The Full Practice Authority Initiative: Lessons Learned from Nevada

Purpose: Identify specific legislative barriers to full practice authority (FPA) legislation and describe how they were overcome during the 2013 legislative session in Nevada. Background: Legislative restrictions in 31 states prevent nurse practitioners from practicing to the full extent of their education and training. FPA legislation is introduced, but not often signed into law. A comprehensive literature review revealed multiple barriers to autonomous practice: conflict between medical and nursing roles, lack of nurse practitioner role recognition, financial challenges, and a lack of business knowledge. Barriers caused by policy limitations were most frequently mentioned: limited scope of practice, limited prescriptive authority, limited clinical privileges, credentialing limitations and reduced reimbursement rates. Methods: This study employed a qualitative, multiple case study design. Semi-structured interviews were conducted with four actively-involved contributors to the 2013 FPA initiative in Nevada. Homogeneous questions were used, guided by the use of a predetermined set of questions based on Kotter’s (1995) Change Management Model. Each interview began with the question, "What prompted this movement and why was it introduced at this time?" Participants were asked to identify perceived barriers to FPA legislation, and how they were overcome. Recorded interviews were transcribed into text, which led to thematic analysis. Results: Repetition of shared perceptions revealed eleven barriers separated into six main themes. 1) Vision includes the barrier of lacking a clear and shared vision. 2) Physician Support includes the barrier of lacking the support of physicians and Organized Medicine. 3) Addressing Stakeholders includes the barriers of the inability to address stakeholders, lack of role recognition and community support, and social media. 4) Community Organization Support includes the barriers of having a Board of Nursing with a poor reputation, and a lack of support from the Board of Pharmacy. 5) Leading Coalition includes the barriers of lacking a strong, leading coalition lacking history of leadership and legislative experiences, and choosing a legislator without experience, authority, and respect in the legislature and the community. 6) Resources include the barrier of lacking necessary resources including time and preparation. Implications: The findings of this study may be useful for those living in one of the 31 states without FPA legislation. This is one of the first published studies to identify the importance of literature identifying legislative barriers to FPA, and starts to fill the current gap in the literature surrounding this topic. This information may be invaluable in the preparation and introduction of FPA legislation in other states. The findings may also act as a stepping-stone to addressing the provider shortage in the U.S., and may be instrumental in improving access to care. Further research is needed to identify whether similar barriers found in this study are prevalent in other states with FPA legislation for nurse practitioners