APRN Practice Restrictions

In its 2010 report titled “The Future of Nursing: Leading Change, Advancing Health”,
the Institute of Medicine (IoM) called for removal of advanced practice registered nurse
(APRN) practice restrictions in the form of policies, regulations and laws (Rollins, 2016).
Such removal would allow APRNs to provide full scope of health care services that they are
trained and often certified to provide. Since then, various states have lifted some restrictions
that limited the practice of APRNs. However, in many states, the restrictions persist despite
overwhelming evidence that the quality of healthcare services provided by APRNs in states
that allow full practice is not different from services provided by APRNs under physician
oversight (Fauteux et al., 2017).
APRN Practice Restrictions
There are many restrictions that prevent APRNs from offering full scope of healthcare
services that they are trained to provide. For instance, some states require that nurse
practitioners have face-to-face visits with a supervising physician every month (Fauteux et
al., 2017). They also limit an APRN’s authority to prescribe medications. Some states have
also refused to recognize clinical nurse specialists as APRNs (Fauteux et al., 2017). Thus,
they limit their practice to the scope of a registered nurse. As such, they are prohibited from,
among others, ordering laboratory work and prescribing medications. Other restrictions
include denial of payment to certified registered nurse anesthetists (CRNAs) for some of the
services that they provide, such as pain management services (Fauteux et al., 2017).
Removing Barriers to APRN Practice
The restrictions that have been highlighted significantly reduce patient access to
APRNs. One way of lifting these restrictions is through removing collaborative practice
agreements (CPAs) that limit an APRNs practice without the supervision of a physician.
Apart from preventing APRNs from offering all healthcare services that they are trained to
provide, the agreements also increase the cost of services that APRNs provide because they
often have to pay physicians for the collaborative agreements (Castaldo, Zickafoose &
Walker, 2018). Additionally, the agreements also prevent APRNs from working in rural areas
as some of the agreements require that the APRN and the collaborative physician do not work
more than 50 miles from each other (Fauteux et al., 2017). Thus, removing restrictions to
APRN practice will significantly improve patient access to services that are offered by
APRNs.

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References

Castaldo, R. R., Zickafoose, P. C., & Walker, R. D. (2018). Delaware’s Pathway to
Achieving APRN Consensus. Journal of Nursing Regulation, 9(1), 23-30.
Fauteux, N., Brand, R., Fink, J. L. W., Frelick, M., & Werrlein, D. (2017). The case for
removing barriers to APRN practice. Charting Nursing’s Future, 30, 1-12.
Rollins, J. A. (2016). Assessing Progress On ‘The Future of Nursing’. Pediatric
Nursing, 42(1), 6-35.