Declare the importance of your independence.

WE CELEBRATE American Independence Day on July 4 every year. Fireworks, parades, carnivals, concerts, and baseball games are just a few of the events commonly associated with the day. If you work on the holiday, you’ll find that most organizations still recognize the day, often with lots of food. Congress declared July 4 a federal holiday in 1870, almost a hundred years after the Declaration of Independence was written. Most Americans don’t know that a century passed before the official recognition was legislated. In addition, it took events such as the deaths of Thomas Jefferson and John Adams on July 4, 1826, to raise the national consciousness and promote the idea that July 4 is important.

An analogy for nursing exists in this history lesson. Will it take 100 years before the nursing profession can celebrate the independence of advanced practice nurses (APRNs) in all states? Let’s hope not. When it comes to the APRN practice environment, some states allow full practice while others have restricted or reduced practice laws. Too often, national and state legislatures have failed to recognize the decades of research that have established the safety and effectiveness of APRN care. That body of evidence has led non-nursing institutions and organizations—from the National Governors Association to the AARP—to join the efforts of the American Nurses Association and many state nurses’ associations to call for lifting barriers to APRN practice.

Removing barriers will improve the health of the nation: A 2014 study found that states with full practice authority for APRNs had lower hospitalization rates and improved healthcare outcomes. It concluded that the barriers to APRN full practice should be removed to improve access to high-quality and affordable healthcare, particularly among underserved patient populations.

Who’s debating the need for patient-centered, team-based, collaborative care that includes APRNs practicing at the top of their license? Many issues are involved, but the main opponents to extending full practice to APRNs are physician groups. APRNs have been leaders in the development of innovative care models and are educationally prepared to serve as primary care providers. Costly and unnecessary legislative and regulatory requirements for physician supervision of APRNs are at odds with efforts to build interdisciplinary teams and create a more effective, efficient, and safe healthcare system. It’s time for evidence-based policy to be recognized and fully implemented. Given the increasing shortage of healthcare providers and the abundance of evidence demonstrating that APRNs offer quality cost-effective services, it’s disappointing that this battle for independent practice continues. Did you know that these highly trained and credentialed nursing professionals are often limited by expensive agreements with physicians to “supervise” their practice? Some APRNs pay up to $100,000 a year to the physicians who “oversee” their practices. Are physicians ready to relinquish costly collaborative agreements to expand access to healthcare?

No matter how you celebrate the 4th of July with family, friends, and colleagues, expand how you show your spirit. Think about the current fight for APRN full practice authority across the country, how you might learn more, and why it’s important to you and the entire profession.

Independence isn’t just about our national heritage. It’s important to APRNs, their patients, and the communities they serve. We can’t wait 100 years before nursing celebrates APRN independent practice. The time is now for nationwide full practice authority.

Lillee Gelinas, MSN, RN, CPPS, FAAN
Editor-in-Chief

Selected References

American Nurses Association. ANA’s principles for advanced practice registered nurse (APRN) full practice authority. June 2015. nursingworld.org/~4af5d1/globalassets/docs/ana/ethics/principles-aprnfull practiceauthority.pdf

Oliver GM, Pennington L, Revelle S, Rantz M. Impact of nurse practitioners on health outcomes of Medicare and Medicaid patients. Nurs Outlook. 2014;62(6):440-7.