The State of Advanced Practice Registered Nursing in Alabama

Abstract

Scope of practice for advanced practice registered nurses (APRNs) varies according to U.S. jurisdiction licensure requirements. Nineteen U.S. jurisdictions currently allow independent practice in all four APRN roles: certified nurse midwife (CNM), certified nurse practitioner (CNP), certified registered nurse anesthetist (CRNA), and clinical nurse specialist (CNS). Twenty-six U.S. jurisdictions allow full practice authority for CNPs. APRNs practicing in the remaining U.S. jurisdictions have varying practice restrictions, which are dictated by their state licensure laws. Alabama’s scope and standards of practice restrict all APRN roles. During the initial months of the COVID-19 pandemic, Alabama was one of many U.S. jurisdictions that implemented emergency waivers, thereby expanding the scope of APRN practice and granting increased autonomy to APRNs while caring for more complex patients. Once the pandemic threat lessened, many U.S. jurisdictions, including Alabama, returned to pre-pandemic restrictive scope of practice regulations. Through empirical evidence, we conducted a review of APRN practice before, during, and after the pandemic. The literature included anecdotal reports of safe delivery of healthcare provided by APRNs working under the emergency waivers. The literature revealed that APRNs are prepared to practice to the full extent of their scope of practice and provide high-quality healthcare services to improve access to care. Alabama and other U.S. jurisdictions where APRN practice is restricted should advocate for legislative changes supporting APRN full practice authority commensurate with their educational training and certification.