The statutory regulation of APRN practice is determined by state rather than federal legislation (Wilken, 1993). As a result, regulations that govern the scope of practice for APRNs vary dramatically from state to state. This variance, compounded by state regulatory influence on policies, promotes inconsistencies in scope of practice from state to state. On the other hand, physician scope of practice is consistent across the United States.
As a result of legislative and administrative rule-making, many barriers are implemented which limit access to healthcare. Regulations surrounding healthcare can serve as barriers that increase the cost and time associated with healthcare delivery (Conover, 2004). Legislators have an important role in developing laws to protect society. Excessive regulations are harmful to society and may restrict free trade and consumer rights. In the sentinel Institute of Medicine (IOM) Future of Nursing report, legislators are encouraged to examine their statutes and reduce barriers to APRN practice. In states where there are excessive barriers to practice, the report recommends that the Federal Trade Commission (FTC) engage in the process of identifying and eliminating barriers to care delivered by APRNs (Institute of Medicine, 2010).
APRNs have practiced in Missouri since 1985 when legislation passed providing statutory authority to provide care to patients. The legislation required APRNs to have a Collaborative Practice agreement with a physician and addressed restrictions in three areas: mileage, number of APRNs in agreement with one physician (6 APRNs to 1 physician) and chart reviews. The Missouri collaborative practice restrictions, now 23 years old, are no longer needed and are contributing to reduced access and lower healthcare outcomes in Missouri. A 2014 study of the levels of barriers to APRN practice in the United States revealed that states considered as “Restricted Practice” or “Reduced Practice” had decreased access to care and lower healthcare outcomes (Oliver, Pennington, Revelle, & Rantz). Missouri is a “Restricted Practice” state due to the current Collaborative Practice rules, while 26 states allow APRNs to practice without restrictions or required collaborative practice rules.