APRN SOP Information

Advanced Practice Registered Nurses

Advanced Practice Registered Nurses (APRNs) are a growing group of registered nurses who are educated, certified, and licensed to provide advanced nursing care to their respective patient population. They work in collaboration with all health care team members to provide high quality care and improve health outcomes. There are four types of APRNs each with a unique specialty, skills, and scope of practice. APRNs include certified nurse practitioners, certified nurse midwifes, certified registered nurse anesthetists, and clinical nurse specialists.

Certified nurse practitioners maybe educated, certified, and licensed in one or more of the following specialties.

APRNs across the country are lobbying for the ability to practice to the full extent of their education. Over half of the states in the United States provide APRNs with the legal authority to practice to the full extent of their education, governed by their respective Board of Nursing. This movement has triggered many organizations to support APRNs’ initiatives and some opposition as well. Opposition to APRNs efforts to gain the ability to practice to the full extent of their education is often seen from physician organizations who provide misleading and false information. They often use the word “scope creep” which is clearly a misnomer as practicing to the full extent of one’s education does not permit one to expand their scope of practice. This is an example of how APRNs scope of practice is not well understood and why this site is dedicated to helping individuals and organizations to understand APRN scope of practice with an emphasis on certified nurse practitioners.

Consensus Model for APRN Regulation 2008

In 2008 the Advanced Practice Nursing Consensus Work Group and the National Council of State Boards of Nursing (NCSBN) APRN Advisory Committee published the Consensus Model for APRN Regulation. This regulatory model was deemed necessary to provide consistency in education, certification, and licensure. Prior to this publication there was no uniform model for regulating APRNs across state lines. Each state’s licensing board determined the legal scope of practice for each APRN, the roles in which an APRN could be licensed, the criteria for entry level APRN practice, and which APRN certifications they would accept. This lack of consistency among states made it difficult for APRNs to get licensed across state lines and decreased access to care.
The consensus model provided consistency in APRN education, certification, licensure and defines the core principles that form the foundation APRN scope of practice.

Consensus Model for APRN Regulation 2008 and APRN Scope of Practice

Two key items were written into the consensus model which sets the foundation for APRN scope of practice.
1. APRNs education, certification, and licensure must all be congruent with the population focus.
2. Scope of practice is defined by the patient’s needs NOT their physical location.

APRN Education, Certification and Licensure as the Foundation for APRN/Nurse Practitioner Scope of Practice

APRNs are educated in a particular patient population. Upon graduation their education is validated by completing a board certification examination that aligns with their educational population focus. Board certification is required for state licensure. State licensure provides the legal authority for the APRN to practice. Congruency in these three areas is required as part of the Consensus Model for APRN Regulation.
For instance, a Family Nurse Practitioner (FNP), is educated to provide primary care to families across their lifespan. Their education includes the evaluation, diagnosis and management of patients experiencing stable acute and chronic health conditions. Since the basis of their education is primary care, they are only eligible to sit for the family nurse practitioner board certification. This examination is specifically geared towards validating their competency as it applies to their specific education. A graduate of a Family Nurse Practitioner program is not eligible to sit for board certification in any other specialty. Once a graduate is board certified as a Family Nurse Practitioner they are then licensed as a Family Nurse Practitioner in their respective state.
Education, certification, and licensure form the foundation for every APRN’s scope of practice. In the above example the FNP must practice with their scope of practice as defined by their education, certification, and licensure. They are held accountable for working within their scope of practice by their state’s licensing board. Should the FNP decide they want to expand their scope of practice, they may only legally do so by enrolling and graduating from another APRN program, one that is aligned with the type of work they would like to perform. They must pass the respective board certification (aligned with the new education) and be licensed by their respective state licensing board in the new APRN role.

National Nursing Policy and Nurse Practitioner Scope of Practice

National Nursing Organizations define the professional scope of practice for each certified nurse practitioner specialty. These definitions provide the guiding principles of scope of practice as it applies to a particular nurse practitioner population specialty. Understanding these definitions and principles are essential to understanding nurse practitioner scope of practice. They provide the boundaries in which nurse practitioners must practice.

