To address shortages and uneven distribution of the primary care workforce, especially in rural areas, states have adopted or considered policies to modify their scope of practice laws for advanced practice registered nurses. The changes would allow APRNs—nurses who have completed a master's or doctoral degree program, and who have advanced clinical training beyond their initial professional registered nurse preparation—to provide care to the full extent of their training.
A 2013 survey found that 41 percent of rural Medicare beneficiaries saw a physician assistant or APRN for all (17 percent) or some (24 percent) of their primary care in 2012. Research suggests that expanded scopes of practice for nonphysician primary care providers, such as APRNs, improves access to primary care services with the quality of services comparable to those provided by physicians.
For example, a recent review of U.S. studies found that rates for patient satisfaction, self-reported patient health status, unexpected emergency department visits and hospitalizations were comparable when care was provided by APRNs instead of physicians. Research also identifies, however, the need for increased educational and licensure standards for providers with expanded scopes of practice, as well as improved data collection to increase accountability and ensure quality of care.
As of 2014, 18 states and the District of Columbia have given APRNs authority to practice and prescribe independently, and another nine allow them to practice independently.
This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UD3OA22893, National Organizations for State and Local Officials. This information should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.