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Advanced practice registered nurses (APRNs) have responded to the 2014 expansion of health care coverage under the Patient Protection and Affordable Care Act (PPACA). This expansion of insurance coverage created a health care access crisis by placing more demands on health care professionals (Sweeney, LeMahieu, & Fryer, 2017). This increase led to APRNs becoming a more prevalent medical provider in primary and specialty care. APRNs are registered nurses with advanced levels of education, knowledge, skills, and scope of practice. There are four general types of APRNs: certified registered nurse anesthetist, clinical nurse specialist, certified nurse midwife, and nurse practitioner. There are more than 372,428 licensed/certified APRNs in the U.S. and nurse practitioners represent the largest group in the APRN population (Phillips, 2019). Like other health care workers, APRN practice is defined by legislative and regulatory rules and requirements at the federal, national, and state levels. With the continued advancement of less restrictive practice, the question of liability or malpractice is often raised.
APRNs have become valued members of the health care team in part because of the expansion of health care coverage for over 30 million people under the PPACA which was a major influence in the growth of nurse practitioners, particularly in the primary care setting (Sweeney et al., 2017). In addition, state legislative changes have removed restrictions previously held on physician supervision, delegation, consultation, or collaboration. Currently, there are 13 states and the District of Columbia (DC) regulated by a board of nursing where nurse practitioners have full, autonomous practice and prescriptive authority without physician attestation or oversight (AK, AZ, DC, HI, IA, ID, MT, ND, NH, NM, OR, RI, WA, and WY) (Phillips, 2019). The remaining 24 states and territories impose reduced or restricted practice which is regulated by a state board of nursing or a combination of the board of nursing and board of medicine and requires oversight through physician supervision, delegation, consultation, or collaboration for authority to practice and prescriptive authority (Phillips, 2019).
The American Association of Nurse Practitioners (AANP) (2019) reports that approximately 98.1% of nurse practitioners have graduate degrees and 87.1% hold certification in an area of primary care. Nurse practitioners also hold prescriptive authority/privileges, including the ability to prescribe controlled substances in...