Kansas’ approximately 3 million residents will soon have direct access to primary care from advanced practice registered nurses.

The Sunflower State on April 15 became the 26^th state – and the second state within a month – to adopt full practice authority, meaning all APRNs can practice to the full extent of their education and training. New York did the same April 9.

Kansas’ change means that more than half of the states, plus the District of Columbia, now give their combined 94* million residents direct access to nurse care.

“Kansas, like so many other states, is experiencing a health care shortage – especially in rural parts of the state,” Kansas Gov. Laura Kelly said in signing the bill. “This will improve the availability of high-quality health care by empowering APRNs to reduce local and regional care gaps.”

AARP supports the Center to Champion Nursing in America (CCNA) in its work to advocate for changes that would allow nurses to practice to the full extent of their education and training. CCNA is an initiative of AARP Foundation, AARP and the Robert Wood Johnson Foundation.

CCNA runs the Future of Nursing: Campaign for Action, also an initiative of AARP Foundation, AARP and RWJF with a vision that everyone in America can live a healthier life, supported by nurses as essential partners in providing care and promoting health equity and well-being.

AARP Kansas State Director Glenda DuBoise noted that Kansas ranks 40^th in the nation for number of physicians per 100,000 people. “Giving APRN’s full authority to provide health care is a big win for our state,” DuBoise said. “Nurse practitioners will be able to help fill the gap, providing quality health care for patients where they live, especially in rural areas of Kansas.”

The legislation eliminates outdate requirements for most advanced practice registered nurses to hold a state-mandated contract with a physician to practice.

The new law also requires nurse practitioners, clinical nurse specialists and certified nurse midwives to have national certification and be covered by malpractice insurance. The new law does not require a transition to practice, which means Kansas is the first state to pass a thorough full practice authority law since North Dakota’s 2010 statute.

Since the Campaign for Action began in 2010, 13 states have increased consumers’ access to care by removing legal barriers that prevented nurse practitioners from providing care to the full extent of their education and training. That’s in addition to the 26 states and the District of Columbia that allow nurse practitioners to provide full care.

*Source: Annual Estimates of the Resident Population for the United States, Regions, States, District of Columbia, and Puerto Rico: April 1, 2020 to July 1, 2021 (NST-EST2021-POP), U.S. Census Bureau, Population Division.

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In order to prescribe drugs, advanced practice registered nurses (APRNs) in Kansas and Ohio must first enter into a contract with a physician. That could change, and the Federal Trade Commission (FTC) is hoping it does.

The agency issued letters earlier this month telling lawmakers in Kansas and Ohio that the FTC supports bills before their legislatures that would modernize APRN scope of practice, allowing the clinicians to practice to the top of their education and training. The Kansas bill, H.B. 2412, would remove the need for APRNs to have a contract with a physician in order to prescribe drugs. The Ohio bill, H.B. 177, would do the same. Why does the FTC care?

The agency argues that requiring physicians to supervise APRNs raises competition concerns because it “effectively give[s] one group of health care professionals the ability to restrict access to the market by another, competing group of health care professionals.” In a 2014 policy paper, the FTC urged policymakers to view “competition and consumer safety as complementary objectives,” and it concluded that removing barriers to APRN practice is “good for competition and American consumers.”

In its recent letters, the agency said its support for the state bills also rests on a body of evidence: research indicating that APRNs provide safe and effective care and have prescribing patterns comparable to those of physicians. “APRNs should be able to evaluate patients and prescribe medications as needed, as long as they do so within the limits of their education and training,” the Ohio letter stated.

“Modernizing public policies related to APRN practice would help improve consumers’ access to care and provide support for family caregivers,” says Winifred Quinn, director of Advocacy and Consumer Affairs at the Center to Champion Nursing in America, an initiative of AARP Foundation, AARP and the Robert Wood Johnson Foundation. “The FTC letters help advance that effort and provide further evidence that APRNs provide high-quality care.”

Twenty-two states and the District of Columbia currently permit fully independent prescribing by APRNs. States considering changes to their APRN practice laws and regulations may want to seek advice from the FTC. As part of the agency’s competition advocacy program, the Commission and its staff often respond to requests, from state legislators and regulators, to identify and analyze specific restrictions that may harm competition without offering countervailing consumer benefits. Action Coalitions seeking input on the likely competitive effects of a bill or a proposed regulation should have the legislation sponsor or state agency  contact Bilal Sayyed, Director, Federal Trade Commission Office of Policy Planning, at bsayyed@ftc.gov.

Want to learn more?

Read about removing barriers to practice and care.

Read the FTC’s letters to lawmakers in Kansas and Ohio.

Read the agency’s 2014 policy paper Competition and the Regulation of Advanced Practice Nurses.

Read a Charting Nursing’s Future policy brief that explains The Case for Removing Barriers to APRN Practice.

Access Campaign for Action resources on Improving Access to Care.

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Problem Statement: Public health systems, like many other systems, function in silos. With dwindling resources and increased demands to address public health concerns, it is important now more than ever to collaborate on addressing issues and improve coordination of these services– leveraging national, regional, state, and local infrastructures. The Midwestern Public Health Training Center (MPHTC) and two RWJF PHN Leaders coordinated an inaugural Region VII summit on diabetes, a condition that has reached epidemic proportions and disproportionately affects minority populations.

Approach: Partnering with the Region VII Midwestern Public Health Training Center, two surveys were developed to assess diabetes prevention and control needs in Missouri, Iowa, Nebraska, and Kansas. The surveys identified current gaps and barriers in offering diabetes prevention program (DPP) services and diabetes self-management education (DSME) services for patients within the health care setting.  In addition, the surveys identified gaps and barriers within current or potential diabetes prevention providers and generated a better understanding of the existing DPP infrastructure within each of the states. Information gained from the surveys framed discussion at the Region VII Diabetes Summit where health care and public health professionals were invited to address diabetes prevention and control efforts in their respective states.

Products/Outcome: Planning teams from multidisciplinary agencies formed within the four states. Representation included professionals from the MPHTC, state and local public health, American Diabetes Association, Y.M.C.A, the Association of Public Health Nurses, nonprofit healthcare organizations and academic staff from the University of Iowa and the University of Nebraska. Data obtained through this project has been instrumental in formulating continued strategies in addressing diabetes prevention and control within the region, states, and locally.

Implications: Diabetes rates in the United States are approaching epidemic proportions. It is estimated that more than 100 million people living in the US are living with diabetes or prediabetes. The increasing financial, physical, emotional and social impact trend this disease has taken is unsustainable. Continued synergy amongst multidisciplinary health care teams such as the ones formed through this project is vital for addressing future diabetes control and prevention efforts.

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• Distribution of population by race/ethnicity
• Percentage of population living in rural versus urban areas
• Distribution of population by federal poverty level
• Areas in which there is a shortage of primary health professionals

These statistics can guide your Action Coalition’s work in shaping a nursing workforce to better meet local needs and overcoming health disparities in your state. As you integrate other Culture of Health aspects into your work, consider how demographics play a role in health equity and fostering cross-sector collaboration.

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Leadership and Mentorship Survey Report
Leadership and Mentorship Survey Executive Summary

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