Supporting nurse practitioner autonomy: A policy proposal to advance hospice nurse practitioner scope

The nurse practitioner (NP) profession has achieved many advancements in its autonomy and scope of practice in the last 61 years since becoming a recognized advanced practice registered nursing role. However, some areas of health care still limit the NP's ability to practice autonomously although it is within their scope of practice. This is notable in the subspecialty of hospice care regarding certifying a terminal diagnosis as part of eligibility determination for a Medicare beneficiary to be able to receive covered hospice services. This health policy paper reviews current hospice regulations and provides evidence to support the benefits of advancing NP scope of practice and autonomy to include the ability to certify terminal diagnoses as defined in federal hospice care regulation 42 C.F.R. § 418.22. The goal of this health policy paper is successful change in federal legislation, allowing NPs to practice to the full extent of their scope and improving access to the provision of hospice care.