Full-Practice Authority for Nurse Practitioners: A Mental Health and Access to Care Issue
Introduction
Nurse practitioners (NPs) are highly educated, clinically trained, and board-certified professionals who deliver high-quality, evidence-based care to millions of Americans. Despite their proven effectiveness, many states in the U.S. still restrict NPs from practicing independently, requiring physician oversight or collaboration to provide basic healthcare services, even when they hold a Doctor of Nursing Practice (DNP) degree.
This isn’t just a policy issue, it’s a mental health crisis within the profession of nursing and a barrier to equitable, accessible care for patients nationwide.
In this blog post, we’ll explore:
What full-practice authority (FPA) means
The emotional toll of restricted practice on nurse practitioners
Real-world examples and statistics
How these barriers affect patient access
Why full-practice authority is vital for the future of healthcare
1. What Is Full-Practice Authority?
Full-practice authority (FPA) allows nurse practitioners to:
Evaluate patients
Diagnose conditions
Interpret diagnostic tests
Initiate and manage treatment plans
Prescribe medications
Without physician supervision, as long as they work within their scope of education and training.
As of early 2025, 27 states and the District of Columbia have granted full-practice authority to nurse practitioners. In the remaining states, NPs are required to have a collaborative or supervisory agreement with a physician, which can:
Limit where they can work
Reduce their autonomy
Affect their compensation
Delay patient care
2. Real-World Examples of Restrictive Practice and Its Impact
Case 1: Texas - A Rural Health Crisis
In Texas, NPs must operate under restrictive collaborative agreements. In many rural communities, there are no physicians available to sign these agreements. As a result, nurse practitioners, who are willing and able to serve, cannot legally open clinics or provide care in these underserved regions.
➡ Result: Entire counties go without primary care providers, and NPs experience burnout, frustration, and helplessness due to bureaucratic red tape.
Case 2: Georgia - Financial and Professional Strain
A Georgia-based DNP reported spending over $10,000 a year in fees to maintain a collaborative agreement with a physician, just to continue practicing.
➡ Result: Professional gatekeeping leads to moral injury and chronic stress, with NPs feeling that their education and experience are undervalued.
3. Statistics Speak: The Consequences Are Real
According to the American Association of Nurse Practitioners (AANP), over 355,000 licensed NPs are practicing in the U.S., with nearly 90% prepared in primary care, yet in restricted states, they are often unable to practice to the full extent of their training.
A 2022 study in Nursing Outlook found that NPs in restricted-practice states reported significantly higher levels of job dissatisfaction, burnout, and mental health symptoms, including depression and anxiety.
A 2023 Medscape survey revealed that 41% of nurse practitioners in reduced-practice states have considered leaving the profession or moving to a full-practice state to regain autonomy.
Meanwhile, the U.S. Health Resources and Services Administration (HRSA) projects a shortage of over 100,000 primary care providers by 2030, a gap nurse practitioners are trained to fill, if only regulations would allow.
4. The Psychological Toll of Being Held Hostage by Another Profession
Nurse practitioners are part of the discipline of nursing, not medicine. Yet, in states with restricted practice, nursing remains subjugated to medicine through mandatory supervision or collaboration agreements, even when the NP has more experience or education than the supervising physician.
This ongoing dependency:
Sends the message that nursing is a lesser profession
Causes moral injury: the violation of a healthcare provider’s core values and professional identity
Fuels imposter syndrome, particularly among doctoral-prepared NPs
Leads to burnout, anxiety, and resentment
Many NPs report feeling like “second-class clinicians” despite their advanced education, which erodes their mental well-being and undermines interprofessional collaboration.
5. How Restricted Practice Hurts Patients, Too
Beyond the personal impact on providers, these outdated regulations:
Delay access to care, particularly in rural and underserved communities
Increase healthcare costs by forcing unnecessary referrals
Worsen health disparities for marginalized populations
Exacerbate the primary care shortage, especially post-COVID
According to the National Academy of Medicine, lifting these restrictions improves healthcare quality and efficiency, without compromising patient safety.
6. The Path Forward: Full-Practice Authority Is the Solution
Granting full-practice authority to nurse practitioners will:
Reduce provider burnout and improve mental health
Empower NPs to fully use their skills and education
Expand access to care in high-need areas
Foster mutual respect among healthcare disciplines
Reinforce the autonomy and integrity of the nursing profession
Organizations like the AANP, National Council of State Boards of Nursing (NCSBN), and American Nurses Association (ANA) continue to advocate for legislation that recognizes the full scope and value of nurse practitioners.
Conclusion: Full Practice, Full Potential
When nurse practitioners are allowed to practice independently, they thrive, and so do their patients. But when arbitrary restrictions force them to operate under unnecessary supervision, the consequences are real: emotional exhaustion, professional invalidation, and lost access to care for the communities who need them most.
Healthcare needs to evolve, by recognizing that full-practice authority isn’t just a workforce issue. It’s a mental health, equity, and access issue too.
If you or someone you know is a working professional struggling with their mental health, Desert Willow Behavioral Health is here to help! Schedule your free consultation today!
