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Full Practice Authority

The LIBRE Initiative empowers people to earn success, contribute to their communities, and live meaningful lives. This requires a health care system that helps more people access better care at a lower cost—where health care providers compete to offer the best health care products and services at the best prices that meet the needs of patients. Unfortunately, many state and federal laws act as barriers to access and innovation.

One way to help providers effectively meet the needs of patients is to reform state regulations that prevent nurses and other non-physician providers practitioners from offering the services they’ve already been trained to provide.


Full Practice Authority (FPA) is an umbrella term for the range of laws and regulations that authorize advanced practice registered nurses (APRNs), physician assistants (PAs), and other non-physician providers to practice medicine to the full extent of their education and accreditations. Under Full Practice Authority, APRNs can independently evaluate patients, deliver procedures and prescribe medications, including controlled substances, under the exclusive governance of a state’s board of nursing. This regulatory system increases the supply of primary and specialty care, especially in underserved communities that lack a reliable supply of physicians.


Although all APRNs are educated and trained to independently provide all these services, many states deny nurses full practice authority and restrict them from delivering care to patients. For example, many states limit the range of tests, procedures, and prescriptions that APRNs can provide. States also mandate advanced nurses to establish a “collaborative practice agreement” with a physician that decides what services they can provide patients. In addition, some states that offer FPA require APRNs to work for a doctor for years before they can independently practice.

These restrictions have significantly contributed to the growing primary care shortage communities face around the country. According to the U.S. Department of Health and Human Services, over 80 percent of all Americans who live in communities that face a physician shortage, roughly 63 million individuals, live in states that restrict the practice authority of NPs.

These primary care shortages impose long-lasting and even fatal harm on America’s most vulnerable patients. Individuals who lack a reliable source of primary care experience delays in diagnosis, pay higher health care costs, and die earlier than patients who can regularly access basic medical care.

Restricting the practice authority of APRNs also increases health care costs by preventing nurses from offering patients lower prices. A 2014 analysis from the National Bureau of Economic Research found that patients pay 17 percent more for pediatric checkups in districts that expanded the practice capabilities of NPs compared to less restrictive states. More recently, a 2019 study in the Journal of Nursing Regulations found that restrictions on NPs increased the cost of outpatient care by 11.6 percent.


Empowering mid-level providers with Full Practice Authority is a crucial element of comprehensive health care reforms that will increase health care access, reduce medical costs, and improve health outcomes for patients. Lawmakers should pursue the following reforms to make their efforts most impactful:

1. Eliminate Collaborative Practice Agreement Mandates:
States should repeal mandates that require APRNs to establish a collaborative practice agreement, a standard care agreement, or a protocol with a physician.

2. Scrap the Clinical Practice Requirement:
States should remove mandates that require APRNs practice under the supervision of a physician for a minimum amount of time before they can independently practice medicine.

3. Lift Scope of Practice Restrictions:
States should eliminate laws that limit the range of tests, procedures, and medications APRNs can provide patients.

4. Adopt Licensing Reciprocity:
States should recognize out-of-state APRN licenses and authorize out-of-state nurses to practice without needing an additional occupational license.