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Advanced Practice Registered Nurses (APRN)

ANA represents the interests of all APRNs, which include:  Certified Nurse Practitioners (NPs), Certified Registered Nurse Anesthetists (CRNAs), Clinical Nurse Specialists (CNS), and Certified Nurse Midwives (CNMs).

Supported by a growing body of evidence of the safe and cost-effective provision of care by APRNs, there is a national call to remove all barriers to full practice authority from organizations such as the Institute of Medicine (IOM), the National Governors Association (NGA), the Federal Trade Commission (FTC), the Bipartisan Policy Center, and the Veteran’s Health Administration (VHA), among others. Removal of regulatory barriers is work in which the ANA and its’ Constituent - State Nurses Associations have been engaged for many years. “Full practice authority” is generally defined as an APRN’s ability to utilize knowledge, skills and judgment to practice to the full extent of their education and training.

ANA is a founding member of the Coalition for Patients' Rights which was formed to address the AMA's Scope of Practice campaign dedicated to limiting the scope of practice for advanced practice nurses and other licensed professionals.

Many non-physician health care providers are trained and willing to help meet this need, but are not permitted to do so because of limitations in their scope of practice. Shortages in primary care providers affect 1 in 5 Americans. Given the shortage of primary care physicians, allowing non-physician professionals such as advanced practice registered nurses (APRNs) to practice to the full extent of their educations and training gives patients more options and offers more types of services.

Determining Scope of Practice for Advanced Practice Registered Nurses

Updated 9/30/2016
On May 25, 2015, the Department of Veterans Affairs (VA) published a proposed rule to standardize the practice of advanced practice registered nurses (APRNs) in the VA system.

  • The proposed rule would allow APRNs to practice to the full extent of education, training and certification without regard to individual State practice regulations concerning requirements such as clinical supervision or mandatory collaboration with physicians.
  • VA proposed to accomplish this standardization through Federal preemption of State nursing licensure laws to the extent that such State laws conflict with the full practice authority as defined by VA.

Comments on the proposed rule were accepted until July 25th.

VA has now finished their internal review of the comments and developed a final rule. On September 28th, the final rule was submitted for review to the Office of Management and Budget (OMB), Office of Information and Regulatory Affairs (OIRA).

ANA will continue to monitor this process and provide additional updates as more information is received. Please visit RNaction.org for more information.

Protecting Scope of Practice

Protecting the scope of practice for nurses, particularly advanced practice registered nurses, is a major initiative at ANA. ANA is working together with our Constituent Member (State) Associations to help remove geographic and practice setting limitations for APRNs. We are still working state by state to ensure that state laws affecting Advanced Practice Registered Nurses are both fair and consistent across the country, and that your scope of practice is not unfairly limited. In addition to this work, we have a number of projects that ANA collaborates on to keep APRNs working to the full potential of their training.

  1. Team-Based Care: New Model or Trojan Horse? - This toolkit was created in response to organized medicine's campaign of "Physician-led team-based care," which has been used in an effort to halt Full Practice Authority (FPA) legislation in some states.
  2. Coalition for Patient's Rights (CPR) - ANA is a founding member of CPR. This coalition of over 35 organizations underscores the fact that our work to protect the nurses' scope of practice is not a doctor v. nurse "turf war," but is critical to building effective patient-centered interdisciplinary teams.
  3. IOM Future of Nursing Report
     A report from The Institute of Medicine (IOM) calls on nurses to take a greater role in America’s increasingly complex health care system. The American Nurses Association (ANA) highly commends the IOM for its newly released report on the nursing profession and acknowledges the need for nurses to take a leadership role in all settings to meet the demands of our changing health care system. The report is the result of the Initiative on the Future of Nursing, sponsored by the Robert Wood Johnson Foundation (RWJF). 
    ANA was gratified to find that many of the elements and recommendations of the IOM Report on the Future of Nursing are reflected in our ongoing work to advance the nursing profession. We are in complete agreement with the four "key messages" of the report. ANA and the ANA constituent state nurses associations have engaged in a wide range of activities over time that support the evidence-based recommendations of the IOM.
  4. Consensus Model for APRN Regulation - The Consensus model is referenced and included as Appendix D in the Future of Nursing Report. ANA is active in efforts to implement the Consensus Model, in which the APRN is defined as an "independent practitioner," to be licensed "with no regulatory requirements for collaboration, direction or supervision ."
  5. Legal Action - ANA weighs in on legal issues to protect nurses' ability to provide the full range of services defined by law.

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