The State of NNP Practice

Elizabeth Welch-Carre, MS NNP-BC APRN
Neonatal nurse practitioner, Children’s Hospital Colorado

There was an interesting article published recently about full practice authority potentially being a gender issue. It may or may not be, but it is a topic to ponder. The article, by Nancy Rudner Lugo, an advanced practice registered nurse (APRN) with a doctorate in public health, noted that those states that supported the Equal Rights Amendment were more likely to move forward with full practice authority than those states that did not.  Furthermore, there is another recent article noting that although only about 10% of nurses are male, males tend to make more money than females. This gap is approximately $17,000 between male and female certified registered nurse anesthetists according to Nurse.com. So going forward, it may not only be practice authority issues that need to be addressed, but also pay practices.

Puerto Rico: In January 2016, the governor signed PC 1051, which recognized for the first time the role of the nurse practitioner (NP) in statute.
Wyoming: This is the first state to pass the National Council of State Boards of Nursing APRN compact. This legislation allows NPs to practice in other compact states with a single multistate license. This opportunity already exists among several states for registered nurses (RNs).
Florida: The state passed HB 1241, which will allow for NPs to order any type of medication within certain facilities. Also, after a long and hard fight, HB 423 was signed. This bill allows NPs to now prescribe controlled substances. Florida was the last state to authorize this for NPs.
Idaho: The governor signed SB 1250, making it the second state to adopt the APRN compact.
Utah: SB 58 was signed into law. This will allow NPs to prescribe schedule II and III medications without a collaborative agreement if they have 2,000 hours of practice and are not setting up or working in a pain clinic.
Oregon: Senate bill SB 1503 was signed into law. This allows for physician assistants and NPs to be reimbursed for services in the same way as physicians.
West Virginia: HB 4334 was signed. This will allow NPs to prescribe schedule III drugs for longer periods of time. It also removes collaborative agreement requirements after a certain number of hours of practice. Furthermore, NPs may now sign forms that are within their scope of practice.
Kentucky: SB 114 was signed into law. NPs are now permitted to sign forms related to some health disorders such as seizures and sign death certificates.
Connecticut: SB 67 was signed by the governor. This bill provided for several practice changes for NPs. NPs may now sign Do-not-resuscitate orders, create collaborative agreements with pharmacists, and order occupational therapy.
Hawaii: SB 2672 allows NPs to sign death certificates and provide worker’s compensation management.
Alaska: SB 53 was signed. This bill fully aligns Alaska with the APRN Consensus Model.
Louisiana: SB 187, which would have allowed NPs to have full practice authority, was pulled from the floor because of lack of support.
Pennsylvania: SB 717, which will allow for full practice authority, passed in the Senate. It will now go to the House for approval.
Massachusetts: The full practice authority bill failed to pass committee.

Federal Legislation

  • Continued support is needed to pass S 578 and HR 1342, the Home Health Planning and Improvement Act. This act would allow NPs to certify eligibility of patients for home health services.
  • Please contact members of Congress to advise the Veteran’s Administration to implement the new proposed rule for full practice authority for NPs in VA facilities.
  • Let Congress know that you want them to cosponsor the Title VIII Nursing Workforce Reauthorization Act.

To gain a better understanding of the practice environments across the nation, Barton and Associates provides a guide to show the current practice environment for each state. There are still several states that require collaborative agreements or physician supervision for an APRN to practice. Advocacy for APRNs and by APRNs will need to continue so that APRNs across the nation have full practice authority to better support the physical and mental needs of people/patients in the United States.

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