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When patients come to MD Anderson Cancer Center in Houston for care, “they come here for our reputation,” said Vivian Crowder, APRN, FNP-C, AOCNP, Anderson’s manager of Advanced Practice Providers, Endocrine Neoplasia and Hormonal Disorders. “They’re coming here because they trust every single individual the moment they walk through the door.” Patients aren’t looking at credentials, she said. “They are looking for trust, [asking] ‘Am I in good hands,’ and trusting you are going to take care of them.”
With rising healthcare costs, limited providers, particularly in rural areas, and clinician burnout, advanced practice registered nurses (APRNs) have taken on duties that used to be handled solely by physicians. Several nurse practitioner (NP) experts who spoke to Medscape Medical News believe this unfettered expanded scope benefits patients, improves population health, and helps shoulder the ongoing need for clinical care.
About Medscape Insights
Medscape continually surveys physicians and other medical professionals about key practice challenges and current issues, creating high-impact analyses. For example, the Medscape APRN Job Market Report 2025 found that:
- 4 in 10 APRNs surveyed checked out new jobs this past year.
- 74% of APRNs surveyed were approached by a recruiter.
- 30% of APRNs surveyed said specialty certifications create more job opportunities.
ARNP Regulations at a Glance
Rules that allow for this expanded scope without requiring physician collaboration vary by state. Currently in the US, 27 states plus the District of Columbia, Guam, and the Northern Mariana Islands give APRNs full practice authority when seeing patients.
This allows them to evaluate and diagnose patients, order and interpret diagnostic tests, prescribe medications, and perform other services without physician oversight or collaboration, according to the American Association of Nurse Practitioners. In another 12 states, American Samoa, Puerto Rico, and the Virgin Islands, APRNs have reduced practice authority; this requires physician collaboration for at least one aspect of care.
Restricted practice authority mandates career-long physician oversight for most elements of practice. This is currently the law in California, Texas, Oklahoma, Missouri, Tennessee, Michigan, Virginia, North Carolina, South Carolina, Georgia, and Florida. APRNs are also given full practice authority in all Veterans Affairs hospitals throughout the US, except for the authority to dispense controlled substances in some cases.
While the American Medical Association asserts that such care should be overseen solely by physicians and is against full practice authority for APRNs, many NPs believe that expanded scope helps improve all patients’ access to healthcare, particularly for preventive and ongoing care for chronic health conditions. Being seen by an NP with expanded scope abilities helps keep patients from seeking routine care in the emergency room (ER) — which helps lower costs and ensures the ER is used for true emergencies.
“There’s more than enough work to go around everywhere, in terms of the number of patients that are here in the United States who are waiting to see healthcare providers,” said Carolyn Dickens, PhD, MBA, APRN-FPA, associate dean for Faculty Practice and Partnerships, and clinical associate professor, Department of Biobehavioral Nursing Science at the University of Illinois Chicago.
With physician shortages, the need for patient care is great, agreed Ann Sheehan, DNP, CPNP, assistant dean for Practice, Innovation and Professional Education and associate professor in the Health Program, Michigan State University College of Nursing in East Lansing, Michigan. “There are about 27 million Americans that are uninsured, 9 million that can’t afford the cost of their health care even though they do have insurance, and 29 million who can’t afford their medication. And there are 120 million Americans that live in counties that have inadequate healthcare access — that’s about 80% of all counties across the United States,” she said.
“What are Americans going to do for healthcare if nurse practitioners can’t be part of this solution? It’s just so important that people have access to healthcare, just for population health and better outcomes.”
Research supports APRN’s expanded scope. One 2024 study about the full practice access in Maryland found that patients were less likely to report they were in fair or poor health and reported better mental health due to being able to be cared for fully by NPs. “Removing regulatory barriers that prevent certified nurse midwives and nurse practitioners from working to the full extent of their training may increase access to primary care and improve patient outcomes,” the study researchers concluded.
Collaboration Is Crucial
Whether APRNs work in states with full practice access or not, most healthcare settings thrive on collaborative practice rather than simply physicians overseeing the work of NPs. With her background in general cardiology, Dickens said there are opportunities for APRNs to consult with other colleagues, such as physicians, pharmacists, and other NPs for patients with more complex issues. “That’s just an expectation in professional collaboration: we’re all a team.” It would be unrealistic to expect that any one clinician would have all the answers for every cardiology patient, she added.
“Patients don’t report that they prefer to be seen initially by a physician instead of an APRN, either. Nurse practitioners can start ordering some things quickly and already have clinical decision-making capacity,” said Crowder. “They can then immediately contact the physician to ask if they have other recommendations for escalation in care.”
Similarly, Sheehan noted that NPs don’t want to replace physicians; APRNs, who have master’s or doctoral degrees, hundreds of hours of clinical training, and ongoing licensing and continuing education, offer a different way of providing patient care. They can provide timely access to healthcare and help manage and recognize disease states before they are too far along.
“We all have to work together,” Crowder said. “In my mind, it isn’t us vs them. It’s, ‘How are we going to get this work done?’”
Cheryl Alkon is a seasoned writer covering healthcare and medicine. She is the author of the book “Balancing Pregnancy with Pre-Existing Diabetes: Healthy Mom, Healthy Baby.” Find her at CherylAlkon.com.
