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Position statement: Full practice authority for advanced practice registered nurses is necessary to transform primary care

      Lack of full practice authority (FPA) for advanced practice registered nurses (APRNs) is a barrier to the provision of efficient, cost-effective, high-quality, and comprehensive health care services for some of our most vulnerable citizens (
      Agency for Healthcare Research and Quality
      Primary care workforce facts and stats no. 3.
      ,
      • Buerhaus P.I.
      • DesRoches C.M.
      • Dittus R.
      • Donelan K.
      Practice characteristics of primary care nurse practitioners and physicians.
      ,
      • Pohl J.M.
      • Hanson C.
      • Newland J.A.
      • Cronenwett L.
      Unleashing nurse practitioners' potential to deliver primary care and lead teams.
      ,
      • Seibert E.M.
      • Alexander J.
      • Lupien A.E.
      Rural nurse anesthesia practice: A pilot study.
      ). APRNs have the education, knowledge, skills, and experience necessary to provide basic and comprehensive primary care services; they are a ready workforce, ideally positioned to improve access to care, contribute to health disparities reduction efforts, and lower the cost of providing such care (

      National Center for Workforce Analysis. (2013). Projecting the supply and demand for primary care practitioners through 2020. Rockville, MD: Health Resources and Services Administration Bureau of Health Professions. Retrieved from http://bhpr.hrsa.gov/healthworkforce/index.html

      ,
      • Perloff J.
      • DesRoches C.M.
      • Buerhaus P.
      Comparing the cost of care provided to Medicare beneficiaries assigned to primary care nurse practitioners and physicians.
      ). However, barriers at the state and national levels continue to prevent these highly qualified health care providers from practicing to the full extent to which their education and training have prepared them. It is the position of the American Academy of Nursing (academy) that FPA of APRNs is essential to achieving health equity.
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      References

        • Agency for Healthcare Research and Quality
        Primary care workforce facts and stats no. 3.
        Agency for Healthcare Research and Quality, Rockville, MD, 2014 (Retrieved from)
      1. American Association of Nurse Practitioners. (2012). Fact sheet: Long term care. Retrieved from https://www.aanp.org/legislation-regulation/federal-legislation/68-articles/351-fact-sheet-long-term-care

      2. American Hospital Association. (2013). Workforce roles for redesigned primary care. Retrieved from http://www.aha.org/content/13/13-0110-wf-primary-care.pdf

        • Brooks Carthon J.M.
        • Barnes H.
        • Altares Sarik D.
        Federal polices influence access to primary care and nurse practitioner workforce.
        The Journal for Nurse Practitioners. 2015; 11: 526-530
      3. Brown MH. (2012). The center to champion nursing in America: A progress report. Retrieved from http://www.rwjf.org/content/dam/farm/reports/program_results_reports/2012/rwjf72607

        • Buerhaus P.I.
        • DesRoches C.M.
        • Dittus R.
        • Donelan K.
        Practice characteristics of primary care nurse practitioners and physicians.
        Nursing Outlook. 2015; 63: 144-153
        • Buppert C.
        Nurse practitioners business and legal guide.
        5th ed. Jones & Bartlett Publishers, Burlington, MA2014
      4. Congressional Budget Office. (2017). H.R. 1628, American Health Care Act of 2017. Washington, D.C. Congressional Budget Office. Retrieved from https://www.cbo.gov/publication/52752

      5. Fauteux N, Brand R, Fink J, Frelick M, Werrlien D. (2017). The case for removing barriers to APRN practice—Robert Wood Johnson Foundation. Princeton, NJ: The Robert Wood Johnson Foundation. Retrieved from http://www.rwjf.org/en/library/research/2017/03/the-case-for-removing-barriers-to-aprn-practice.html

        • Federal Trade Commission
        Policy perspectives: Competition and the regulation of advanced practice nursing.
        2014 (Washington, D.C.: Federal Trade Commission. Retrieved from)
      6. Federation of State Medical Boards. Assessing scope of practice in health care delivery: Critical questions in assuring public access and safety. Retrieved from https://www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/2005_grpol_scope_of_practice.pdf

