Upcoming Laws & Proposals on Full Practice Authority (FPA)
- Mississippi: House Bill 98 (2025) -Grants full practice authority to nurse practitioners after completing 3,600 hours of clinical practice, removing the requirement for a collaborative agreement with a physician. CRNAs would require 8,000 hours. (Empower Mississippi –)
- South Carolina: Bill 45 (2025–2026 legislative session) –The state Board of Nursing would have the authority to grant FPA to APRNs who: Complete 2,000 clinical hours post-license, Maintain malpractice insurance, Apply to and are approved by the board. Once approved, APRNs can independently perform a full scope of functions—including diagnosing, prescribing, ordering diagnostics, and population health activities—without a practice agreement. (South Carolina Legislature)
- North Carolina: Senate Bill 537 / House Bill 514 (2025) -A bipartisan “SAVE Act” proposal would grant APRNs full practice authority. Advocates estimate it could save $650 million to $6 billion annually, especially in rural and underserved communities. (Daily Nurse)
- State Trends & Pending Legislation -As of 2025, 34 states plus DC grant FPA, with several notable transitions in recent years (e.g., Michigan, Alabama, Louisiana, South Carolina, Wisconsin) (Nurse Practitioner Online).
- Pending proposals are active in Missouri, Georgia, Mississippi, and Pennsylvania—indicating growing momentum. (Nurse Practitioner Online, Fullscript)
- Federal: H.R. 1317 – “I CAN Act” –Aims to remove physician supervision requirements for APRNs (including NPs, CRNAs, PAs, midwives) within Medicare and Medicaid programs. Would allow NPs to bill at parity with physicians for covered services and certify post-hospital care, subject to state law. (Congress.gov)
How to Support Full Practice Authority: Best Strategies
- Join NP Advocacy Organizations: Engage with groups such as the American Association of Nurse Practitioners (AANP) and state-level NP associations. These groups provide tools, legislative updates, and collective advocacy platforms. (preceptornetwork.com, Fullscript)
- Educate and Lobby Lawmakers: Schedule meetings, write letters, or submit testimony to legislators—especially in states like Mississippi, South Carolina, and North Carolina where bills are active. Use data-driven arguments: FPA improves access, reduces costs, and maintains high quality of care. (preceptornetwork.com, Nurse Practitioner Online)
- Leverage Real-world Success Stories: Share patient outcomes and practice experiences from FPA states to illustrate benefits, especially in psychiatric care, rural health access, or underserved areas. (The Washington Post, preceptornetwork.com)
- Amplify Messages via Social Media and Public Campaigns: Promote infographics, research highlights, and personal success stories across platforms—especially on trending legislative milestones like HB 98, SB 45, or the I CAN Act.
- Encourage Mentorship and Transition Support: Advocate for “transition to practice” programs, such as structured mentorship or supervised clinical hours, as required in Pennsylvania bills. These help ensure safe, effective autonomous practice. (pacnp.org, preceptornetwork.com)
- Push for Reimbursement Parity: Lobby for laws ensuring equal pay for equal work, so NPs are reimbursed at the same rate as physicians for the same services. This increases financial viability of independent NP-led practices. (Fullscript, Nurse Practitioner Online)
- Engage in Institutional Policy Reform: Even after legislative wins, APRNs face institutional barriers—e.g., hospital bylaws or credentialing systems that still require physician oversight. Partner with healthcare organizations to update internal policies consistent with state laws. (Fullscript).
Here’s a case-style example to illustrate how a nurse practitioner (PMHNP) might join professional organizations and influence laws toward Full Practice Authority (FPA):
“Dr. Lopez, PMHNP, and the Road to Full Practice Authority”
Background: Dr. Maria Lopez, a psychiatric nurse practitioner in North Carolina, faced barriers due to physician supervisory agreements. Even after years of independent clinical experience, she couldn’t prescribe without a physician’s signature—adding costs and delays for her patients, many of whom were in rural, underserved communities.
