The scope of practice for APRNs consists of “parameters within which advanced practice nurses may legally practice”, defining “what they can do for and with patients, what they can delegate, and when collaboration with others is required.” 1 This scope of practices varies not only across APRN roles – CNS, CRNA, NP, CNM – but also across individual states.1 For the FNP specialty, scope of practice entails diagnosis and management of illnesses in the primary care setting for individuals across the lifespan. The three benchmarks of APRN practice and education are advanced practice nurse competencies, professional advanced practice registered nurse competencies, and Master’s and Doctor of Nursing Practice Essentials.2 APN competencies, which distinguish
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Issues surrounding APN regulation include numerous titles and roles that confuse policymakers who determine reimbursement; state discrepancies in scope of practice and licensing criteria, creating hardships for prescriptive authority and reimbursement across state lines; and variation in composition of regulatory boards, ranging from pharmacy to medicine, among different states.9 Unfortunately, these challenges result in restricted scope of practice for NPs, limiting their ability to practice to the full extent of their education. For example, in California, collaborative agreements defining the parameters in which the APRN can perform delegated medical acts – disease diagnosis, treatment management, and medication prescription – are required for APRNs to practice. Reimbursement of APRN-provided services is another important issue that is determined by individual states. While the federal government encourages direct reimbursement of nonphysician providers, state-level discriminatory rules and regulations continue to limit APRN reimbursement.10 The ongoing debate of whether APNs should receive the same physician reimbursement as opposed to only a percentage of the physician payment is highlighted by “incident- to billing,” which decreases APRN visibility by allowing reimbursement of the full physician rate, whereas direct billing by the NP decreases reimbursement to only 85% of the physician rate.11 APNs, including future APNs like myself, must address these discrepancies and challenges by seeking influential positions within the policy-making
Issues surrounding APN regulation include numerous titles and roles that confuse policymakers who determine reimbursement; state discrepancies in scope of practice and licensing criteria, creating hardships for prescriptive authority and reimbursement across state lines; and variation in composition of regulatory boards, ranging from pharmacy to medicine, among different states.9 Unfortunately, these challenges result in restricted scope of practice for NPs, limiting their ability to practice to the full extent of their education. For example, in California, collaborative agreements defining the parameters in which the APRN can perform delegated medical acts – disease diagnosis, treatment management, and medication prescription – are required for APRNs to practice. Reimbursement of APRN-provided services is another important issue that is determined by individual states. While the federal government encourages direct reimbursement of nonphysician providers, state-level discriminatory rules and regulations continue to limit APRN reimbursement.10 The ongoing debate of whether APNs should receive the same physician reimbursement as opposed to only a percentage of the physician payment is highlighted by “incident- to billing,” which decreases APRN visibility by allowing reimbursement of the full physician rate, whereas direct billing by the NP decreases reimbursement to only 85% of the physician rate.11 APNs, including future APNs like myself, must address these discrepancies and challenges by seeking influential positions within the policy-making