APRN Scope of Practice: Utah's Model and National Trends

Introduction: State Inconsistencies in APRN Scope of Practice

Significant inconsistencies exist among states regarding restrictions on advanced practice registered nurse (APRN) scope of practice. These variations have important implications for patient access to care, professional roles, and regulatory oversight across the country.

Utah's Broad APRN Autonomy and Professional Tensions

The state of Utah gives APRNs a great deal of leeway regarding the provision of primary care. APRNs can function as primary care providers in autonomous practice settings. They are also authorized to prescribe medications and offer physical therapy independent of physician collaboration, delegation, or supervision. APRNs in Utah can sign death certificates, issue handicap parking permits, and oversee worker compensation claims.

From the perspective of the profession, APRNs are increasingly being called upon to fulfill roles traditionally held by physicians. This is considered a cost-effective approach to care and an acknowledgment of the advanced training that APRNs undergo. However, from the perspective of other healthcare providers — such as physicians and licensed and registered nurses — tensions may arise from the perception that APRNs are straddling the line between different professional boundaries and blending two distinct approaches to care. Physicians may feel their roles are being encroached upon, while other nurses may worry that what is distinctive about nursing could be lost.

Regulatory and Academic Responsibilities

Academic institutions, nursing associations, and professional organizations must acknowledge the new roles and responsibilities that nurses are fulfilling in many states. They must also set clear standards for APRNs working in the field and for student nurses regarding the preparation needed to perform high-level tasks. As the American Association of Colleges of Nursing (AACN) states, "Education, certification, and licensure of an individual must be congruent in terms of role and population foci" (The new APRN regulatory model, 2013, AACN).

State boards, certification bodies, and accreditation organizations must likewise be vigilant that the requirements for practice are sufficiently rigorous given the expanded duties of APRNs. As the AACN further notes, "Advanced practice registered nurses will be licensed independent practitioners who are expected to practice within standards established or recognized by a licensing body. Licensure will be required because these APRNs will be practicing in a role beyond that of the Registered Professional Nurse" (The new APRN regulatory model, 2013, AACN). State representatives, legislators, and lobbyists must balance the needs of patients, providers, and the justice system when framing legislation. Because Utah's allowances for APRNs are so broad, APRN responsibilities are particularly significant and may expand further in the future in response to the evolving needs of the healthcare profession.

Conclusion

Although the state of Utah does not place substantial restrictions upon APRN practice, by continuing to support legislation that reflects the advanced education and knowledge of APRNs — while setting clear standards for nursing education — high-quality and cost-effective care can continue to be enjoyed by state residents. Utah's model demonstrates how progressive APRN policy, when paired with rigorous academic and regulatory standards, can serve as a viable framework for addressing the primary care provider shortage on a national scale.