Ask a Professor: The Fight for Full Practice Authority by Pennsylvania’s NPs
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“One important shift has been increased administrative clarity and standardization around collaborative agreements.”
Susan Renz, PhD, DNP, Practice Professor and Primary Care Program Director, Penn Nursing
As the Baby Boomers retire, the nation is experiencing a primary care crisis. More patients need more services than ever before, and medical schools cannot graduate enough primary care physicians to meet the growing demand. Those who suffer the worst from the primary care crisis are seniors, veterans, and residents of rural areas. In Pennsylvania, the state’s 10,000-plus nurse practitioners (NPs), already a vital resource in providing healthcare services, could be part of the solution.
Approximately half a million Pennsylvanians live in areas that lack adequate access to primary care, while over half of all NPs are trained in primary care (KFF 2025). These NPs can also provide cost savings that are competitive with MD practice. Their services are desperately needed in Pennsylvania’s rural and underserved areas. Unfortunately, antiquated laws prevent Pennsylvania’s NPs from practicing to the full extent of their training and education.
Meet the Experts
Ann Lawrence O’Sullivan, PhD, FAAN, CRNP
Dr. Ann Lawrence O’Sullivan was the Dr. Hildegarde Reynolds Endowed Term Professor of Primary Care Nursing at the University of Pennsylvania School of Nursing, where she also served as the director of both the family nurse practitioner program and the pediatric nurse practitioner program.
A clinician educator since 1987, Dr. O’Sullivan worked for over a decade to develop policies that expanded full practice authority for advanced practice registered nurses. She is recognized as a leading proponent of the movement, and has written and lectured extensively on the need to remove scope of practice restrictions and increase professional collaborations between physicians and advanced practice registered nurses. In 2016, Dr. O’Sullivan served as chair of the Pennsylvania State Board of Nursing’s advanced practice registered nurses committee, which was monitoring full practice authority legislation introduced in the Pennsylvania House and Senate.
Dr. O’Sullivan was interviewed for this article in 2020, prior to her retirement.
Susan Renz, PhD, DNP, GNP-BC
Dr. Susan Renz is a practice professor and primary care program director at the University of Pennsylvania School of Nursing. Born at the Hospital of the University of Pennsylvania and raised by a Penn Nursing alumna, she’s a verified product of The Keystone State. Dr. Renz earned her BSN and MSN from the University of Pennsylvania, her DNP from New York University, and her PhD from the University of Arizona.
Dr. Renz’s research has included a study of how use of the Situation Background Assessment Recommendation—a structured assessment and communication protocol—improves communication between nurses and physicians, and reduces unplanned hospital transfers at a skilled nurse facility. In 2015, she received first-place awards for her research from the National Gerontological Nursing Association and the Eastern Nursing Research Society.
Dr. Renz was interviewed for an update to this article in 2026.
How NPs in Pennsylvania Can Alleviate Healthcare Service Shortages
“NPs are twice as likely as MDs to practice in rural areas,” Dr. O’Sullivan says. “They also provide a great deal of care to veterans, who often go unserved, much less underserved.”
But NPs in Pennsylvania aren’t able to help as much as they’d like. Pennsylvania is classified as a reduced practice state, according to the American Association of Nurse Practitioners (AANP), meaning that certain restrictions prevent NPs from delivering the full scope of services they are trained to provide. Those restrictions require NPs to secure business contracts, called collaborative agreements, with two physicians. That undercuts the reinforcement that NPs could offer and amounts to putting red tape in between NPs and the patients who desperately need their services.
“Years ago, an NP in Oil City lost her collaborating MD and had to close a practice of 3,000 visits a year,” Dr. O’Sullivan said. “After months of work, one was finally found, but her MD was retiring, and large health systems forbid such MD collaboration outside of the health system.”
Collaborative agreements add the burden of cost and logistics to NP practice, forcing NPs to seek approval for services that they’ve already been trained to provide themselves. This is putting undue stress on a health system that’s already significantly stretched.
The Promise of Expanded Practice Authority for Pennsylvania’s NPs
One solution is to establish full practice authority (FPA), also known as full scope of practice (FSP), for Pennsylvania’s nurse practitioners. Such a move would follow the lead of 27 other states and the District of Columbia in reducing barriers to NPs providing patients care. Pennsylvania has been pushing to ease the restrictions on its NPs for years.
“My work on full scope of practice started more than 40 years ago,” Dr. O’Sullivan said. “More recently, State Representative Jesse Topper sat on the PABON with me and truly heard the issues before he left the Board and became a State Representative.”
