Early implementation of full-practice authority: A survey of Massachusetts nurse practitioners : Journal of the American Association of Nurse Practitioners

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Early implementation of full-practice authority: A survey of Massachusetts nurse practitioners

O'Reilly-Jacob, Monica PhD, FNP-BC (Assistant Professor)1; Zwilling, Jana PhD, FNP-C (Clinical Assistant Professor)2; Perloff, Jennifer PhD (Senior Scientist)3; Freeman, Patricia BSN(c) (Undergraduate Nursing Student)1; Brown, Emily RN, MSN(c) (Graduate Nursing Student)1; Donelan, Karen ScD, EdM (Stuart H. Altman Professor and Chair in U.S. Health Policy)3

Author Information

1Boston College, William F. Connell School of Nursing, Chestnut Hill, Massachusetts,

2College of Nursing and Professional Disciplines, University of North Dakota, Grand Forks, North Dakota,

3Schneider Institutes for Health Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts

Correspondence: Monica O'Reilly-Jacob, RN, PhD, FNP-BC, Boston College, William F. Connell School of Nursing, 140 Commonwealth Avenue, Chestnut Hill, MA 02467. Tel: 802-999-6235; E-mail: [email protected]

Competing interests: The authors report no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jaanp.com).

Authors' contributions: M. O'Reilly-Jacob, conceptualized the project, conducted all of the analysis, revised, and prepared the final manuscript draft for submission. J. Perloff conceptualized the project, developed the survey tool, and assisted with data interpretation. J. Zwilling helped develop the survey tool, assisted with data interpretation, and reviewed early drafts. P. Freeman drafted the initial literature review and assisted with data interpretation. E. Brown assisted with data entry, analysis, and interpretation. K. Donelan developed the survey tool and assisted with data interpretation. All authors contributed toward writing and editing the manuscript.

Journal of the American Association of Nurse Practitioners 35(4):p 235-241, April 2023. | DOI: 10.1097/JXX.0000000000000853

Abstract

Background: 

In January 2021, Massachusetts granted nurse practitioners (NPs) full-practice authority (FPA). Little is known about how FPA changes the day-to-day work of NPs.

Purpose: 

To examine changes in practice barriers and care delivery in the early stages of FPA.

Methodology: 

Descriptive analysis of a web-based survey of clinically active NPs in Massachusetts from October to December 2021, using Fisher exact tests to examine the associations between the perception that FPA improved work and other variables.

Results: 

Survey response rate was 50.3% (N = 147). Overall, 79% of NPs believe that clinical work is unchanged by FPA. Practicing outside institutions is a significant predictor of FPA improving work (p < .05). Larger proportions of respondents feel that efficiency (22%), patient centeredness (20%), and timeliness (20%) are improved by FPA compared with effectiveness (16%), equity (14%), and safety (10%). Almost half of those reporting that FPA improves overall care also report improved efficiency (50%, p < .0001), but only 22% report improved safety (p < .05). Of those believing that FPA improved work, a minority no longer need physician review of new controlled substance prescriptions (29%, p < .01), a practice agreement (32%, p < .05), or physician signature on clinical documentation (22%, p < .05).

Conclusions: 

Almost 1 year after FPA was passed in Massachusetts, the large majority of NPs report no changes in their day-to-day work, suggesting that FPA implementation is slow.

Implications: 

Concerted efforts by regulators, employers, and individual NPs are needed to ensure that legislated FPA is effectively implemented inside organizations and among payers.

© 2023 American Association of Nurse Practitioners

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