18th Annual Legislative Update: A comprehensive look at the legislative issues affecting advanced nursing practice

So often, our professional meetings are mired in discussions of what practice authority nurse practitioners (NPs) don't have and the barriers of practice that still exist. Members are given open forum to discuss and inquire about issues they would like to see addressed, which vary from state to state. The global theme that emerges during all of these sessions is that associations, organizations, and agencies are not doing enough to change the practice landscape for providers who are on the front lines. This article will highlight the practice authority of NPs across the nation, focusing on the practice authority that NPs do possess. The United States is unique in that, although advanced practice nursing (APN) varies from state to state as defined by individual state law, the national NP organizations are working every day to improve the practice of NPs nationwide. National organizations are able to impact NP practice from a global perspective and where federal policy change is required. The national organizations also remain in a position to influence statutory change at the state level. Nurse practitioner practice in the United States is better now than it was last year, and the year before that, and 5 years ago, and so on. Nurse practitioners nationwide have been successful in scientifically demonstrating their contribution to healthcare. Access to healthcare has improved dramatically because of the emergence and advancement of NP practice and will continue to do so at an accelerated rate. It is thrilling to review the legislative accomplishments in preparation for this annual report. Nurse practitioners are on the same page, and continue to move forward in legal authority to practice, reimbursement for services, and prescriptive authority. Nurse practitioners are part of the healthcare team. According to Webster's II New Riverside University Dictionary, "collaboration" means, "to work together, especially in a joint intellectual effort." Optimal patient care comes when members of the healthcare team collaborate to provide the best possible healthcare to a patient. Nurses, and thereby NPs, are leaders in collaboration, working with all healthcare team members who contribute to the ultimate well-being and care of a patient. Eighteen states have successfully passed laws or drafted regulations removing practice barriers for NP practice and other APN practice. This report divides updates into three categories: Legal Authority, Reimbursement, and Prescriptive Authority. A new category, Legislative Accomplishments, highlights specific legislation passed in 2005. Information contained within the following state updates was generously provided by each state's Board of Nursing (BON) and the professional organizations responsible for, or who contribute to, the advancement of NP practice through legislative activity.