        • Gates G.J.
        In U.S., LGBT more likely than non-LGBT to be uninsured; LGBT adults more likely to lack a personal doctor and enough money for healthcare.
        Gallup Poll News Service, Los Angeles, CA2014 (2014. Retrieved from)
        • Government Accountability Office
        Nurse anesthetists billed for few chronic pain procedures: Implementation of CMS payment policy inconsistent.
        Government Accountability Office, Washington, DC2014
        • Hanson C.
        Understanding regulatory, legal, and credentialing requirements|nurse key.
        in: Hamric A. Hanson C. Tracy M. O'Grady E. Advanced practice nursing: An integrative approach. 5th ed. Elsevier, St. Louis, MO2014: 557-558
        • Hossain W.A.
        • Ehtesham M.W.
        • Salzman G.A.
        • Jenson R.
        • Calkins C.F.
        Healthcare access and disparities in chronic medical conditions in urban populations.
        Southern Medical Journal. 2013; 106: 246-254
        • Institute of Medicine
        The future of nursing: Leading change, advancing health.
        National Academies Press, Washington, DC2011
        • Josiah Macy Jr. Foundation
        Who will provide primary care and how will they be trained.
        Josiah Macy Jr. Foundation, Durham, NC2010 (Retrieved: http://ww.macyfoundation.org/docs/macy_pubs/JMF_PrimaryCare_Monograph.pdf)
        • Kleiner M.
        • Marier A.
        • Park K.W.
        • Wing C.
        Relaxing occupational licensing requirements: Analyzing wages and prices for a medical service.
        The Journal of Law and Economics. 2014; 59: 261-291
        • Kurtzman E.T.
        • Barnow B.S.
        • Johnson J.E.
        • Simmens S.J.
        • Infeld D.L.
        • Mullan F.
        Does the regulatory environment affect nurse practitioners' patterns of practice or quality of care in health centers?.
        Health Services Research. 2017; 52: 437-458
        • Lenz E.R.
        • Mundinger M.O.
        • Kane R.L.
        • Hopkins S.C.
        • Lin L.S.
        Primary care outcomes in patients treated by nurse practitioners or physicians: Two-year follow-up.
        Medical Care Research and Review. 2004; 61: 332-351
        • Lugo R.M.
        Full practice authority for advanced practice registered nurses is a gender issue.
        Online Journal of Issues in Nursing. 2016; 21: 6
      7. Mather M, Jacobsen LA, Pollard KM. (2015). Population bulletin. 70. Retrieved from http://www.prb.org/pdf16/aging-us-population-bulletin.pdf

      8. National Center for Workforce Analysis. (2013). Projecting the supply and demand for primary care practitioners through 2020. Rockville, MD: Health Resources and Services Administration Bureau of Health Professions. Retrieved from http://bhpr.hrsa.gov/healthworkforce/index.html

      9. National Coalition of State Boards of Nursing. (2008). Consensus model for APRN regulation: Licensure, accreditation, certification & education. Chicago, IL: APRN Consensus Work Group & the National Council of State Boards of Nursing APRN Advisory Committee. Chicago, IL: Retrieved from https://www.ncsbn.org/Consensus_Model_for_APRN_Regulation_July_2008.pdf

        • National Council of State Boards of Nursing
        NCSBN model act.
        2012 (Chicago, IL. Retrieved from)
      10. National Governors Association. (2012). Nurse practitioners have potential to improve access to primary care. Retrieved from http://www.nga.org/files/live/sites/NGA/files/pdf/1212NursePractitionersPaper.pdf

