New York Nurse Practitioners Get Full Practice Authority

Last week, New York became one of 25 states in the U.S. to grant permanent full practice authority to Nurse Practitioners (NPs). The authority was granted when New York Gov. Kathy Hochul signed the 2022 State of the State proposal into law, eliminating the 2014 requirement for nurse practitioners (NPs) to have a written practice agreement with a physician.

The proposal both amends the “Education Law,” which required NPs to complete 3,600 practice hours under collaboration with a physician and makes the Nurse Practitioners Modernization Act, set to expire in June of 2022, permanent. According to the New York State Nurses’ Union, the amendments now mean that NPs with over 3,600 hours can practice independently in primary care only. Additionally, NPs with under 3,600 hours are allowed to complete their “practice hours” under either a physician or an NP.

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"Requirements will be waived for nurse practitioners to have a written practice agreement with a physician, which is an obstacle that stands in the way of nurse practitioners providing the maximum amount of care to New Yorkers," the State of the State proposal states. "New York's health workforce is filled with tremendously talented professionals. We should leverage the growing skills of the workers already caring for New Yorkers to provide even more care when it is needed most."

The move is an important one, as it represents one of the country’s biggest cities moving to permanently recognize NPs as full-practice primary care practitioners and significantly increasing healthcare access.

What is Full Practice Authority?

Full practice authority refers to the scope of practice granted by a healthcare professional’s license. In some states, NPs do not have full practice authority, so they cannot act as independent practitioners, but instead have limited authority to act within their own license. They may not be able to independently diagnose, prescribe, or manage patient healthcare, for instance.

A full practice authority designation, however, means NPs do not have to work underneath a supervising physician’s license, and their own NP license grants them full authority to diagnose, prescribe, treat, and manage patient care.

There has long been a “controversy” in the healthcare world between some groups that believe that NPs should not have the same practice authority as doctors, while others that argue that data shows that NPs provide safe, quality, and economic care. Some argue that increasing NP authority will harm patients by displacing patient care away from physicians, while others argue that NP-led care only expands healthcare access and may better free up more speciality practices.

However, the National Academy of Medicine's The Future of Nursing 2020-2030 report recommends that full-practice authority be granted for advanced practice registered nurses (APRNs) to allow nurses to practice to the full extent of their licenses and better provide for patients. It’s no secret the healthcare system is already strapped and patients have seen the firsthand effects, so groups such as the American Association of Nurse Practitioners (AANP) and the American Nurses Association (ANA) fully support granting more state full practice authority designations.

What Does a Move Like This Mean for Nurses?

With New York allowing NPs full practice authority, nurses who are looking to become APRN can have better confidence that they will be able to act in their roles as independent practitioners. The move also further solidifies nursing as its own professional field that can act alongside the physician-led medical community, enhancing, not competing for, patient care. And, of course, it can improve access, especially in low-income and rural areas, where physicians may not be practicing.

The American Academy of Nurse Practitioners commended the act, calling it one that will increase health care access for New York state residents.

“New York has taken a critical step forward in our country, increasing access to vital health care services. New Yorkers will now have full and direct access to the comprehensive care NPs provide,” April N. Kapu, DNP, APRN, ACNP- BC, FAANP, FCCM, FAAN, president of AANP, said in a press release. “Over the past two years, New York has waived unnecessary and outdated laws limiting access to health care. AANP applauds the state legislature and Gov. Hochul for recognizing that these provisions need to continue. These changes will help New York attract and retain nurse practitioners and provide New Yorkers better access to quality care."

The announcement also prompted much celebration on the AANP’s Facebook page, with commenters and current NPs lauding the move, as well as lamenting that more states need to follow suit.

The Nurse Practitioner Association of New York State (NPA) also praised the move, calling the new law a “big win for New Yorkers.”

“Today is a big win for all New Yorkers. The NPA has long advocated for full practice authority for experienced NPs;and the latest statutory changes is a recognition that NPs are collaborative partners who are integral to New York’s health workforce,” Dr. Stephen Ferrara, DNP, FNP, FAAN, Executive Director, The Nurse Practitioner Association New York State said in a press release. “We are grateful for Governor Hochul’s commitment to eliminating arbitrary barriers will help ensure that New York can meet its current and future healthcare workforce demands.”