want to be. Of course, every new mom’s situation and needs are unique, so we never want them to feel pressured to approach the program in a specific way
My position is the perfect mix between maternal health nursing and psychosocial nursing. I love how holistic my role is and advocating for my patients while teaching them how to advocate for themselves and their families.
Winning $9,000 for your department, plus a six-month supply of WaterWipes, is amazing. But do you know yet how the Southcentral Foundation’s Nutaqsiivik Nurse Family Partnership will use the money?
We’re still discussing where the funds will be used to support the moms and babies in our community. This will positively impact the families we serve by allowing us to continue advocating for and empowering moms on their journeys to be the parents they want to be.
How do you make a difference in the communities you serve? What are the biggest challenges in the communities?
Every mom is different, and every situation is unique. Just being there for each mom, meeting them where they are in their journeys, and encouraging them to be the parents they want to be is how we make a difference every day in our community. When moms are supported and empowered, they are, in turn, able to support and empower their children, and that is where generational growth and change can happen. So it’s long-term change and prevention that is our goal.
What are the most significant rewards you experience by working with the people you serve?
First, serving the Alaska Native/American Indian community is an honor. I love to be able to come alongside and partner with families on their journeys. It is always a privilege to be invited into a family’s home and trusted with their stories and dreams. I’ve encountered all sorts of challenges new and expecting mothers face, and through it all, it’s always worthwhile to see them understand that they can do this.
And even when things don’t turn out as we hope, I am honored to support them through maybe that grief and loss too. At the end of the program, we host a graduation ceremony where the moms are given a chance to celebrate their growth and achievements alongside their children, and the smiles and gratitude I receive are their rewards.
What was your favorite part about this whole experience? Why are you proud of the work you do?
There were many great things about this experience, the first being that Sarah called me and told me she nominated me, and I won. I remember being in the parking lot of my PT’s office feeling torn about leaving my baby to go back to work, and it was so encouraging for her to tell me this.
My second favorite part was making the video; one of the moms I worked with was willing to participate. That was special. I’m proud of my work because it’s what holistic nursing is all about–truly meeting the patient where they are and educating and advocating for what they want for themselves and their families.
Being a nurse in Alaska, working with the Alaska Native population is the best. I wouldn’t want to be a nurse anywhere else.
The $125 million donation by Penn alumnus Leonard A. Lauder, Chairman Emeritus of The Estee Lauder Companies, to create this first-of-its-kind, tuition-free program is the largest gift ever to an American nursing school.
The gift comes at a time when the COVID-19 pandemic has magnified the nation’s acute shortage of primary care providers and persisting inequities in access to quality healthcare.
“This is the most timely and consequential gift not only for our university but for our country. It is unprecedented in its potential to address America’s most critical need of providing primary health care to all who currently lack it by investing in nurses,” says former Penn President Amy Gutmann. “Growing the number of nurse practitioners who are prepared and committed to working in underserved areas is the most practical and inspiring way to ensure a healthier country. I am grateful and honored that Leonard would make this gift to Penn Nursing, and thrilled to know that it will have an immediate impact that will last far into the future.”
University of Pennsylvania’s new tuition-free program to recruit, train and deploy nurse practitioners to underserved communities across the U.S.
Nurse practitioners are leaders on the front lines of care, a role never more important as Americans confront a primary healthcare shortage in their communities. With their advanced clinical training and graduate education, nurse practitioners have the knowledge and skill to supervise and manage critical aspects of care in decision-making, from patient diagnosis to ordering and interpreting tests, to prescribing medication. In addition, nurse practitioners deliver high-quality primary care to people of all ages, such as treating common illnesses, managing chronic conditions, and providing preventive care that helps patients stay healthy.
Nurse practitioners can also able to take on key leadership roles, from managing and operating walk-in or community clinics to leading interdisciplinary teams within health systems. The new program will better the lives of patients and communities most in need while providing a pathway for the many nurses interested in advanced education who may not otherwise have the
“Now more than ever, the country needs greater and more equitable access to quality primary care—and highly-skilled nurse practitioners are the key to making that happen,” says Leonard A. Lauder. “The program will ensure that more Americans receive the essential healthcare services that everyone deserves, and I’m so pleased to be working with Penn Nursing on this initiative. I look forward to welcoming our first class of future nurse practitioners this fall. I know their expertise will be matched only by their commitment to serving our communities.”
Cybersecurity threats are real, but you can take many steps to help protect your own information. October is designated as Cybersecurity Awareness Month and offers excellent resources to help you take steps to make it tougher for anyone to gain your information.
Whether it’s keeping patient information private at work or keeping your own personal information away from strangers, you do have control over some of the most common threats. The Cybersecurity and Infrastructure Security Agency (CISA) has an excellent toolkit that gives tips and directions to help assess your risk and take actions to reduce it.
Here are a few simple ways to get started.
Passwords Offer Entry
Passwords are one of the easiest ways to add a line of defense to your information and accounts. Choosing a strong password means that you aren’t using your name or a sequential string of numbers and that you include variations on capital and lowercase letters and some symbols. Don’t have one password that you use for everything because if someone gets that one password, all your information is now vulnerable. And don’t keep the same password; changing it up makes it more difficult to get. Protect your passwords fiercely and don’t share them. If you have a family password for something like a streaming account, make sure that’s not the same password as what you use for your other accounts.
Be Cautious and Slow Down
Phishing is much more complex than it used to be, so be extra careful about any texts, emails, or phone calls. Texts or emails that say your account has been frozen or that ask for information from you to clear up a problem should be scrutinized. Never click on any link or attachment in a message until you are completely certain it is legitimate. One easy way to do that are to check the return email address; if it is from your bank, it should have your bank’s email (and really look at the spelling–even one extra letter or missing letter makes a difference). If you’re confused by the request, don’t click on links to see if it helps you find answers. Call the source by finding the number on your own; don’t use any phone number provided in a suspicious email or text. Your bank, credit card provider, health care office, or virtually any account holder will tell you if they requested information or if the problem is real.
Use Software as a Line of Defense
Make sure your devices are protected by up-to-date anti-viral software. And if you’re using a work device, get in touch with your IT department to follow all the proper steps and precautions they recommend for security out of the office. Don’t log into an open Wi-Fi account in a coffee shop or airport, for example, as that provides easy access for someone to get into your systems. And check all the app permissions on your phone to ensure the greatest privacy and security possible. Many apps track your location and your search history or even want permission to access your microphone and camera. You can control who sees what, so do an app assessment frequently to keep what you share to a minimum.
Make It Difficult
When you get a credit card application or a letter about applying for life insurance in the mail or even bring home receipts from shopping, don’t recycle that paper. It makes it too simple for people to snag your information and take over your identity. Shred or burn anything with your identifying information that can be used to capture your identity–and also take care to treat QR codes or offer numbers on applications the same way. This simple step keeps all that information in your control.
Consider Nursing Informatics
The nursing informatics field is wide, and if you’re intrigued by cybersecurity, there’s a need for your skills. Nursing informaticists are essential to the safety of healthcare organizations. They are needed to develop cybersecurity curriculum as educators, provide direction and guidance for their organizations, offer routine education to the healthcare workforce about cybersecurity, and advocate for security in the industry.
This week, get started on your personal cybersecurity assessment by seeing if your passwords are strong enough and making sure your protective software is current. After that, continue to be vigilant about your information to keep it out of the hands of people who shouldn’t have it.