Continuing the momentum of the last fourteen years, the fifteenth annual legislative update illustrates The Nurse Practitioner journal's commitment to provide the most recent state-by-state information regarding the legislative issues that affect advanced practice nurses (APNs)-nurse practitioners, clinical nurse specialists, nurse midwives, and nurse anesthetists. Compiled each year with assistance from more than 100 state Boards of Nursing and nursing associations and NP organization executives, directors, and officials, this update continues to be a broadly cited and utilized reference for APNs throughout the nation. Nursing leaders, colleagues in the health care profession, state and national legislators, and the print and TV media continue to depend on the "annual update" for the legal trends in APN practice.
The following report reflects the latest state-by-state regulatory and statute updates for APN practice. "Summary of APN Legislation: Legal Authority for Scope of Practice" presents a summary of APN legislation related to legal authority for scope of practice (with the exception of prescriptive authority). "Summary of APN Legislation: Prescriptive Authority" overviews APN prescriptive and dispensing authority. And "Summary of APN Population" presents the number of recognized APNs in each state, compiled from information given by each state's Board of Nursing. The numbers illustrate how the APN profession is growing, including an increase of 11,534 (12%) nurse practitioners in 2002. This growth remains consistent with the prediction that by 2005 there will be approximately as many NPs as family physicians in the United States. 1
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This Year's Findings
Throughout the past fifteen years, The Nurse Practitioner journal has documented the legislative success of APNs. During the past year, APNs have continued their march toward a complete and fully autonomous practice. Nine states expanded their legal authority in some way (for example, APNs are now allowed to sign for athletic forms, disability stickers, and home health aide and physical therapy referrals within the state). One of the nine proved to be a major victory for NPs when PA passed a bill removing NPs from the jurisdiction of the Board of Medicine. It would not have passed without the grassroots efforts of CRNPs and nurses all across the state. Additionally, three states have expanded some aspect of APN reimbursement status (for example, recognition as primary care providers on insurance panels). Compared with last year, three states expanded some aspect of APN prescriptive authority (for example, ability to prescribe controlled substances).
Countless studies have demonstrated that APNs provide safe, cost-effective, patient-popular health care. Nonetheless, barriers still remain-preventing APNs from providing the full scope of care that they are qualified to deliver and that our nation desperately needs. The remaining roadblocks to full practice autonomy continue, primarily because of the resistance of organized physician groups to relinquish control over the health care dollar. This sad reality reinforces the need for all APNs to continue the struggle. Look for a report on our efforts in 2003 in the sixteenth annual update.
ACKNOWLEDGMENT
I would like to specifically thank the countless experts (from every state) for their time, invaluable information, and perspective, including the executive directors and legislative consultants from the state Boards of Nursing and state nursing associations and chairpersons from nurse practitioner special interest groups and associations. Every attempt has been made to present the most current information possible; however, feedback is welcome and any validated corrections or updates will be printed in a future issue.
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