Nurse Practitioner Scope of Practice vs Independent Practice

All nurse practitioner malpractice policies mention coverage “within in scope of practice.” And we’ve all heard the terms “scope of practice” and “independent practice” before, but what do they mean when comparing them to each other? The difference all boils down to where you live.

The majority of states and territories each have different regulations on the way nurse practitioners handle their practice. Sadly, the variation of laws throughout the nation makes it difficult for nurse practitioners (NPs) to utilize their education fully, and it prevents some patients from receiving the best care. This article will help you understand how the scope of practice is measured throughout the nation, and how you can educate yourself on these regulations.

What is scope of practice?

The scope of practice refers to what NPs are educated to do. It is defined as the particular procedures, actions, and processes that a healthcare provider is legally permitted to do.

As for NPs, the American Association of Nurse Practitioners (AANP) has defined an NPs’ scope of practice as: “Nurse practitioners (NPs) are licensed, independent practitioners who practice in ambulatory, acute and long-term care as primary and/or specialty care providers. NPs assess, diagnose, treat and manage acute episodic and chronic illnesses. NPs are experts in health promotion and disease prevention. They order, conduct, supervise, and interpret diagnostic and laboratory tests; prescribe pharmacological agents and non-pharmacologic therapies; and teach and counsel patients, among other services.”.

The AANP has also placed the states and territories into three different categories that describe the freedom of practice these places permit. How do these categories look in practice? Taking a look at this interactive wheel, we can see a clear trend between independent practice and region. States like Washington or Maine, as well as the regions these states are in allow for NPs to practice while fully independent. These are called “full practice” states.

Unfortunately, certain states have created laws that restrict what NPs can do. Once a state begins restricting even one element of NP practice, it becomes a state with restricted practice. States in this category are things like South Carolina, or Alabama which have restricted or reduced almost every element of practice. In those states, NPs are lobbying to remove these restrictions that prohibit them from providing care or require them to have costly supervision agreements with physicians. Thanks to these lobbying efforts, NPs are making progress in obtaining their independent practice.

What is independent practice?

Independent practice refers to a state where these restrictions have been removed, and thus NPs can provide care within their full scope of practice. Each NP is educated to perform these tasks under their discretion, yet many states continue to hold them back for various reasons. In restricted states specifically, costly agreements between NPs and physicians are required and many patients are left with less access to medical care due to these restrictions.

As mentioned above, there are efforts from organizations like the AARP, Institute of Medicine, National Council of State Boards of Nursing (NCSBN), and others that are working for full, independent practice for NPs across the nation. This is something that needs to happen, as the inconsistencies between states are superfluous and only impede the care given to patients.

What can NPs do? Get out there and advocate for independent practice, or contact your local NP organization to let them know that you deserve to have the freedom to practice using the full scope of your education. I also implore every NP to educate themselves on this topic, as it can be a complicated one. Here are some other resources that you can explore to further your knowledge on the subject:

By Melissa DeCapua, DNP, PMHNP
Dr. Melissa DeCapua is a board-certified psychiatric nurse practitioner who graduated from Vanderbilt University. Her background is in child and adolescent psychiatry as well as psychosomatic medicine, and she currently works as a researcher Microsoft. She is a strong advocate for empowering nurses, and she fiercely believes that nurses should play a pivotal role in shaping modern healthcare. For more information, visit melissadecapua.com and follow her on Twitter @melissadecapua.

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