NP Autonomy

Angeline Motari

Introduction
Professional

autonomy
- the abilities of trained
individuals to exercise
substantial control over their
practice and to make practice
related decisions without
limitations (Bahadori & Fitzpatrick, 2009).

State regulatory map

https://www.aanp.org/images/document

s/state-leg-reg/stateregulatorymap.pdf

National outlook, 2013 survey

Only18

states and the District of Columbia

Dont require physician oversight

Maryland and Arizona

states require physician oversight for

prescribing

Michigan and Indiana

25

states require oversight for diagnosis,

treatment plans, and prescriptions

Massachusetts and Arkansas .

(Yee et al., 2013).

NP Autonomy Advocates
The

National Institute for Health Care

Reform (NIHCR)
- a solution to PCP shortage
Institute of Medicine and the Robert
Wood Johnson Foundation (RWJF)

allow NPs to practice to the full extent of

their knowledge, training and scope of
practice.

NP Autonomy Advocates
The

American Association of Nurse

Practitioners (AANP)

NPs successful in managing clinics (Selvam,

2013).

National

council of State Boards of Nursing

Allow full scope of practice

The

Coalition for Nurses in Advanced

Practice in Texas

Educate legislators on the role of the NP

(Pericak, 2011).

Barriers to NP autonomy
Lack

of uniform regulations across the

states

each state independently determines the

scope of practice, roles, and certification
exams acceptable for NPs (Kline et al., 2009).

Barriers to NP autonomy
Lack

of initiative among many NPs

Few participate in state associations

(Pericak, 2011)

The

medical societies

physicians who do not have sufficient

experience of the NP role (Cossman, 2010).

Review of Literature

NP autonomy can be improved by

Consumer knowledge of NP role

Revising restrictive laws

Creating awareness among legislators,
lawmakers (Pericak, 2011)
improves care and satisfaction (Brown, 2007)

NPs advocating for their role

Participate in state associations (Pericak, 2011)

Review of literature
Physician

oversight & federal

reimbursement regulations

Negatively impact autonomy (Maylone et al.,

2011)

Legal

and organizational restrictions

hinder autonomous NP practice (Bahadori
and Fitzpatrick, 2009).

Opposition from medical societies

(Poghosyan, Lucero, Rauch, & Berkowitz,2012).

References

Bahadori , A., Fitzpatrick, J. J. (2009). Level of autonomy of primary care nurse

practitioners. Journal of the American Academy of Nurse Practitioners, 21(9), 513519. doi.org/10.1111/j.1745-7599.2009.00437.x
Brassard, A. (2014, March 23). Making the case for NPs as primary care providers |
The American Nurse. Retrieved March 23, 2014, from
http://www.theamericannurse.org/index.php/2013/07/01/making-the-case-for-nps-asprimary-care-providers/
Brown, D. (2007). Consumer perspectives on nurse practitioners and independent
practice. Journal of the American Academy of Nurse Practitioners, 19(10), 523-529.
doi:10.1111/j.1745-7599.2007.00261.x
Buttaro, T. M., Trybulski, J., Bailey, P. P., & Sandberg-Cook, J. (2013). Primary care: A
collaborative practice. St. Louis, Mo: Elsevier/Mosby.
Cossman, S. D. (2010). Does Familiarity Breed Respect? Physician attitudes toward
nurse practitioners in a medically underserved state. Journal of American Academy of
Nurse Practitioners, 22(8), 431-439. Retrieved from
http://www.medscape.com/viewarticle/729832
Institute of Medicine (2010). The Future of Nursing: Focus on Scope of Practice Institute of Medicine. Retrieved from http://www.iom.edu/Reports/2010/The-Future-ofNursing-Leading-Change-Advancing-Health/Report-Brief-Scope-of-Practice.aspx

References

Kline, A., Frautschy, B. C., Dawsy, R., McMurtrie, M., Sheehan, A., Shuren, A., . . .
Keesing, H. (2009). NAPNAP position statement on reimbursement for nurse
practitioner services. Journal of Pediatric Health Care, 23(6), A13- A14.
doi:/10.1016/j.pedhc.2009.06.013
Maylone, M. M., Ranieri, L., Griffin, M. T., McNulty, R., & Fitzpatrick, J. J. (2011).
Collaboration and autonomy: Perceptions among nurse practitioners. Journal of the
American Academy of Nurse Practitioners, 23(1), 51-57. doi.org/10.1111/j.17457599.2010.00576.x
Pericak, A. (2011). Increased autonomy for nurse practitioners as a solution to the
physician shortage. The Journal of the New York State Nurses' Association, 42(1-2), 47. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22187859
Poghosyan, L., Lucero, R., Rauch, L., & Berkowitz, B. (2012). Nurse practitioner
workforce. Nursing Economics, 30(5), 268-274. Retrieved from
http://www.medscape.com/viewarticle/773243_4
Selvam, A. (2013). The next level: Annual workforce report shows nurse practitioners
pushing for increased autonomy in their roles. Modern Healthcare, 43(12).
http://search.ebscohost.com/login.aspx?
direct=true&db=cmedm&AN=23947262&site=ehost-live
Yee, T., Boukus, E. R., Cross, D., & Samuel, D. R. (2013). NIHCR: Primary care
workforce shortages: Nurse practitioner scope-of-practice laws and payment policies
(NIHCR Research Brief No. 13). Retrieved from The National Institute for Health Care
Reform website: http://www.nihcr.org/PCP-Workforce-NPs