Barriers to Nurse Practitioner Full Practice Authority (FPA): State of the Science


  • Cameron G Duncan University of Arizona
  • Kate G Sheppard University of Arizona, College of Nursing


Full practice authority, autonomous practice, independent practice, barriers, legislation, nurse practitioner, primary care, health policy, leadership, scope of practice


Purpose: To explore the various barriers to full practice authority (FPA) of nurse practitioners (NP) in the United States, and to identify the specific legislative barriers to FPA.

Background: FPA for NPs is cited as a way to reduce the provider shortage in the U.S, increasing access to healthcare. However, the majority of states across the country restrict the NP ability to provide primary care. As of 2015, only 21 states offer NP’s full practice authority.

Data Sources: A comprehensive literature search was conducted using data bases by PubMed, and MeSH, EBM Search, CINAHL, and Google Scholar. Thirty articles were chosen for synthesis.

Results: Several barriers impede the ability of NPs to practice autonomously including lack of formal business or marketing education, reduced reimbursement rates, and lack of recognition from public and other health professionals about their preparation. The most common barrier is restrictive legislation halting NP practice at the level of their full knowledge and preparation. No articles were found identifying specific barriers to implementing FPA legislation.

Implications: There is a gap in the literature identifying specific barriers to implementing successful legislation to remedy this problem. Understanding how NPs, NP organizations, legislators, and policy-makers are working to overcome these barriers and attain full practice authority in their respective states will help other states in their efforts to obtain similar legislation.

Author Biographies

Cameron G Duncan, University of Arizona

PhD Student, DNP & MSN Alumni

Kate G Sheppard, University of Arizona, College of Nursing

Clinical Associate Professor
PMHNP Specialty Coordinator
Division of Community and Systems Health Sciences


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