New York and Kansas Grant Full Practice Authority to NPs
Nurse practitioners licensed in New York and Kansas are now fully able to practice independently, joining 24 other states, the District of Columbia, and two US territories in adopting Full Practice Authority (FPA) legislation.1-3 With this new legislation in New York and Kansas, more than half of US states (26 states) now have full practice authority for NPs.
New York State
NPs in New York State gained full practice authority when Governor Kathy Hochul signed the 2022-23 state budget bill on April 9, 2022, which included elimination of the requirement for NPs to have a written practice agreement with a physician in order to practice. Like other states, New York has been under an emergency order during the COVID-19 pandemic that allowed NPs to practice to their full authority because of staffing shortages. That order was extended several times but was set to expire early this year. According to New York State Nurses Association (NYSNA) Director at Large Michelle Jones, RN, MSN, ANP-C, NPs who were allowed to practice independently during the pandemic campaigned for that provision to become permanent once the emergency order expired, and the American Association of Nurse Practitioners (AANP) and NYSNA had been working hard to get full practice authority for NPs.4
AANP president April N. Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, noted that over the past two years of the COVID-19 pandemic, New York waived unnecessary and outdated laws limiting access to health care. “For the past two years, patients have experienced full and direct access to the services NPs provide as executive orders waived unnecessary requirements for NPs to maintain a collaborative relationship in order to care for patients,” she said. “Governor Hochul’s State of the State specifically calls out her desire to permanently remove this obstacle for New Yorkers accessing healthcare.” The law will also help NPs open private practices and serve underserved patients in areas that lack access to healthcare, NYSNA’s Ms. Jones notes.
Before this change, New York was one of 15 states with ”reduced” practice authority for NPs. NPs were required to have a written practice agreement with a physician in their specialty area, with provisions for the physician to review patient records periodically, make referrals, be available for consultation, and have the final word in disagreements over patient care. NPs with more than 3,600 hours of experience could have a less restrictive “collaborative” relationship with a physician or a healthcare facility—not needing a signed agreement with a physician or supervision, but the relationship had to be proven by attestation form and documentation showing communication between the two parties. The written practice agreement and the collaborative relationship were subject to approval or inspection the New York State Education Department.
The new legislation gives full practice authority to those with more than 3,600 hours of experience and NPs with under 3,600 hours are now allowed to complete their “practice hours” under either a physician or an NP.5
Kansas NPs gained full practice authority April 19, 2022, when Governor Laura Kelly signed House Bill 2279 into law, eliminating what she said are outdated regulatory barriers that have previously restricted the scope of practice for NPs, improving patient access to healthcare.
Kansas had and continues to face serious primary care and mental care access challenges due to severe primary care shortages.6 The US Health Resources and Services Administration data shows that as of 2021, nearly 781,000 Kansas residents live in a federally designated primary care health professional shortage area where only half the need for primary care services is met. “Kansas, like so many other states, is experiencing a health care shortage – especially in rural parts of the state,” Governor Kelly said. “This will improve the availability of high-quality health care by empowering APRNs to reduce local and regional care gaps.7
1. American Association of Nurse Practitioners. State of New York grants full and direct access to nurse practitioners. https://www.aanp.org/news-feed/state-of-new-york-grants-full-and-direct-access-to-nurse-practitioners Accessed April 11, 2022.
2. American Association of Nurse Practitioners. Kansas law strengthens patient access to health care. https://www.aanp.org/news-feed/kansas-law-strengthens-patient-access-to-health-care Accessed May 1, 2022.
3. Rodriguez S. Patient engagement HIT. Kansas nurse practitioners gain full practice authority. https://patientengagementhit.com/news/kansas-nurse-practitioners-gain-full-practice-authority Accessed April 30, 2022.
4. Robbins R. New York NPs join half of States with Full Practice Authority. Medscape. April 14, 2022. https://www.medscape.com/viewarticle/972221 Accessed April 28, 2022.
5. New York States Nurses Association. Nurse Practitioner Modernization Act: Information/Updates. https://www.nysna.org/new-nurse-practitioner-modernization-act-informationupdates#.YmlQEC-B1WN Accessed April 28, 2022.
6. Rodriguez S. KS patients support expanded nurse practitioner scope of practice. Patient Engagement HIT.com. https://patientengagementhit.com/news/ks-patients-support-expanded-nurse-practitioner-scope-of-practice Accessed April 28, 2022.
7. Japsen B. Kansas lifts hurdle to nurse practitioners, becomes 26th state to do so. Forbes. https://www.forbes.com/sites/brucejapsen/2022/04/15/kansas-lifts-hurdle-to-nurse-practitioners-becomes-26th-state-to-do-so/?sh=5fc95cbf793f Accessed April 27, 2022.