Step 1: Joining Professional Groups
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Action: Maria became a member of ANCC and her state NP psychiatric chapter.
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Impact: Through these groups, she gained access to policy briefs, advocacy toolkits, and legislative updates. She also completed the AANP’s “Advocacy 101” online module, which helped her understand how bills move through her state legislature.
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Lesson: Membership provided structure, credibility, and resources she couldn’t access alone.
Step 2: Grassroots Advocacy & Testimony
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Action: When the SAVE Act (North Carolina’s FPA bill) was reintroduced, Maria worked with ANCC and her state NP council to submit testimony describing patient delays due to physician sign-offs. She shared anonymized case studies of veterans and single mothers waiting weeks for care.
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Impact: Her testimony was cited by a legislator during committee hearings as evidence of real patient harm caused by outdated restrictions.
Step 3: Legislative Relationships
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Action: Maria signed up for “NP Lobby Day” at the state capitol, where she met with three representatives. She later followed up with personal thank-you letters and patient outcome data.
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Impact: One legislator invited her to join a roundtable on rural behavioral health access, giving her an ongoing advisory role.
Step 4: Professional Influence & Media Engagement
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Action: With coaching from her state NP association, Maria published an op-ed in the local newspaper about how FPA could save North Carolina up to $6 billion while expanding access to psychiatric care.
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Impact: The op-ed went viral locally, earning her a segment on the regional news where she discussed the bill—bringing public attention to the issue.
Step 5: Leadership in Professional Organizations
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Action: Maria was later elected as the legislative liaison for her state psychiatric NP chapter.
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Impact: In that role, she coordinated email campaigns, organized town halls with legislators, and mentored younger NPs in advocacy.
Results: While FPA was not passed immediately, Maria’s persistent involvement through professional groups, testimony, lobbying, and media engagement helped keep the issue alive. By the following legislative session, the bill gained bipartisan co-sponsors and is now considered one of the strongest chances for passage.
Takeaway for Other NPs
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Membership matters: National (AANP, ANA, ANCC) and state NP associations provide infrastructure, lobbying power, and credibility.
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Storytelling is powerful: Patient-centered stories influence legislators more than statistics alone.
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Visibility creates momentum: Op-eds, local news, and advocacy days amplify the NP voice.
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Leadership multiplies impact: Serving on a board or as a liaison extends influence beyond the clinic.
In Conclusion
The strongest takeaway from this is how the little things mattered. Major changes in healthcare, the government, and in general takes a long time or at least a few months locally… Overall, NP’s continue to fill a void but we are heavily restricted to the point that I’m advising people to consider other means of income or careers. It’s simply not worth the burden and our governmental officials are completely out of touch -hence the reasons you have to take baby steps with legislation and awareness. Also, consider your work/life balance and your tolerance to add MORE stress. The priority is to make efforts without compromising your personal life and be mindful of the energy you’re putting out there.
One of the things that’s not mentioned in Chat GPT is how with care providers and politics -be aware of your DIGITAL FOOTPRINTS/ANTICS. You can have the best intentions, but if you’re having crazy/negative/hostile views -you’re career and advocacy could be destroyed. It’s nothing wrong having quirks or being different, the general rule is don’t be a red flag, risk your license, or any illegal stuff… Focus on what’s in your control and practical, this is a marathon to hopefully not burn yourself out, but to improve the access of care.
Quick Summary
| Category (States) | States |
|---|---|
| Full Practice (34 + DC) | Broad list, including newer FPA states like Michigan, Alabama, Louisiana, SC, Wisconsin, TX, Indiana(The HJN Blog) |
| Reduced Practice (~12) | AL, NY, OH, PA, UT, IL, IN, KY, LA, MS, NJ, WV, WI |
| Restricted Practice (~11) | CA, FL, GA, MI, MO, NC, OK, SC, TN, TX, VA |
| Pending Proposals | Missouri, Georgia, Mississippi |
