Nurse Practitioner Practice: Full Scope, Better Outcomes

Tom G. Bartol, NP


October 08, 2014

In This Article


NP scope of practice varies by state in this country. Each state board of nursing determines how independent or restricted NP practice will be. Politics, rather than logic, often influences this determination. For example, several years ago I practiced as an NP in the state of Missouri. In Missouri, there were nurses, pharmacists, and physicians on the board that licensed NPs. I was required to practice under the supervision of a licensed physician. I could only practice in an office on my own if a physician was available within a 30-mile radius of my location. Prescribing any controlled substance was not permitted.

Later, I moved to the state of Maine. In Maine, I am licensed independently and practice independently, without the requirement of any supervision. Now I am permitted to prescribe schedule II-V controlled substances without supervision. Maine, which had only nurses regulating NPs on its licensing board, doesn't restrict NP practice.

Did my competency or my skills change with the move to Maine? Am I more knowledgeable or able to provide better clinical care in Maine? Absolutely not! I was the same NP I had been in Missouri. The change was in the rules of the state.

The Institute of Medicine issued a report 3 years ago titled, "The Future of Nursing: Leading Change, Advancing Health."[1] A key recommendation in this report was to remove scope-of-practice barriers for advanced practice registered nurses (APRNs). The Federal Trade Commission also raised the question of the legitimacy of barriers to APRN practice in a recent report.[2] They stated that removing barriers that limit full scope of practice for NPs will improve access and quality of healthcare.

This study looks at how full scope of NP practice might improve health outcomes and health status. Comparing outcome data from states that have full scope of practice with those permitting only limited scope of practice, Oliver and colleagues found significantly fewer avoidable hospitalizations, readmissions after discharge from rehabilitation, and nursing home resident hospitalizations. States with full scope of practice also had higher health outcome rankings than states with limited scope of practice for NPs.

Are the barriers to full practice affecting access, cost, and outcomes of care? Although these data show an association or relationship, and not cause and effect, they merit some attention. The barriers to practice that result in reduced or restricted practice of NPs are allegedly to protect the public, yet the research has shown NP care to be equal to that of physicians.[3,4,5] In some studies, patients preferred care by NPs over physicians.

This study echoes the calls from the Institute of Medicine, the Federal Trade Commission, and numerous publications that support removal of barriers to the full scope of practice for NPs, saying that supervision and collaborative practice add to the burden of providing care without any gains in quality or lowering of the cost of care. Independent practice for NPs has proven to result in safe, high-quality, compassionate, and cost-effective care.



Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.