The shifting landscape of NP practice authority

Across the US, NPs have been steadfast in the fight for full practice authority (FPA). The progress made in the last decade is significant, yet the profession continues to face a fragmented regulatory landscape that restricts access to care and limits the potential of a highly educated NP workforce. As the nation confronts health care provider shortages, aging populations, and persistent health disparities, the ability of NPs to practice to the full extent of their training is no longer a matter of professional autonomy, it is a matter of public health. FPA allows NPs to evaluate, diagnose, order and interpret diagnostic tests, initiate and manage treatments, and prescribe medications without depending on physician involvement.1 Support for FPA has been demonstrated by its growth from 14 states plus Washington, D.C. in 2010 to 22 states in 2016 to 27 states in 2025, reflecting mounting recognition that restrictive laws do not improve patient outcomes.2,3 The movement toward FPA has been driven by a convergence of factors and underscores what decades of evidence have shown: NP-led care achieves patient outcomes comparable to those of physicians, with high satisfaction and often at lower cost. Ongoing barriers and uneven progress Despite progress, 23 states still operate under reduced or restricted practice laws. Reduced practice states typically require NPs to maintain collaborative agreements for certain aspects of care, such as prescriptive authority, whereas restricted practice states require career-long supervision or delegation for one or more clinical functions.1 Even in full practice states, challenges can persist, including restrictions in hospital bylaws, outdated insurer policies, and federal reimbursement structures that sometimes fail to reflect state-level practice gains, limiting the real-world impact of legislative victories. Transition-to-practice (TTP) requirements have also emerged as a political leverage tool mandating a defined period of supervised practice before NPs gain FPA. Although intended to ensure competence, these rules often add unnecessary layers of bureaucracy that delay access to care. The TTP model is a regulatory barrier, not a quality assurance measure, and there is no evidence that it improves safety.4 38th Annual APRN Legislative Update Every January, readers of The Nurse Practitioner enjoy the Annual APRN Legislative Update authored by Susanne Phillips, DNP, APRN, FNP-BC, FAANP, FAAN. The 38th update provides a comprehensive snapshot of the “state of the states” for all four advanced practice roles: NPs, clinical nurse specialists, certified nurse midwives, and certified registered nurse anesthetists. The report details ongoing changes in practice authority, TTP periods, licensure and titling, prescriptive authority, reimbursement, and other regulatory provisions affecting advanced practice. I was honored to step in and author the 35th edition and can attest to the effort required. We are extremely fortunate in Dr. Phillips's ongoing commitment in this work. Looking forward The realization of nationwide FPA for NPs is closer than ever, but true success requires more than statutory change, it demands cultural, institutional, and financial recognition of NPs as autonomous, accountable, and exceptional providers. Advocacy remains the profession's policy foundation, yet sustained legislative success will rely on strategic partnerships with policymakers, payers, and patient coalitions. Consider how you can move from reader to participant by joining professional organizations, contacting legislators, contributing to policy discussions, and educating the public about the critical role of NPs in today's health care landscape.