Researchers link full practice laws for APRNs to better state health rankings

Editor's Note

States that grant full practice authority to advanced practice registered nurses (APRNs) rank significantly higher in health system performance than those that impose physician supervision requirements, according to a July 3 report from the University of Missouri.

The article focuses on a study led by researchers at the university’s Sinclair School of Nursing and published in the Journal of the American Medical Directors Association. Researchers found that states with full practice laws averaged 16 to 18 places higher in the Commonwealth Fund’s national rankings than states with reduced or restricted practice rules.

As detailed in the article, APRNs can diagnose illness and prescribe treatments, but only 27 states currently allow them to do so independently. The remaining states require physician oversight, which researchers say can limit access to care. Researchers’ findings on how legal differences in APRN authority affect health outcomes across states suggest that removing barriers to APRN autonomy correlates with improved care access and stronger overall system performance.

Researchers also reportedly found that full practice authority is associated with a 374% increase in APRNs launching their own practices—a level of autonomy that can expand patient access, particularly in underserved areas. In one example cited, an APRN operating a rural mental health clinic in a restricted practice state had to close her practice after her collaborating physician moved, placing her outside the required geographic range for supervision.

The article also details how restrictive policies may create operational uncertainty and impose financial burdens. APRNs in restricted states often pay physicians for oversight, which may add to the cost of care for patients.