Background on Full Practice Authority
The Birth of the Nurse Practitioner Role: The first nurse practitioner (NP) program was established in 1965 at the University of Colorado by Dr. Loretta C. Ford and Dr. Henry Silver. Their goal was to train registered nurses with advanced skills to provide primary and preventative care, addressing physician shortages and the need for accessible healthcare in underserved areas. Dr. Ford's vision combined nursing's focus on patient care with advanced clinical expertise, creating a new healthcare role capable of diagnosing, treating, and educating patients independently while collaborating with physicians (Berg, 2020). By 1970, the first group of nurse practitioners was trained in this innovative approach. As nurse practitioners (NPs) gained recognition, their services became increasingly in demand, especially in rural and underserved areas in the 1980s, where they provided primary care services like physical exams, tests, and prescriptions. In the 1990s, NPs expanded into hospitals, specialty clinics, and private practices, with many states granting them the authority to prescribe and perform clinical duties independently (aanp.org). Education for NPs advanced, with most programs requiring master's degrees by the late 1990s and the introduction of Doctor of Nursing Practice (DNP) programs in the early 2000s, raising the standard of education and expertise. (History of Nurse Practitioners in the United States - OAAPN).
Historically, the Institute of Medicine’s landmark report on the future of nursing recommended that state legislatures and other governments remove Standard of Practice (SOP) barriers, arguing that “advanced practice registered nurses
should be able to practice to the full extent of their education and training” (Institute of Medicine, 2010).
Nurse practitioners are involved with a wide range of stakeholders across both the public and private sectors, all of whom play important roles in shaping the practice, policies, and future of NPs. Below is a breakdown of the key stakeholders from both sectors:
Public Sector Stakeholders:
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Government Agencies:
- U.S. Department of Health and Human Services (HHS): This department, including subagencies like the Centers for Medicare & Medicaid Services (CMS), plays a major role in regulating reimbursement policies, scope of practice, and workforce planning that affects NPs. https://www.hhs.gov
- State Health Departments: These agencies regulate NP licensure, scope of practice, and professional standards at the state level.
- National Institutes of Health (NIH): NIH funds research on the effectiveness of nurse practitioners in delivering care, especially in underserved and rural communities.
- Government stakeholders are extremely important in the context of nurse practitioners (NPs) and healthcare as a whole because they play a key role in shaping the policies, regulations, and funding that impact healthcare delivery, including the role of NPs.
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Public Healthcare Systems:
- Veterans Health Administration (VHA): NPs provide primary care to veterans, particularly in rural or underserved areas, through this government-run health system. https://www.va.gov
- Community Health Centers (CHCs): Federally funded centers that often rely heavily on NPs to deliver care to underserved populations. https://www.hrsa.gov
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State and National Legislators:
- State Legislators: They influence the laws that govern NP practice, including the scope of practice, prescriptive authority, and reimbursement.
- Federal Legislators: Influence national healthcare policy, including how NPs are reimbursed under Medicare and Medicaid, and advocate for changes in scope-of-practice laws and advanced education requirements.
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Advocacy Organizations:
- National Organization of Nurse Practitioner Faculties (NONPF): Advocates for education standards for NPs and policy changes related to practice.
- American Association of Nurse Practitioners (AANP): A key advocacy group that influences public policy regarding NPs, including efforts to secure full practice authority and equitable reimbursement for NP services. https://www.aanp.org
- National League for Nursing (NLN): Focuses on nursing education, helping to shape the curriculum and development of future nurse practitioners.
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Regulatory Bodies:
- State Boards of Nursing: Regulate and oversee NP licensure, continuing education, and professional practice standards. https://www.ncsbn.org
- American Nurses Credentialing Center (ANCC): Certifies NPs across various specialties, ensuring they meet the standards required for professional practice.
Private Sector Stakeholders:
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Healthcare Employers:
- Private Hospitals and Health Systems: They employ nurse practitioners to provide care in various specialties, including primary care, urgent care, emergency medicine, and mental health.
- Private Medical Practices: Many NPs work in private family practices, specialized clinics, and other settings, collaborating with physicians and other healthcare professionals to provide patient care. https://www.aafp.org
- Insurance Companies:
Insurers, including private health insurers, are key stakeholders, as they determine reimbursement rates for NP-provided services and influence access to care models. National Association of Insurance Commissioners (NAIC): https://www.naic.org
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Healthcare Professional Associations:
- American Medical Association (AMA): Although primarily focused on physicians, the AMA plays a significant role in shaping the broader healthcare policy, including issues related to NP practice, scope of authority, and interprofessional collaboration.
- American Academy of Nurse Practitioners (AANP): A key private sector association, AANP represents the interests of NPs, advocating for legislative, regulatory, and educational advancements.
- American Academy of Nurse Practitioners Certification Board (AANPCB): Provides certification for NPs, ensuring that they meet the required competencies for their practice https://www.aanpcert.org
3. Our Patients:
Patients are the primary recipients of the care provided by nurse practitioners. Their experiences, needs, and health outcomes directly influence NP practice. The care they receive from NPs is centered around patient preferences, values, and health goals, making them central to the process of healthcare delivery. Their feedback and satisfaction are crucial in determining the effectiveness of NP services.
In both the public and private sectors, these stakeholders work together to shape the role of nurse practitioners, influencing their scope of practice, regulatory frameworks, and ability to deliver quality care across diverse populations.
References:
Berg, J. A. (2020). The perils of not knowing the history of the nurse practitioner role. Journal of the American Association of Nurse Practitioners, 32(9), 602-609.
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