Scope of Practice vs. Independent Practice for NPs

As a nurse practitioner (NP), you have the opportunity to work in a variety of healthcare settings and provide a wide range of services to patients. However, the scope of practice for NPs varies depending on the state in which you practice. Some states allow NPs to practice independently, while others require physician oversight.

In the healthcare community, there’s a debate about the scope of practice and independent practice for nurse practitioners (NP). In our guide, we’ll explain the basics of this discussion and break down the laws regarding the independent practice authority of NPs and the benefits of full practice authority to NPs and patients.

Scope of Practice for NPs

What does the scope of practice mean, and how does it apply to NPs? Scope of practice refers to the procedures, actions, and processes a healthcare professional, such as an NP, is legally permitted to do.

The scope of practice for an NP can vary from state to state, as each state has the legal authority to enact its scope of practice laws on healthcare professionals such as NPs. In all states, though, NPs have the scope of practice to assess, diagnose, treat, and manage illnesses by ordering, conducting, and interpreting tests or prescribing medication. The discrepancy from state to state involves the supervision of NPs.

Independent Practice for NPs

For NPs, independent practice allows them to provide care without the mandated supervision from a physician that some states require. An NP that works in a state with full practice authority can open their own practice and assess, diagnose, and treat patients in much the same way a physician might.

There are also degrees of independence that vary by state, and the debate of scope of practice vs. independent practice for NPs can be a contentious topic between NPs and physicians. There’s some friction among healthcare professionals because some states require NPs to compensate physicians for overseeing their work. Naturally, NPs prefer to be independent and not be on the hook for this expense.

Prescriptive Authority for NPs

Much of the discussion and debate on the independence of NPs revolves around the issue of prescriptive authority. Prescriptive authority is a health professional’s legal ability to prescribe prescriptive medication.

In all 50 states, NPs have prescriptive authority, but the degree to which they can exercise this authority without mandated physician supervision is where the debate between scope and independence hinges. NP advocates say the extra step of supervision and legal barriers is wasteful and only harms the patient through delays and expenses. In contrast, others claim that supervision is explicitly for the patient’s benefit.

State boards of nursing aim to earn the ability to regulate prescriptive authority instead of physician state boards, which is the situation in many states currently.

Practice Regulation for NPs

As we discussed, there are some discrepancies between states regarding the legal practice authority of NPs. The states are divided into three categories of varying independence—full practice, reduced practice, and restricted practice authority.

Full Practice Authority

There are benefits of full practice authority for nurse practitioners. In a full practice authority state, NPs can prescribe, diagnose, and treat patients without physician oversight. Full practice states allow NPs to establish and operate their independent practice as a physician may do in other states.

NPs can freely prescribe medication based on their education, training, and skills for a patient and also prescribe other health services like home care. As of this writing, around half the states (and Washington DC) have full practice authority laws for NPs, while the other half are basically evenly split between reduced and restricted laws.

Reduced Practice Authority

As its title suggests, reduced practice authority laws allow for some independence on behalf of NPs but limit their scope of practice in at least one area. The area that’s limited for NPs varies by state, but it’s most often in the area of prescriptive authority.

In most reduced practice states, NPs can still diagnose and treat patients, but physician oversight is required when prescribing medicine or health services.

Restricted Practice Authority

At the other end of the spectrum, the opposite of full practice authority is restricted practice authority states. Clearly, these states are the most restrictive and require that an onsite physician supervise NPs for the prescription, diagnosis, and treatment of patients.

While a handful of states still have restrictive laws, their number has diminished in recent years as most states are at least creating legislation to lax restrictive laws and move towards reduced practice authority instead of restrictive.

Benefits of Full Practice Authority for NPs and Patients

NPs are strong advocates for full practice authority and offer many arguments for why it would improve the healthcare system and provide better care for patients. We’ll explain some benefits of full practice authority that NPs cite below.

Greater Access to Care

Perhaps the primary benefit of affording full practice authority to NPs is that it allows for greater patient access to medical care. In many areas of the country, especially rural regions that are sparsely populated, physicians and doctors are scarce, and medical resources are stretched thin.

With full practice authority, NPs can open independent practices and treat patients as a physician would without legally requiring supervision from a physician. This independence for NPs means that patients will have more choices in the areas where they live in to provide more healthcare to areas that traditionally have few options.

Fill Personnel Shortages

Unfortunately, gaps in the American healthcare system regarding access to care in many places are due to personnel shortages. During the pandemic, healthcare personnel shortages became evident in many areas of the country as physicians and nurses were shorthanded in dealing with the influx of patients.

According to many experts, those personnel shortages are expected to only worsen as physician and nursing shortages are predicted throughout the decade. NPs can help fill the gap in personnel from these shortages, especially for physicians, by providing quality care and access to full practice authority.

Better Care to Patients

Many NPs also rave about the direct benefit to the patient when NPs are allowed full practice authority. As we discussed, full authority means patients have more options—which means less time waiting for appointments and quicker follow-ups.

Patients no longer have to drive hours in some parts of the country to see a physician or wait around for NPs to have their prescription orders confirmed by supervising physicians. Overall, full authority means a faster, more accessible, and better healthcare experience for many patients.

Conclusion

There are many other considerations when discussing practice authority for NPs, including nurse practitioner malpractice insurance, but overall, NPs would prefer the accountability and responsibility of independent practice rather than the restrictive supervision measures. If you have further questions about nurse practitioner practice authority or malpractice insurance, don’t hesitate to contact our expert staff at Baxter & Associates.

Like other clinicians, nurse practitioners can also be subjected to claims of malpractice. Having malpractice insurance can reduce your risk of liability. If you have further questions about nurse practitioner practice authority or malpractice insurance, don’t hesitate to contact our expert staff at Baxter & Associates.