FIGURE 3-3 Requirements for physician–nurse collaboration, by state, as a barrier to access to primary care.

NOTE: Collaboration refers to a mutually agreed upon relationship between nurse and physician.

SOURCE: AARP, 2010b. Courtesy of AARP. All rights reserved. This figure combines Map 1, Overview of Diagnosing and Treating Aspects of NP Practice and Map 2, Overview of Prescribing Aspects of NP Practice, both developed by Linda Pearson (2010).

2008; Hogan et al., 2010; Horrocks et al., 2002; Hughes et al., 2010; Laurant et al., 2004; Mundinger et al., 2000; Office of Technology Assessment, 1986). No studies suggest that care is better in states that have more restrictive scope-of-practice regulations for APRNs than in those that do not. Yet most states continue to restrict the practice of APRNs beyond what is warranted by either their education or their training.

Depending on the state, restrictions on an APRN’s scope of practice may limit or prohibit the authority to prescribe medications, admit patients to hospitals, assess patient conditions, and order and evaluate tests. Box 3-1 provides an example of the variation in state licensure regulations, detailing examples of the services an APRN would not be permitted to provide if she practiced in a more restrictive state (Safriet, 2010). In addition to variations among states, the scope of practice for APRNs in some cases varies within a state by geographic location of the practice within the state or nature of the practice setting.