nurs practitioner conluting with elderly woman in a face mask
Locums News July 14, 2020

By Melissa Wirkus Hagstrom

The Scope of Practice for Nurse Practitioners and the Impact of COVID-19

Nurse practitioners, or NPs, are advanced practice registered nurses who acquire graduate education at the master’s, post-master’s, or doctoral level and obtain national board certification. You can find NPs in virtually every type of setting—from major hospitals and medical centers to retail clinics, rural facilities, surgical centers, medical practices, urgent care settings, and many others. 

The American Association of Nurse Practitioners (AANP) has conducted over five decades of research that affirms NPs provide safe, high-quality, cost-effective, patient-centered care. 

How has the scope of practice for nurse practitioners changed over the years? We connected with Sophia L. Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP, president of AANP, for an in-depth look at NP practice today.

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Scope of practice for nurse practitioners


NPs are licensed in all states and the District of Columbia, and they practice under the rules and regulations of the state in which they are licensed. Some states allow more independent practice than others. 

“In 22 states and the District of Columbia, patients have full and direct access to NPs, providing consumers a choice of healthcare provider, and strengthening patient access to primary care,” Thomas said. 

According to the AANP, NP practice includes (but is not limited to):


  • Assessment of the patient;
  • Ordering, performing, supervising, and interpreting diagnostic and laboratory tests;
  • Making diagnoses;
  • Initiating and managing treatment, including prescribing medication and non-pharmacologic treatments;
  • Coordinating patient care;
  • Counseling; and
  • Educating patients and their families and communities.

As licensed, independent practitioners, NPs practice autonomously and in coordination with healthcare professionals and other individuals.

Nurse practitioner regulatory board

While NPs are regulated at the state level, by that state’s board of nursing, the AANP is a key association for nurse practitioners that reviews and revises the scope of practice guidelines for NPs at their annual meetings. The most recent revision was published in 2019. This continual review process helps ensure that nurse practitioners are always up to date and held to the highest clinical and ethical standards.  

In addition to the AANP, nurse practitioners are also included in the American Nurses Association (ANA). According to the ANA, they represent and advocate for the interests of all advanced practice registered nurses (APRNs), which include certified nurse practitioners (NPs), certified registered nurse anesthetists (CRNAs), clinical nurse specialists (CNS), and certified nurse-midwives (CNMs).

Full practice authority and the COVID-19 pandemic

The scope of practice for NPs and other APRNs has been a topic of growing interest in recent years. Many organizations are calling to protect and expand practice authority for these types of healthcare professionals, in part to expand access to care.

“Supported by a growing body of evidence of the safe and cost-effective provision of care by APRNs, there is a national call to remove all barriers to full practice authority from organizations such as the Institute of Medicine (IOM), the National Governors Association (NGA), the Federal Trade Commission (FTC), the Bipartisan Policy Center, and the Veteran’s Health Administration (VHA), among others,” according to 
ANA’s APRN policy and advocacy page.  

The ANA goes on to note that they have been working with their constituent state nurses associations for years, aiming to remove regulatory barriers for APRNs and allow them “full practice authority, which is generally defined as an APRN’s ability to utilize knowledge, skills, and judgment to practice to the full extent of their education and training.”

Advocates note that full practice authority has become more important than ever during the COVID-19 global pandemic. Removing barriers to practice allows NPs to fully leverage their skills and clinical experience to assist in areas being hit hard.

“NPs are on the frontlines of the COVID-19 crisis and they are expanding healthcare access for millions of Americans,” Thomas said. “Most recently, during the COVID-19 pandemic, governors of Kentucky, Louisiana, New Jersey, New York and Wisconsin suspended state regulatory barriers that limit NPs from combatting the growing COVID-19 crisis. The actions enable these states to surge the number of frontline care providers, treat patients with underlying health conditions, and meet vital primary care needs.” 

“AANP continues to urge governors to permanently waive restrictive barriers that undermine patient access to NP-provided care. Many states are considering legislation that would grant NPs full practice authority,” Thomas added.

“In the areas of the country where we continue to see an increase in cases, we’re concerned and we’re committed to helping combat outbreaks,” she continued. “People and policymakers need to remain vigilant—and everyone needs to continue to play their part in wearing masks, handwashing, social distancing, and avoiding crowds.”

The AANP recently surveyed NPs nationwide to better assess the impact of the COVID-19 pandemic on patients and NP clinical practice across settings. 

“Among some of the findings, the majority of nurse practitioners (61 percent) are treating patients diagnosed with COVID-19. And 58 percent say they are testing patients at their practices,” Thomas reported. “Lack of testing is the most critical barrier facing NPs as they treat COVID-19 patients in their communities. In fact, 47 percent of NPs cite a lack of testing as the biggest barrier to caring for their patients during this crisis, and 69 percent say that, in their communities, COVID-19 testing remains limited to patients meeting a narrow set of criteria.”

“The NP profession is leading the way in adopting strategies to meet patients’ ongoing healthcare needs. Over half of NPs are utilizing 
telehealth and virtual platforms to provide care while reducing patient exposure to COVID-19.” 

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