About Laura Searcy, MSN, PPCNP-BC: Laura Searcy is a Pediatric Nurse Practitioner with over 20 years of experience in clinical practice with a focus on primary care, child and adolescent injury prevention, and government affairs. She currently serves as President of the 8,700-member National Association of Pediatric Nurse Practitioners (NAPNAP), where she formerly served as the Health Policy Chairperson, working closely with Association staff on advocacy at the state and national levels.
Ms. Searcy has held many leadership roles in her profession and within her community. She is a founding member of the Georgia Coalition of Advanced Practice Registered Nurses and also serves as clinical faculty for nursing within the State University System. In addition, she has over 10 years of non-profit board experience, most recently as a charter member of the board of the Cobb County Alliance to Prevent Substance Abuse. She is an experienced public speaker, and has presented on a variety of professional and leadership topics at the local, state and national levels.
Ms. Searcy earned her Bachelor’s Degree in Nursing from the University of Florida in 1976, and her Masters in Child Health and Pediatric Nurse Practitioner from Emory University in 1991. She served three terms on the Cobb County Board of Education, and was elected as Chair of the Board of this large suburban-urban school district of over 100,000 students during her tenure. She currently works as a Pediatric Nurse Practitioner at Marietta Neonatalogy and at Newborn Clinics of North America, where she provides immediate and follow-up care to newborn infants.
[OnlineFNPPrograms.com] Could you please provide an overview of the different scope of practice levels that are established for advanced practice registered nurses, and what rights and privileges they provide APRNs in their care of patients?
[Laura Searcy, MSN, PPCNP-BC] APRNs, which include certified nurse practitioners, certified registered nurse anesthetists, certified nurse-midwives and clinical nurse specialists, all must meet educational (at least masters but more often doctoral level) and clinical training requirements in addition to national board certification. Per the National Council of State Boards of Nursing APRN Advisory Committee and APRN Consensus Workgroup, “While education, accreditation, and certification are necessary components of an overall approach to preparing an APRN for practice, the licensing boards–governed by state regulations and statutes–are the final arbiters of who is recognized to practice within a given state.” Currently, there is no uniform model of regulation of APRNs across the states. Each state independently determines the APRN legal scope of practice, the roles that are recognized, the criteria for entry into advanced practice, and the certification examinations accepted for entry-level competence assessment.
Since Individual states define what/how each APRN can practice within the state through both state laws and regulations, this results in different and inconsistent practice authority across the states. Full, reduced or restricted practice are terms used to describe the degree to which APRNs can perform in relation to the full extent of their education and certification. For example, AANP defines the terms as:
Full Practice: State practice and licensure law provides for all nurse practitioners to evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage treatments—including prescribe medications—under the exclusive licensure authority of the state board of nursing. This is the model recommended by the Institute of Medicine and National Council of State Boards of Nursing.
Reduced Practice: State practice and licensure law reduces the ability of nurse practitioners to engage in at least one element of NP practice. State law requires a regulated collaborative agreement with an outside health discipline in order for the NP to provide patient care or limits the setting or scope of one or more elements of NP practice.
Restricted Practice: State practice and licensure law restricts the ability of a nurse practitioner to engage in at least one element of NP practice. State requires supervision, delegation, or team-management by an outside health discipline in order for the NP to provide patient care.
Yet even in states that have achieved full practice authority per AANP or NCSBN evaluation, there are still differences in state laws and regulations. In addition, health care systems, institutions, and practice sites can impose additional restrictions on practice, even in states that have “full practice authority.” There is no national standard in legislation or regulation.
[OnlineFNPPrograms.com] What legislation at the state and national levels controls APRNs’ scope of practice?
[Laura Searcy, MSN, PPCNP-BC] At the state level, nurse practice acts and other statutes and regulations implemented by the state governing bodies, most often state boards of nursing, control state scope of practice for each APRN role. At the federal level barriers remain that prevent APRNs from fully providing care to the top of their license and certification. There is some physician exclusive language in older statutes and regulations that need to be modernized to include APRNs. Federal barriers exist in relation to practice authority, ordering authority and reimbursement with federal programs like Medicare and Medicaid.
[OnlineFNPPrograms.com] Why do you believe achieving full practice authority for APRNs in as many states as possible is important for overall accessibility and quality of care for patients nationwide?
