Introduction
With the inception of the Affordable Health Care Act, an estimated 32 million Americans are expected to join the ranks of those already insured, and the existing shortage of primary care physicians available to provide care will continue to increase (Fairman, Rowe, Hassmiller, & Shalala, 2011). Nurse practitioners are currently helping fill this gap by providing care to a large portion of this population. However, many nurse practitioners providing care are now limited in their practice due to individual state regulations placed on their scope of practice. The implementation of full practice authority for all nurse practitioners, regardless of their state of practice, ideally will increase the availability and access to health care for Americans, especially those in underserved areas.
Full Practice Authority “Full practice authority is a collection of state licensure laws that allow for nurse practitioners to practice, diagnose, order, and interpret diagnostic tests as well as initiate and manage treatments, including prescribing medications, under the executive licensure authority of the state board of nursing.” (AANP, 2015). Currently, only 20 states and the District of Columbia provide full practice authority (FPA) for nurse practitioners. States vary regarding what they allow nurse practitioners to do, and this variance appears not to correlate with performance on any measure of quality or safety (Fairman, Rowe, Hassmiller, & Shalala, 2011). Current recommendations from the American Academy of Nurse Practitioners and the Institute of Health are to remove any and all scope of practice barriers, thereby allowing nurse practitioners to practice to the full extent of their education and training (AANP, 2015).

Kotter’s Change Theory
There are many different change theory models, however the Kotter Change Theory model is one that has been successful to promote change in the healthcare field. This model is comprised of eight stages that can be divided into three phases. The first phase is “creating a climate for change” and includes establishing a sense of urgency, creating a guiding coalition, and developing a vision and strategy. The second phase is “engaging and enabling the organization” and includes communicating the vision, empowering action, and creating short-term wins. The final phase is “implementing and sustaining the change” and includes consolidating gains and producing more change, and anchoring new approaches in the culture (Neumeier, 2013).
Need for Change
As of 2015, there are currently more than 205,000 nurse practitioners practicing in the United States. Despite the number of nurse practitioners currently practicing and continuing to enter the workforce, there is still a shortage of clinicians available to provide care to those in need. “Projections estimated that by the year 2025, the supply of providers will fall short of demand for services by 20%, despite a projected increase in the overall number of NPs in the coming decade.” (Poghosyan, Boyd, Knutson, 2014). Allowing nurse practitioners full practice authority in all states will help to alleviate the current and continuing growing shortage of clinicians, therefore increasing access to health care for Americans, especially for those living in underserved areas.

Creating a Climate for Change It has been established that individual state based regulations are responsible for dictating a nurse practitioners scope of practice. To promote change, it is essential to establish an interdisciplinary team to advocate for nurse practitioners. Members of this panel should include physicians, nurse practitioners, educators, social workers and patient advocates as well as hospital and clinic administrators. This team will identify specific challenges and access to health care in a variety of regions. Advocating to allow for nurse practitioner to practice at their full educational capacity is the first step in implementing full practice authority nationwide. “Nurses should practice to the full extent of their education and training through the elimination of historical, regulatory, and policy barriers.” (Iglehart, 2013).

Engaging the Organization
Once full practice authority has been implemented, it is important to emphasize the need for nurse practitioners and their role. With effective implementation, nurse practitioners are providing care to patients with conditions for chronic disease management and transitional care. This requires the establishment of interdisciplinary teams in which nurse practitioners provide a range of services, from case management to health and illness management. With an expanded scope of practice and team-based approaches, nurse practitioners have shown to improve quality, patient satisfaction while reducing overall costs (Fairman, Rowe, Hassmiller, & Shalala, 2011).