Attitudes, perceptions, and beliefs related to full practice authority for advanced practice registered nurses

Advanced practice registered nurses (APRNs) play a critical role in addressing health care access, yet regulatory barriers in states without full practice authority (FPA) limit their capacity to provide care. Tennessee remains a restricted-practice state, and limited data exist on Tennessee APRNs' attitudes and perceptions regarding FPA.

The purpose of this Doctor of Nursing Practice project was to examine the attitudes, perceptions, and beliefs of APRNs in Tennessee related to FPA and to identify factors influencing their perspectives.

A cross-sectional, web-based survey was distributed via email to all APRNs listed in the Tennessee state licensure database from October 1 through December 31, 2023. The survey included a total of 26 structured questions with Likert-type responses and open-ended questions. Descriptive statistics and thematic analysis were used to analyze quantitative and qualitative data, respectively. The Vanderbilt Institutional Review Board exempted the study.

A total of 1,484 APRNs responded (9% response rate), with 1,281 complete responses. Most respondents were nurse practitioners (n = 1,285; 86.6%). More than two thirds (n = 978; 67.4%) indicated a preference for FPA, with rural APRNs showing significantly higher support (76.5%) compared with suburban (63.3%) and urban (63.5%) APRNs. Although 81.5% of respondents reported a strong understanding of FPA, qualitative analysis of 7,630 open-ended responses revealed that approximately 25% of those reporting a high level of understanding held misconceptions about FPA's scope and implications.

Tennessee APRNs broadly support FPA, particularly those in rural settings, yet significant misconceptions persist. These findings highlight the need for targeted educational initiatives and informed advocacy to advance FPA policy in Tennessee and other restricted-practice states.

Targeted education is needed to address APRN knowledge gaps and bolster advocacy. Advancing FPA will require coordinated education, legislative action, and public awareness to improve health care access and workforce utilization.