        • Office of Disease Prevention and Health Promotion
        Access to health services.
        2010 (Washington, DC: United States Department of Health and Human Services. Retrieved from)
        • Oliver G.M.
        • Pennington L.
        • Revelle S.
        • Rantz M.
        Impact of nurse practitioners on health outcomes of Medicare and Medicaid patients.
        Nursing Outlook. 2014; 62: 440-447
        • Perloff J.
        • DesRoches C.M.
        • Buerhaus P.
        Comparing the cost of care provided to Medicare beneficiaries assigned to primary care nurse practitioners and physicians.
        Health Services Research. 2016; 51: 1407-1423
        • Phillippi J.C.
        • Barger M.K.
        Midwives as primary care providers for women.
        Journal of Midwifery & Women's Health. 2015; 60: 250-257
        • Phillips S.J.
        27th Annual APRN legislative update.
        The Nurse Practitioner. 2015; 40: 16-42
        • Poghosyan L.
        • Boyd D.
        • Knutson A.R.
        Nurse practitioner role, independent practice, and teamwork in primary care.
        The Journal for Nurse Practitioners. 2014; 10: 472-479
        • Pohl J.M.
        • Hanson C.
        • Newland J.A.
        • Cronenwett L.
        Unleashing nurse practitioners' potential to deliver primary care and lead teams.
        Health Affairs (Millwood). 2010; 29: 900-905
        • Pohl J.M.
        • Hanson C.M.
        • Newland J.A.
        Nurse practitioners as primary care providers: History, context, and opportunities.
        in: Who will provide primary care and how will they be trained? Josiah Macy Jr. Foundation, Durham, NC2010: 167-213
      11. Ritchie A. (2014). Access to primary care remains a challenge for 62 million Americans. Medical Economics, Practice Management. Retrieved from http://medicaleconomics.modernmedicine.com/medical-economics/content/tags/affordable-care-act/access-primary-care-remains-challenge-62-million-

      12. Safriet, B. J. (2011). Federal options for maximizing the value of Advanced Practice Nurses in providing. In The future of nursing: Leading changes, advancing health (pp. 443–475). Washington, D. C.: The National Academies Press.

        • Safriet B.
        Closing the gap between can and may in health care providers' scopes of practice: A primer for policymakers.
        Yale Journal of Regulation. 2002; 19: 301-334
        • Schirle L.
        • McCabe B.E.
        State variation in opioid and benzodiazepine prescriptions between independent and nonindependent advanced practice registered nurse prescribing states.
        Nursing Outlook. 2016; 64: 86-93
        • Seibert E.M.
        • Alexander J.
        • Lupien A.E.
        Rural nurse anesthesia practice: A pilot study.
        AANA Journal. 2004; 72: 181-190
        • Starfield B.
        • Shi L.
        • Mackinko J.
        Contribution of primary care to health systems and health.
        The Milbank Quarterly. 2005; 83: 457-502
        • The Henry J. Kaiser Family Foundation
        Percent of women who report having no personal doctor/health care provider, by race/ethnicity.
        Menlo Park, CA: The Henry J. Kaiser Family Foundation, 2016 (Retrieved from)
        • The Henry J. Kaiser Family Foundation
        Percent of men who report having no personal doctor/health care provider, by race/ethnicity.
        Menlo Park, CA: The Henry J. Kaiser Family Foundation, 2016 (Retrieved from)
      13. Traczyndski, J., & Udalova, V. (2013). Nurse practitioner independence, health care utilization, and health outcomes. Paper presented at the Fourth Annual Midwest Health Economics Conference, Madison, WI.

      14. U.S. Department of Veterans Affairs. (2016). VA grants full practice authority to advance practice registered nurses. Retrieved from https://www.va.gov/opa/pressrel/pressrelease.cfm?id=2847

        • Ward B.W.
        • Schiller J.S.
        • Freeman G.
        • Clarke T.C.
        Early release of selected estimates based on data from the January-June 2015.
        National Health Interview Survey, Hyattsville, MD2015
        • Weaver R.G.
        • Manns B.J.
        • Tonelli M.
        • Sanmartin C.
        • Campbell D.J.T.
        • Ronksley P.E.
        • Hemmelgarn B.R.
        Access to primary care and other health care use among western Canadians with chronic conditions: a population-based survey.
        CMAJ Open. 2014; 2: E27-E34
        • Xue Y.
        • Ye Z.
        • Brewer C.
        • Spetz J.
        Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review.
        Nursing Outlook. 2016; 64: 71-85