Advanced Practice Registered Nurse Scope of Practice

Advanced practice registered nurses (APRNs) are nurses with advanced degrees who practice as certified nurse practitioners, certified nurse midwives, certified registered nurse anesthetists, or certified clinical nurse specialists. APRNs in these roles are often primary care providers and can provide acute, gynecological, and pain management care. In each state, scope of practice (SOP) laws determine which procedures and treatments APRNs may administer. In Missouri, APRNs are required to enter into collaborative practice arrangements (CPAs) with a physician to prescribe, administer, and dispense medications; examine and evaluate patients; and formulate treatment plans. In addition to defining APRN scopes of practice, Missouri statute (MO Rev. Stat. § 334.037, 104) restricts the number of APRNs that may enter into a CPA with a physician, defines geographic proximity requirements, and requires that physicians regularly review the services provided by APRNs. 

Highlights 

• APRNs are significant healthcare provider alternatives in rural and underserved areas, which contain a relatively high proportion of APRNs.

• APRNs provide healthcare services at a similar level of quality to physicians in many settings.

• Less restrictive scope of practice laws have been associated with more hours worked by APRNs and greater access to healthcare services for consumers without increases in the cost of services.

Limitations 

• Very few studies are able to gauge the effects of specific SOP provisions (e.g. degree of independence, number of APRNs that may enter into collaborative practice agreements with an individual practitioner, strictness of geographic proximity requirements) and instead compare full practice authority regimes to reduced or restricted practice states.

• The effects of SOP laws on physicians and physician assistants’ workload and quality of care are unknown.