Quality and Safety of Nurse Practitioner Care:
The Case for Full Practice Authority in Pennsylvania
By Hilary Barnes, PhD, CRNP
By Linda H. Aiken, PhD, RN, FAAN
By Antonia M. Villarruel, PhD, RN, FAAN
Center for Health Outcomes and Policy Research
Leonard Davis Institute of Health Economics, University of Pennsylvania, School of Nursing
Introduction
Pennsylvania is one of the most
restrictive states in the nation
for nurse practitioners (NP)
despite having a shortage of primary care throughout the state,
especially in rural areas and
low-income urban neighborhoods (Association of American
Medical College, 2012; Brown,
Polsky, Barbu, Seymour, &
Grande, 2016). Pennsylvania
requires nationally-certified and
fully-licensed NPs to maintain
formal, written collaborative
agreements with at least two
physicians. Independent research estimates that removing
NP practice restrictions could
Fall 2016 Pennsylvania Nurse 12
save the Commonwealth $6.4
billion and improve access to
care over the next 10 years without any harm to patients (Jeap &
Bailey, 2015).
Improving access to primary
care in Pennsylvania now depends upon the Pennsylvania
House of Representatives adopting SB 717, companion legislation to HB 765, that removes
the outdated and unnecessary
requirement that each NP has
written collaborative agreements
with at least two physicians.
In July 2016, the Pennsylvania
State Senate voted 41 to 9 in
support of SB 717 to eliminate
these required collaborative
agreements. Major stakeholders
in Pennsylvania favor the adoption of SB 717 and granting NPs
full practice authority, including: consumers; the Hospital
and Healthsystems Association
of Pennsylvania (HAP); AARP;
the Pennsylvania Higher Education Nursing Schools Association (PHENSA) and its 43 nursing school members whose NP
graduates leave Pennsylvania
because of practice restrictions;
the Pennsylvania State Nurses
Association (PSNA); and the
Pennsylvania Coalition of Nurse
Practitioners (PCNP) representing more than 172,000 nurses
in Pennsylvania. Additionally,
full practice authority for NPs