Full Practice, Full Potential: Policy and Innovation in Nursing Roles Hollin Macklin BSN, RN
University of North Texas Health Science Center College of Nursing
NURS. 6305 Health Policy and Leadership for Advanced Practice Nursing
Cheryl A. Thaxton, DNP, APRN, CPNP, FNP-BC, CHPPN, FPCN, ACUE, FAANP, Associate Dean & Chair Graduate Education
June 22, 2025

Registered Nurse (RN)

RN Scope of Practice (Jersey College, 2025)

Provides direct care under supervision of APRNs or physicians

Administers medications, monitors vital signs, and offers emotional and educational support

Cannot diagnose conditions or prescribe medications

Requires: ADN or BSN

Integral in patient care coordination and advocacy

Key Barriers to Full Practice (RN)

Legal: Scope-of-practice statutes limit autonomous roles (Baker & Williams, 2016)

Regulatory: Inconsistent national licensure and lack of privileging policies (Feringa et al., 2018)

Institutional: Hospital policies limit RN protocol use and nurse-initiated care pathways (Kleinpell et al., 2022)

Strategies to Engage Stakeholders (RN) (Zalon et al., 2024; Morris, 2024)

Present patient safety and quality metrics tied to RN-led interventions

Collaborate with hospital boards and quality councils

Use ANA’s Healthy Nurse Healthy Nation and Future of Nursing framework as leverage

Addressing Rural & Underserved Needs (RN) (Yates et al., 2022)

Empower nurse-led clinics and home visit models

Train RNs from rural communities through targeted pipeline programs and scholarships

Emphasize care coordination and chronic disease management

Support legislation recognizing RN clinical decision-making authority

Policy/Organizational Changes & Advocacy (RN) (Chiu, Cummings, Thorne, & Schick-Makaroff, 2021; Rash, 2024; Sutor & Painter, 2020; Ferguson, 1998)

Support legislation recognizing RN clinical decision-making authority

Develop rural RN advocacy fellowships and legislative internships

Use data dashboards to highlight RN shortages and outcomes

Launch storytelling campaigns through the Campaign for Action

Expand BSN-preparation mandates and create RN residency programs

Advanced Practice Registered Nurse (APRN)

APRN Scope of Practice (Boehning & Punsalan, 2023)

Includes 4 Main Roles

Nurse Practitioner (NP)

Certified Nurse-Midwife (CNM)

Certified Registered Nurse Anesthetist (CRNA)

Clinical Nurse Specialist (CNS)

Can diagnose, prescribe, and can independently manage care

Authorized for independent practice in 26 states

Requires a Master's or Doctoral degree

Emphasizes evidence-based practice, leadership, health policy, and systems-level care

Key Barriers to Full Practice (APRN)

Legal: SOP laws require physician collaboration in many states (Peterson, 2017; Hain & Fleck, 2014)

Regulatory: Inconsistent certification, privileging, and transition-to-practice mandates (Feringa et al., 2018; Kleinpell et al., 2023)

Institutional: Restrictions on prescriptive authority, hospital admitting, and billing (Kleinpell et al., 2022; Barton et al., 2021)

Strategies to Engage Stakeholders (APRN) (Mark, 2023; Zalon et al., 2024)

Leverage data showing APRN cost-effectiveness and quality outcomes

Engage through national policy briefings and interprofessional forums

Leverage AANP, ANA, and interdisciplinary coalitions

Addressing Rural & Underserved Needs (APRN) (Tapp et al., 2025; Taylor, 2023)

Expand telehealth and remote prescribing services

Launch APRN residency programs in rural FQHCs

Build community trust and retention through culturally responsive care

Policy/Organizational Changes & Advocacy (APRN) (National Academies, 2016; Kleinpell et al., 2023; Mark, 2023)

Push for APRN Compact legislation for multi-state practice

Promote standardization via the APRN Consensus Model

Use FTC and CMS data to advocate for removal of anticompetitive policies

Expand CMS reimbursement rules and hospital privileging reforms

Empower APRN students through policy fellowships and media training

Leadership in care management (APRN)

APRN and RN Differences and Similarities in Scope of Practice

Both emphasize holistic, dignified, patient-centered care, advocacy, and follow similar laws, protocols, and regulations.

Equally accountable and responsible for patient care within their legal and institutional frameworks.

Both roles work collaboratively with physicians and other care team members.

Both play major roles in Patient advocacy
, Health promotion, and education

RN's typically do not operate independently

APRNs have independent diagnostic and prescribing authority (APRN)

APRNs possess deeper theoretical knowledge, advanced clinical skills, and are perceived as more autonomous

Differences:

Similarities:^

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