[Laura Searcy, MSN, PPCNP-BC] Research has shown that access, quality and cost of health care is improved when barriers limiting the ability of patients to access the care provided by APRNs are removed. Emerging evidence suggests health outcomes are better in states where APRNs have achieved full practice authority. Patient access to high quality, cost effective care from the qualified provider of their choice should not vary based on state or zip code. APRNs’ ability to utilize the advanced education and clinical skills that they have worked so hard to obtain should not be limited by geography.
[OnlineFNPPrograms.com] What are the main barriers preventing APRNs from obtaining full practice authority in certain states, and how can nursing students and APRNs collaborate to overcome these barriers?
[Laura Searcy, MSN, PPCNP-BC] Barriers preventing APRNs from obtaining full practice in certain states include opposition from organized medicine and poor understanding by the public/legislators about nursing titles and authority. Most stakeholders do not understand the advanced education and training that APRNs have and the high level of care they are qualified to provide.
A variety of strategies are necessary to address these objections. There is a continual need to educate and inform both legislators and the public about the competencies, skills and 40 years of research that has shown APRNs to be high quality, safe and cost effective providers of care. Language and approach are important. We urge APRNs and the public to please eliminate “independent practice” and “mid-level provider” from their vocabulary. We desire full practice authority in order to increase access to care for patients, but no health care provider functions independently. The perception of the term “independent practice” is almost universally negative where legislators and organized medical groups are concerned. We practice in collaborative teams with leadership of the team determined by the patients’ needs at that time. It’s all about patient access and improving health outcomes, not about “us” (APRNs) vs “them” (physicians).
Students and APRNs need to understand the basics of APRN regulation. They need to understand the APRN Consensus Model, the uniform model of regulation for the future of advanced practice nursing that is designed to align the interrelationships among licensure, accreditation, certification, and education. The model provides guidance for states to adopt uniformity in the regulation of APRN roles. They need to understand their individual state nurse practice acts and other state laws and regulations that control their practice.
More students and APRNs need to participate in the basic grassroots work of developing ongoing relationships/communication with their elected officials at both the state and federal levels. They must educate and inform these officials about their advanced education and training and the contributions they make to the elected official’s constituents’ health. They should join the professional association(s) of their choice to have the networking and resources in order to accomplish this outreach.
APRNs at the state level need to involve other stakeholders as allies in reducing barriers to practice to prevent the perception that discussions about scope of practice are merely turf battles between the medical and nursing professions. Improving patients’ access to care from qualified providers improves states’ healthcare outcomes while also improving the business and economic climate within states.
[OnlineFNPPrograms.com] How does joining organizations such as their state NAPNAP chapters (as well as independent state and local nursing associations) empower graduate nursing students and advance practice registered nurses to impact APRNs’ scope of practice, both in their state and nationwide? What are the benefits of NAPNAP membership, both for the overall state of the APRN profession as well as on an individual level? How does NAPNAP benefit nursing students?
[Laura Searcy, MSN, PPCNP-BC] When students and APRNs join professional associations, they can amplify their voices with the support of a much broader group of like-minded professionals. When students and pediatric-focused APRNs join NAPNAP, they have the benefits of a national organization, as well as more personalized relationships with fellow providers within their chapter. NAPNAP’s national benefits include access to expert-developed in-person and online continuing education, professional resources, clinical practice tools, career guidance, in-person and e-community networking, national policy analysis, scholarly journal/positions, timely child health news, and patient resources. Our chapters provide additional opportunities for localized continuing education programs, networking events and grassroots advocacy.
NAPNAP members have access to our Advocacy Center to research state or federal laws and quickly contact elected officials, as well as numerous resources related to advocacy including our Child Health Coalition Building Toolkit. Our Child Health Policy Learning Collaborative provides topical policy speakers on a monthly basis and allows members to ask questions and get assistance with their advocacy efforts.
NAPNAP partners with professional leaders to assist our members with career development and job searches. NAPNAP offers certification review courses for those seeking their Primary Care Pediatric Nurse Practitioner and Acute Care Pediatric Nurse Practitioner national certifications, as well as review for those seeking the Pediatric Primary Care Mental Health Specialist certification. Our chapter also assist local student members in their search for preceptors.
Thank you, Ms. Searcy, for your insight into scope of practice legislation and advocacy for APRNs nationwide!