Several policy proposals have received vocal support from the Pennsylvania Coalition of Nurse Practitioners, the Hospital and Healthsystem Association of Pennsylvania, Geisinger Health System, Thomas Jefferson University Hospitals, the University of Pennsylvania Health System, the Lehigh Valley Health Network, and others.
Other predominantly rural states, such as Nevada, have retired their collaborative agreement requirements and, as a result, have seen a 20 percent increase in the number of NPs seeking licensure. Six years after Arizona retired its legal condition of physician involvement in NP practice, the state’s rural areas saw a 73 percent increase in NP practice. These are exactly the sort of results that Pennsylvania needs, and the state’s NPs are advocating heavily for the type of legislation that would help realize them.
“Our NP students and all Pennsylvania NPs are writing and talking to their representatives, especially those in the districts of a person on the House Professional Committee, to help us move the bill out of committee for a full vote,” Dr. O’Sullivan says.
NPs are expertly trained to provide team-based, patient-centered care. In practice, this means taking a holistic approach that looks at and listens to the whole patient. Pennsylvania’s legislators would be wise to view their state in the same fashion.
Update 2026: Incremental Change, Lasting Impact
Pennsylvania remains a reduced practice state. Sentiment among local NPs is mixed, but evolving. While Pennsylvania lags behind its neighbors, a growing sense of pragmatic momentum exists. In recent years, incremental changes have meaningfully impacted daily practice and workforce sustainability.
“One important shift has been increased administrative clarity and standardization around collaborative agreements,” Dr. Renz says. “While physician collaboration is still required, we’ve seen less variability and fewer arbitrary barriers in how those agreements are structured, particularly in large systems and rural settings. That may sound modest, but for new graduates entering practice, it has translated into faster onboarding and fewer care disruptions.”
An acceleration of the acceptance of telehealth and remote supervision models began with the Covid-19 pandemic, and has persisted even after the pandemic has receded and emergency conditions lapsed. NPs and patients both benefit: access to specialty collaboration allows NPs to practice more effectively, particularly in underserved areas.
While major policy changes remain elusive, cultural shifts are headed in the right direction. Comfort with NP-led medication management, especially for chronic disease, has increased among employers and interdisciplinary teams. And many systems within the state are pushing internally for policies that reduce friction for multi-state practice, even if the law fully hasn’t caught up yet.
“In practice, that cultural shift matters almost as much as statutory language,” Dr. Renz says.
But statutory language is still important, and NP organizations in Pennsylvania are taking a more disciplined and strategic advocacy approach.
“Rather than framing every effort as an all-or-nothing push for full practice authority, recent advocacy has focused on patient access, workforce shortages, and system capacity—language that resonates more strongly with legislators and the public,” Dr. Renz says. “There’s been a deliberate effort to align NP practice modernization with broader healthcare system needs, especially in primary care, behavioral health, and rural health.”
Those efforts are occurring at the grassroots levels, as more NPs meet directly with legislators, write op-eds, and participate in coalitions alongside hospitals, health systems, and community organizations. For Pennsylvania NPs, this type of advocacy is part of the job. In addition to teaching clinical competencies, Penn Nursing explicitly prepares its students to engage with advocacy efforts.
“Advocacy is no longer perceived as something that happens ‘elsewhere’,” Dr. Renz says. “It’s increasingly seen as part of professional responsibility.”
Pennsylvania is unlikely to switch to full practice authority overnight. However, as healthcare needs increasingly align with NP capabilities, the case for more progressive policy only becomes clearer. From Dr. Renz’s perspective, employers are less focused on statutory limits and more focused on outcomes, access, and retention. NP students are entering the profession with sharp clinical skills, policy awareness, and a commitment to serving communities that struggle to access care. Their impact on Pennsylvania will be substantial.
“I would describe the future of NP practice in Pennsylvania as both pragmatic and cautiously optimistic,” Dr. Renz says. “While the policy environment may move slowly, the practice environment is evolving more rapidly. And, over time, that disconnect becomes harder for lawmakers to ignore. In that sense, the future feels not just hopeful, but inevitable—grounding in the realities of patient need and healthcare delivery.”
Matt Zbrog
WriterMatt Zbrog is a writer and researcher from Southern California, and he believes nurse practitioners (NP) are an indispensable component of America’s current and future healthcare workforce. Since 2018, he’s written extensively about the work and advocacy of NPs, with a particular focus on the rapid growth of specialization programs, residencies, fellowships, and professional organizations. As part of an ongoing series on state practice authority, he’s worked with NP leaders, educators, and advocates from across the country to elevate policy discussions that empower NPs. His articles have featured interviews with the leadership of the American Association of Nurse Practitioners (AANP), the National Association of Pediatric Nurse Practitioners (NAPNAP), and many other professional nursing associations.