Last Updated 26 Jan 2021

Nurse Practitioner Scope of Practice in the United States

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Nurse Practitioners are registered nurses who are outstandingly recognized for providing primary care and treating acute and chronic illness and diseases. They acquired practiced skills and experience through advance education and medical training, and are authorized to serve as health and medical care resources and interdisciplinary consultants for diverse populations during health and illness. Nurse Practitioners may be generalists, like family nurse practitioners, or specialists whose areas of expertise include pediatrics, geriatrics, and psychiatry.

Nurse Practitioners render a wide range of different types of preventive and clinical services as authorized by a state's Nurse Practice Act that vary from state-to-state in which some allow independent practice for nurse practitioners. In the United States, the state from which a nurse practitioner is practicing gives the nurse practitioner’s license being certified by the American Nurses Credentialing Center (ANCC). Since the profession is regulated by the state, the extended care-giving role played by Nurse Practitioners varies. Nurse practitioners in the community may be engaged in health maintenance organizations, home health care agencies, public health departments, school or college clinics, and physician’s offices, to mention a few.

With increasing demand for primary care services to underserved groups and communities, nurse practitioners are successfully qualified for rendering such service, being fully equipped with appropriate knowledge and training. Standards for practice developed by the American Academy of Nurse Practitioners (1993) provide the specific activities that a nurse practitioner can perform and govern the services granted.

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In general, regardless of specialty, the scope of services practiced by nurse practitioners is divided into three categories. The first category covers the assessment of health status. This includes activities such as obtaining medical and health record of an individual, performing nursing assessments, and conducting physical examination on patients. Nurse practitioners also perform preventive screening procedures based on the patient’s age and history. Such screening includes those for hearing, sight, and cancer. Identification of medical health risks and requirements is also under the scope of practice of this profession.

The second category is the application of suitable diagnosis based on previous examinations and clinical findings. They execute and interpret diagnostic studies such as routine laboratory tests, EKGs and X-rays. Diagnosing, treating, evaluating, and managing minor and common and acute and stable illness and diseases such as injuries, diabetes, and high blood pressure are being employed by nurse practitioners. Also, with proper training or with supervision, they are also allowed to perform minor surgeries and procedures and may be First Assistants in the OR.

Central to the care provided by nurse practitioners are the conditions of the patients and the further effect of illness on the lives of the patients and the patients’ relatives. Thus, supportive counseling and educating patients regarding their health behaviors stressing out health promotion and citing preventive measures on illness and diseases are also under the practice of nurse practitioners. Providing prenatal care, conducting well-child screenings and immunizations, prescribing rehabilitation treatments and medications, though limited in some states, are also being practiced. All of these fall under the third category and can be summarized as the management of the case.

This further identifies the needs of individual, family or community the assessment and interpretation of data collected.  Evaluation and execution of plan of care are also being stressed in the practice of such profession. Nurse practitioners also establish collaborative working relationship with physicians to provide comprehensive care and refer patients to other health professionals as needed to meet the appropriate health and medical goals.

Nurse practitioners with specialization may include other specific activities in their scope of practice in line with their acquired specialty to further serve the target population. For pedriatric nurse practitioner, for instance, one may include the analysis of factors that may affect the child’s growth and development. Studies relating to abnormal and normal development in relation to anatomical, physiological, motor, cognitive, and social behavior of the child may be included in his scope of practice. Women’s health care nurse practitioner may perform fertility counseling and infertility management and may also give prescription and management of birth control pills and diaphragms or provide family planning services.

To further improve the scope of practice, there are nurse practitioners that take advance training for certain clinical procedures. These procedures which can be accomplished by nurse practitioners with effective training which depends on previous experience and practice limitations of individual state Nurse Practice Acts.

The continuing progress to cope with changing health care needs of the society is the responsibility of the nurse practitioners. They unite the role of being a care resource person, counselor and educator, researcher and administrator especially in the field of primary health care. Members of such profession are liable for the expansion and improvement of the practice of such profession and this can be achieved through involvement and active participation in professional health care organizations and their activities as they ensure that the standards on the scope of practice for nurse practitioners are maintained.


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