Full Practice Authority


How much do you know about full practice authority (FPA)? As NPs, we have state and federal laws and regulations that govern our practice. As we prepare for fall elections and legislative sessions in the new year, we all need to consider our ability to practice to the full extent of our education and training.

I live in Virginia. If you look at the AANP State Practice Environment map (AANP, 2016), Virginia is a red state, meaning we have restricted practice. Twenty-one states and DC have granted NPs FPA. There are only 12 states that are red. In Virginia, NP practice is regulated by the joint boards of the Board of Medicine and the Board of Nursing. We must practice under a written collaborative agreement with a physician that acknowledges the physician is the lead of any patient care team: “‘[C]ollaboration’ and supervision requirements establish physicians as gatekeepers who control APRNs’ independent access to the market,” (FTC, 2014, p. 29). There is no other profession that is regulated by another profession. Further, we have a joint board. FPA means we should be regulated and licensed under the exclusive authority of the Board of Nursing.

As we work on grassroots advocacy, we need to ensure a consistent message to our legislators, patients and colleagues. We need to gather momentum from grassroots NP support as well as legislative support before proposing additional legislation. If we take the time to develop a solid base of support, our legislative efforts will be more rewarding. A consistent message signifies unity within our profession and clarifies our argument.

Here is my proposed elevator speech about FPA:

“As an NP, I am a board certified healthcare provider. FPA means I am allowed to practice to the full extent of my education and training under the exclusive licensure authority of the Board of Nursing.”

Do you know what color your state is? How does restricted practice affect your ability to care for patients? Are you involved in your professional organization and advocating for FPA?

I challenge each of you to use the DNP essentials (organization/systems leadership, healthcare policy for advocacy, information systems/technology to improve and transform healthcare, and clinical scholarship and analytical methods for EBP [AACN, 2006]) as an advocate for FPA to be a leader in improving healthcare outcomes.


American Association of Nurse Practitioners (AANP). (2016). State practice environment. Retrieved fromhttps://www.aanp.org/legislation-regulation/state-legislation/state-practice-environment

American Association of Colleges of Nursing (AACN). (2006). The essentials of doctoral education for advanced nursing practice. Retrieved from http://www.aacn.nche.edu/publications/position/dnpessentials.pdf

Federal Trade Commission. (2014). Policy perspectives: Competition and the regulation of advanced practice nurses. Retrieved from https://www.ftc.gov/system/files/documents/reports/policy-perspectives-competition-regulation-advanced-practice-nurses/140307aprnpolicypaper.pdf


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About Author

Rebecca Bates, DNP

Rebecca Bates, who has been a nurse since 2000, is passionate about providing healthcare for vulnerable populations. She earned her DNP at Old Dominion University, Norfolk, Va., and has been a family nurse practitioner in primary care since 2009. Her DNP research explored NP assessment of adolescent psychosocial risk factors. During her doctoral program, she completed a health policy fellowship and remains active in state and federal health policy advocacy. She has also engaged in global health advocacy and medical missions. She recently left private practice and currently works at a Free Clinic where she continues to precept NP students. She is an assistant professor for graduate and undergraduate nursing students. Rebecca believes nurses must have a seat at the table to improve the health of individuals and communities throughout the world.

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