Advocating For Full-Practice Authority

The first nurse practitioner program opened at the University of Colorado in 1965, but decades later an NP's legal scope still depends on which state they work in. Full-practice authority (FPA) lets NPs diagnose, treat, and prescribe without physician oversight, and run their own practices. Supporters argue it expands access to care, lowers costs, and helps close gaps in a strained system.

Not everyone agrees. The American Medical Association (AMA) backs a physician-led team model in which physicians retain authority over patient care, with NPs, physician assistants, social workers, and pharmacists working under them. The AMA supports legislation in state after state to limit independent practice by advanced practice registered nurses (APRNs).

The stakes are real. The AAMC projects a physician shortage of up to 86,000 by 2036, spanning primary and specialty care. Research suggests NPs in emergency and critical care improve patient outcomes and help meet rising demand, and the National Nurse-Led Care Consortium credits full-practice authority with expanding access, reducing costs, and improving care. NPs also report high patient satisfaction. If you want NPs to gain and keep full-practice authority, the time to make that known to your legislators is now.

The Three Levels of Practice Authority

Every state falls into one of three categories.

Full practice means NPs can evaluate patients, diagnose, order and interpret tests, and initiate and manage treatments, including prescribing, under the sole authority of the state board of nursing. As of 2025, 27 states plus Washington, D.C., and two territories grant full-practice authority.

Reduced practice limits at least one element of NP practice and requires a career-long collaborative agreement with another provider, or restricts the settings where NPs can work.

Restricted practice requires physician oversight of at least one element of practice, such as diagnosis or treatment. How these rules are interpreted and enforced varies widely by state.

The remaining states fall into the reduced and restricted categories. The National Academy of Medicine, in its Future of Nursing 2020-2030 report, renewed its call for full-practice authority to remove barriers that keep NPs from addressing social needs and improving access, quality, and value. Check the AANP state practice environment map for your state's current status, since these rules change.

How to Advocate

You do not have to be an NP, a nursing student, or even work in healthcare to weigh in. If you care about access to quality care, contact your state legislators and U.S. senators and tell them where you stand on full-practice authority. It takes a few minutes.

A few ways to be effective:

• Find your state and federal representatives through your state legislature's website and senate.gov, and use their official contact forms or phone lines.
• Be specific about your state and your connection to the issue, whether you are an NP, a student logging clinical hours, or a patient who relies on NP-provided care.
• Point to the evidence: NPs deliver safe, high-quality, cost-effective care, and full-practice authority widens access without lowering standards.
• Join the advocacy effort through the American Association of Nurse Practitioners (AANP) or the American Nurses Association (ANA), both of which track legislation and organize members.

National Nurse Practitioner Week each November is a natural moment to reach out, both to advocate for expanded practice and to thank the NPs already filling gaps across all 50 states.