Nurse practitioners in nine states submitted legislation this year seeking complete statutory independence. NPs in Vermont and North Dakota succeeded, bringing the tally of states with complete independent practice authority to 16.

In North Dakota, NPs launched a campaign to educate colleagues, legislators and the public about the abilities of NPs and then to seek support for a legislative change that would remove a requirement for a physician's signature on prescriptions. The bill passed, and the new law took effect Aug. 1.

This was the first attempt North Dakota NPs had made at changing this law. State Sen. Judy Lee sponsored the bill, which sought the necessary change to the Nurse Practice Act. "She has historically been very supportive of nursing," said Gwen Witzel, MSN, FNP-C, cofounder of the North Dakota Nurse Practitioner Association (NDNPA).

Lee attended the association's annual meeting, during which members discussed the bill. "If there was any hesitation from NPs, . after hearing Sen. Lee speak and encourage us to move forward, everyone there was on board," Witzel said.

Witzel said that grassroots efforts secured the bill's success. NDNPA helped connect legislators with their constituent nurse practitioners for education about the bill. Members also visited legislators in their home district offices.

"If a legislator was contacted by an NP in their district, our issues became personal, and the legislators were more likely to vote with us," Witzel said. Because North Dakota is very rural, lawmakers were aware of the need for NPs to have more practice authority, she said.

NDNPA's multifaceted plan to garner support for the bill included member distribution of a letter outlining the patient care improvements the legislative change would bring. NDNPA asked larger organizations to send letters of support as well, such as county commissioners, hospital boards and leaders of rural hospitals. The Board of Nursing sent a letter to the Legislature supporting the bill. NDNPA members sought signatures from collaborating physicians who supported the legislation.

"We had many physician signatures with us when we testified in the Senate and House committees," Witzel said. Four NPs and two physicians testified in support of the bill. The North Dakota State Board of Medical Examiners testified against it, but they were not able to show any evidence of decreased quality or safety with NP practice, Witzel said. NDNPA testimony included studies showing quality care by NPs, and each chamber of the Legislature voted overwhelmingly to pass the bill.

In Vermont, the Board of Nursing had the opportunity to change its rules to provide full statutory authority to NPs. According to Tay Kopanos, DNP, past director of health policy and state government affairs for the American Academy of Nurse Practitioners, the Vermont Board of Medical Practice intervened in the rule-making process and proposed legislation (H 358) that would have required NPs to be supervised by a physician for 5,000 hours before entering solo practice. Efforts by NPs led to passage of alternative legislation (H 420) that provides full autonomy and requires new graduate NPs to be mentored in prescribing by another prescribing advanced practice nurse or physician for 2 years or 2,400 hours before earning full statutory authority. Practicing NPs who have met the supervision requirement would earn prescriptive authority.

"It's a graduated autonomy bill, similar to what you see in Maine," Kopanos said. That model, however, diverges from the National Council of State Boards of Nursing (NCSBN) licensure, accreditation, certification and education (LACE) model for NP practice. The AANP and other national NP associations recommend that all efforts to increase statutory authority for NPs follow the LACE model and the NCSBN's model nurse practice act language.

Kopanos says NPs in 12 other states are planning to submit legislation seeking full statutory authority in their states' next legislative session.