SBerno - APRN Scope of Practice Discussion Podcast

The podcast discusses the importance of removing practice barriers for advanced practice registered nurses (APRNs) to improve access to healthcare. It highlights how APRNs, with specialized training and experience, face varying regulations across states, impacting their scope of practice. States with full practice authority for APRNs show improved access, health outcomes, and lower costs. Restrictions on APRNs lead to worse health outcomes, especially in underserved areas like rural Mississippi. Removing barriers for APRNs can enhance equity, reduce costs, and improve patient experience without requiring significant resources. This policy change is crucial in addressing healthcare challenges effectively. Welcome back to the podcast, where we break down healthcare issues without the boring stuff. Today, we're talking about something that sounds technical, but secretly affects your ability to get an appointment with a medical provider, and even the price you pay for care. We're talking about removing practice barriers for advanced practice registered nurses or APRNs. And trust me, once you understand what they do, you're going to wonder why we haven't fixed this already. Before we get into the discussion of APRNs, though, and their scope of practice, let me tell you a recent story out of East Texas. Picture long stretches of pine trees and farmland, not much out there, including no hospital, no urgent care, not even a doctor's office for miles. This is Coveyville, Texas. And for years, people living there just went without care because they had nowhere to go. But on a Tuesday morning, something unusual rolled into town. A big white mobile clinic bus. Inside that bus, a nurse practitioner sets up for the day. This bus had become the town's primary care home. One of the patients in the article, a woman named Shelly, climbs aboard because she's been struggling with a thyroid problem. She's uninsured. A regular clinic visit would have cost her almost $80, money she simply doesn't have. But here, she pays only $25. Only that. $25 for real medical care from someone who listens, examines her, and helps her get her medications back on track. And that's the thing the article highlights. In rural East Texas, nearly a third of counties don't even have a hospital. People aren't choosing between one thing or another. They're choosing between a mobile clinic or nothing at all. And in this case, it's an APRN stepping up to provide that lifeline. Now let's step back a bit and ask the question, what exactly is an APRN? In short, APRNs are advanced practice nurses with master's or doctoral degrees, specialized training, and years of clinical experience. Here's something most people don't realize. What an APRN is allowed to do depends almost entirely on which set of state borders they're standing on. Same training, same degree, same certification, but across the state line and the rules change. There are three different types of regulation standards that states use to determine the scope of practice for licensed APRNs in their state. One, full practice authority, two, reduced practice authority, or three, restricted practice authority. In some states, APRNs have what's called full practice authority. That means they can evaluate patients, diagnose conditions, order tests, and prescribe medications using their own license. No required sign-off from a physician who may be hours away. Then we have reduced practice states, and this is where APRNs can do most of their job with strings attached. Maybe they can prescribe, but they need a doctor's chart review. Maybe they can diagnose, but only because of a collaborative agreement. Imagine being able to drive anywhere you want, but only if someone else is willing to sit in the passenger seat and oversee you. And finally, there are restricted practice states. These states require direct and ongoing physician's provision for some of the most basic elements of APRN practice. An APRN may know exactly what treatment a patient needs, but the law forces them to wait for a physician's approval. This is a situation in many parts of the South where physician shortages are severe and APRNs are ready to step in, but the law won't let them. So when we talk about practice barriers, it's not just a policy discussion within a death theorem. It determines whether a rural APRN can open a practice, whether a patient can get their child seen quickly, and whether chronic diseases get managed before they land someone in the ER. Several critics oppose the expansion of APRNs autonomy. For one, physicians have long opposed the expansion of APRNs scope of practice due to the fact that under a fee-for-service schedule, physicians and independent nurse practitioners are competitors. Additionally, many physician and physician groups feel as though APRNs are not qualified or trained enough to care for patients without physician's oversight. By contrast, those who support the expansion of APRN authority argue that the available research does not support these claims. For example, there was a 2018 literature review that concluded nurse practitioners provide care of equivalent quality to physicians at a lower cost while receiving comparable or higher patient satisfaction marks. Other studies have reached similar conclusions, finding that nurses also serve as better patient advocates due to their previous nursing education experience. As we just discussed, an important aspect of a healthy population is access to care, defined as a patient's ability to obtain the care they require. Many U.S. states have areas considered to be medical deserts, where access to physicians is very limited or almost nonexistent. Recent studies on the impact of APRNs on the ongoing physician shortage have found that states with full practice authority are associated with improved primary care access and health outcomes, along with higher patient satisfaction rates, quality of care, and childhood immunization rates. Now let's explore a state that has taken a different approach in handling the provider shortage and APRN scope of practice legislation. For example, we're traveling to the state of Mississippi, a state with some of the worst health outcomes in the nation. Here, several rural counties have zero primary care doctors, zero. But guess who is there currently and ready to help alleviate these disparities? APRN professionals. Unfortunately, Mississippi currently has restrictive laws that mean these APRNs can't fully practice unless they have a physician agreement. The result is worse health outcomes for the people of the state, specifically for their most vulnerable population groups. Improving practice barriers isn't just about convenience, it's about equity, it's about making sure your zip code doesn't determine your health. Now let's look at the expansion of APRN authority from an economic angle. In short, there are the costs associated with keeping APRN restrictions. Some of these costs are states with a restricted practice environment require a career-long practice agreement with a cost in the thousands of dollars. These additional costs play a role in increasing the overall cost of health care system and the cost that patients pay when accessing care. For low-income populations, the increased economic burden can result in these individuals not seeking out care initially and later having to present to the emergency room once an issue has gotten worse. By contrast, states with expanded practice authority have reduced their overall health care costs, including the amount of money spent by Medicaid and Medicare. As such, lifting the scope of practice restrictions has both positive medical and economic benefits for the patients of a given state. Now let's bring this conversation to APRN's home. Removing practice barriers for APRNs is part of the solution. This isn't a small policy tweak. It's one of the most effective, low-cost ways to, one, expand access, two, reduce health disparities, three, health care costs, and four, improve patient experience. It doesn't require training new doctors, building new hospitals, or passing expensive legislation. It simply requires letting highly trained professionals do their jobs they were educated to do. While lifting these barriers won't fix every problem in our health care system, it's one of the smartest, most cost-effective ways we can take right now. Thanks for joining me today, and join me next time as we explore another issue shaping the future of health care. This podcast episode was recorded by Sean Burnham on the Audacity platform using my own natural voice on November 17th, 2025.