Expanding Scopes of Practice for Nurses

For several decades, the trend in the United States has been toward expansion of scope-of-practice regulations for APRNs, but this shift has been incremental and variable. Most recently, the move to expand the legal authority of all APRNs to provide health care that accords with their education, training, and competencies appears to be gathering momentum. In 2008, after 5 years of study, debate, and negotiation, a group of nursing accreditation, certification, and licensing organizations, along with several APRN groups, developed a consensus model for the education, training, and regulation of APRNs (see Appendix D). The stated goals of the APRN consensus process are to:

  • “strive for harmony and common understanding in the APRN regulatory community that would continue to promote quality APRN education and practice;

  • develop a vision for APRN regulation, including education, accreditation, certification, and licensure;

  • establish a set of standards that protect the public, improve mobility, and improve access to safe, quality APRN care; and

  • produce a written statement that reflects consensus on APRN regulatory issues” (see Appendix D).

The consensus document will help schools and programs across the United States standardize the education and preparation of APRNs. It will also help state regulators establish consistent practice acts because of education and certification standardization. And of importance, this document reflects the consensus of nursing organizations and leaders and accreditation and certification boards regarding the need to eliminate variations in scope-of-practice regulations across states and to adopt regulations that more fully recognize the competence of APRNs.

In March 2010, the board of directors of AARP concluded that statutory and regulatory barriers at the state and federal levels “are short-changing consumers.” Acknowledging that nurses, particularly APRNs, can provide much of the care that Americans need and that barriers to their doing so must be lifted, the organization updated its policy on scope of practice. AARP states that “the policy change allows us to work together to ensure that our members and all health care consumers, especially in underserved settings such as urban and rural communities, have increased access to high quality care.” The amended policy reads as follows:

Current state nurse practice acts and accompanying rules should be interpreted and/or amended where necessary to allow APRNs to fully and independently practice as defined by their education and certification. (AARP, 2010a)

Meanwhile, after passage of the ACA, 28 states began considering expanding their scope-of-practice regulations for NPs (Johnson, 2010). Expanding the scope



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