Nurse Practitioner Population Scope of Practice Definitions

1. Primary care nurse practitioners include family nurse practitioners, adult gerontology nurse practitioners and the primary care pediatric nurse practitioners. In November 2021 the National Organization of Nurse Practitioner Faculties published the position paper, Statement on Acute care and Primary Care Nurse Practitioner Practice. In this document they provide a definition for primary care “The main emphasis of primary care NP educational preparation is on comprehensive, continuous care delivery characterized by a long-term relationship between the patient and primary care NP for health maintenance and stable acute and chronic conditions.”
2. Acute care nurse practitioners include adult gerontology acute care nurse practitioners, and acute care pediatric nurse practitioners. The American Association of Critical Care Nurses maintains the professional definition for the acute care nurse practitioner scope of practice. In 2021, AACN published, Scope and Standards for Adult-Gerontology and Pediatric Acute Care Nurse Practitioners. Bedded within this document is the scope of practice definition for the acute care nurse practitioner, “The population focus for the ACNP is either pediatric, late adolescent, or adult-gerontology patients with acute, critical and/or complex chronic illness or injury who may be physiologically unstable, technologically dependent, and highly vulnerable for complications.”
3. Women’s Health Nurse Practitioners’ scope of practice is defined by the organization, Nurse Practitioners in Women’s Health. The 8th edition of Women’s Health Nurse Practitioner: Guidelines for Practice and Education (2020) provides the following scope of practice definition. “The WHNP is an APRN prepared at the master’s or doctoral level to provide holistic, client-centered primary care for women from puberty through the adult lifespan, with a focus on common and complex gynecologic, sexual, reproductive, menopause-transition, and post-menopause healthcare; uncomplicated and high risk antepartum and postpartum care; and sexual and reproductive healthcare for men.”
4. Psychiatric Mental Health Nurse Practitioners’ scope of practice is defined in the publication Psychiatric-Mental Health Nursing: Scope and Standards of Practice 3rd edition (2022) by the American Nurses Association, American Psychiatric Nurses Association, and the International Society of Psychiatric-Mental Health Nurses. “PMH-APRN practice focuses on the application of competencies, knowledge and experience to individuals, families or groups with complex psychiatric-mental health problems… PMH-APRNs care for individuals, families, groups from prebirth until death…Functions of the PMH-APRN include prescribing or recommending psychopharmacological agents; providing integrative therapy interventions, various forms of psychotherapy and community interventions, case management, consultation…”
5. Neonatal Nurse Practitioners’ scope of practice is defined by the American Nurses Association and National Association of Neonatal Nurses. The scope of practice definition is provided in the publication, Neonatal Nursing: Scopes and Standards of Practice 3rd edition (2021). “The Neonatal nurse practitioner (NNP) applies theory and advanced knowledge and clinical training to the management of a case-load of infants, in collaboration with the neonatologist. The NNP typically is responsible for medical and nursing management of acutely ill and convalescent infants…”
6. Pediatric Nurse Practitioners both acute and primary care have an additional scope of practice provided in the 2015 publication; Scope and Standards of Practice: Pediatric Nursing 2nd edition. This publication is a collaborative effort between the American Nurses Association, the National Association of Pediatric Nurses Practitioners, and the Society of Pediatric Nurses. “The PNP provides comprehensive health care to children from birth through young adulthood by assessment, diagnosis, management, and evaluation of care…PNPs provide a wide range of pediatric healthcare services in a variety of primary and specialty healthcare settings emphasizing health promotion, injury and disease prevention, and chronic illness management.”

Patient’s Needs as the Foundation for APRN/Nurse Practitioner Scope of Practice

The Consensus Model was first to clarify that APRN scope of practice is not dependent on the patient’s physical location but rather defined by the patient’s needs. To best determine if a patient’s needs fall into the scope of practice for a particular nurse practitioner, one must understand the above definitions and apply them to the patient scenario.
For example, an adult patient who is admitted to the intensive care unit, who is intubated, on vasopressors and being resuscitated with the massive blood transfusion protocol requires the expertise of the adult gerontology acute care nurse practitioner to care for their needs. The AGACNP is prepared in their education to care for these types of patients, whereas the nurse practitioner trained in primary care such as the FNP did not receive in their education the management of critically ill patients. The AGACNP scope of practice as defined by their education, certification, licensure, and the American Association of Critical Care Nurses is best aligned with caring for this patient’s needs.
Each APRN must practice within their education, certification, licensure, and professional scope of practice as defined by their governing national nursing organization. Each patient population has unique needs and APRNs are education, certified and licensed to align with their respective population specialty.

APRN and Nurse Practitioner Scope of Practice Overview Concepts

1. Scope of Practice is defined by one’s education, certification, and licensure.
2. APRN/Nurse Practitioner professional scope of practice are defined by their respective, governing national nursing organization.
3. An APRN or Nurse Practitioner may not expand their scope of practice beyond their education, certification, and licensure without returning to school to obtain a graduate level education, board certification and licensure in a population focus that aligns with the patient population needs for which they would like to provide care.
4. The registered nurse (RN) role and APRN scopes of practice are different. The RN experience and education does not impact the APRN Scope of Practice.
5. APRN scope of practice is based on the patient’s needs not their physical location.
6. Practicing to the full extent of the APRN’s education requires one to practice within their professional scope of practice and does not constitute “scope creep”.
7. On the job experience does not expand an APRN’s scope of practice.