| Course | DNP 820 Health Policy and Advocacy |
|---|---|
| Module | Module 4 |
| Paper type | Scope of practice policy paper |
| Length | About 1,065 words, 6 pages |
| Format | APA 7 student paper |
| School | Aspen University |
| Program | DNP |
| Updated | September 2026 |
Free sample paper for DNP 820 Module 4
Collaboration Agreement or Full Authority? The Evidence and the Politics of a State Nurse Practitioner Practice Bill
Student Name
Doctor of Nursing Practice Program, Aspen University
DNP 820: Health Policy and Advocacy
Instructor Name
Month Day, Year
Collaboration Agreement or Full Authority? The Evidence and the Politics of a State Nurse Practitioner Practice Bill
Every state decides for itself how much independence nurse practitioners have. In states with full practice authority, nurse practitioners may evaluate, diagnose, order tests, treat and prescribe without a required relationship with a physician. In reduced and restricted practice states, they must have a collaborative agreement or physician supervision for some or all of their practice. This paper analyzes a composite full practice authority bill in a reduced practice state: the problem it addresses, the arguments of supporters and opponents, the evidence on quality and access, and the political dynamics that will decide its fate.
The Bill and the Problem
Under current law in the composite state, nurse practitioners may prescribe only under a signed collaborative agreement with a physician, and the collaborating physician must audit a set number of the nurse practitioner's charts every quarter. Collaborating physicians may charge fees, and when a physician retires or leaves, the nurse practitioner must stop prescribing until a new agreement is signed. The bill would remove the collaborative agreement requirement for nurse practitioners who have completed a transition period of 4,000 practice hours under collaboration. Supporters point to the state's 38 primary care shortage areas, rural clinics that closed when collaborating physicians left, and fees that some nurse practitioners pay for agreements that involve little actual collaboration.
The Arguments
Supporters, including nursing organizations, rural health advocates and some health systems, argue that nurse practitioners are educated and licensed to practice independently, that collaborative agreements add cost and administrative burden without improving care, and that removing them will expand access, particularly in rural and underserved areas. Opponents, primarily physician organizations, argue that physicians' longer education and training produce better outcomes, that care is safer when a physician leads the team, and that independent practice may increase costs through more referrals and testing. Both sides claim to speak for patients.
The Evidence on Quality
Comparative studies generally find similar quality. Using five years of national data on 23,704 visits to community health centers, representing about 30 million visits, one study found no statistically significant differences among nurse practitioners, physician assistants and physicians in primary care on seven of nine outcomes, including quality indicators, service use and referral patterns (Kurtzman & Barnow, 2017). Health centers serve many low-income and underserved patients, which makes the finding relevant to the access problem the bill targets.
The Evidence on Access and Outcomes
Studies that exploit the timing of state law changes provide evidence about the effect of independence itself. An analysis of states that granted nurse practitioners independence found that the change increased routine checkups, improved measures of care quality and reduced emergency department use by patients with conditions that good ambulatory care should control. The authors attributed these effects to lower administrative costs for clinicians and lower indirect costs of access for patients (Traczynski & Udalova, 2018). The most recent national nursing workforce report from the National Academies likewise recommended that states and federal agencies remove restrictions on nurses' scope of practice so that nurses can use all of the skills their education and training prepared them for, citing their importance in addressing health equity (National Academies of Sciences, Engineering, and Medicine, 2021).
The evidence has limits. Studies of quality compare care as it is currently practiced, often within teams, and may not capture what happens when nurse practitioners practice alone in complex settings. Access gains depend on whether nurse practitioners actually locate in shortage areas, which independence makes possible but does not guarantee. Opponents' concern about increased testing and referrals has some support in individual studies but is not consistent across the literature.
The Politics
Scope of practice bills are decided as much by politics as by evidence. Physician organizations are well funded and have long relationships with legislators, particularly on health committees. Nursing's advantages are numbers, public trust and support from rural legislators whose constituents have lost clinics. In the composite state, the bill's sponsor is a rural legislator from the majority party, which gives it a path through committee. Its prospects depend on amendments. A transition period of supervised practice before independence, already in the bill, has helped in other states. Additional compromises under discussion include requiring nurse practitioners in their first independent years to maintain referral relationships, and reporting requirements so that the legislature can evaluate effects on access.
Policy Options
Legislators have more than two choices. They can keep the current collaborative agreement requirement but limit fees and require that agreements continue for a period when a physician leaves, which would address the most disruptive problems without changing independence. They can grant full practice authority after a transition period, as the bill proposes. Or they can grant independence only in designated shortage areas, a targeted approach that addresses access where it is worst but creates a two-tier license that is complicated to administer and may discourage nurse practitioners from moving to shortage areas if practice rules change when they cross a county line.
Each option can be judged against criteria that both sides accept: effects on access in underserved areas, quality and safety, cost, administrative feasibility and political viability. Laid out this way, the bill's approach, full authority after a supervised transition with evaluation, performs well on access and feasibility and is supported by the available evidence on quality, while the fee-limit option is the most politically viable but does the least for access.
The Role of Doctoral Nurses
Doctoral nurses can strengthen the case by producing state-specific data, such as maps of shortage areas, lists of clinics that closed when collaborating physicians left and surveys of nurse practitioners about agreement fees and time. They can testify with evidence rather than slogans, meet with opponents to understand concerns and propose reasonable safeguards, and help build coalitions with rural hospitals, community health centers and patient groups whose support carries weight with legislators.
Conclusion
The composite bill would remove collaborative agreements for experienced nurse practitioners in a state with serious primary care shortages. Evidence suggests similar quality of care and improvements in access and avoidable emergency use when states grant independence, although gains depend on where nurse practitioners practice. The bill's fate will turn on politics, particularly on amendments such as a transition period and evaluation requirements. Doctoral nurses contribute most by bringing credible state data and constructive proposals to that debate.
References
Kurtzman, E. T., & Barnow, B. S. (2017). A comparison of nurse practitioners, physician assistants, and primary care physicians' patterns of practice and quality of care in health centers. Medical Care, 55(6), 615-622. https://doi.org/10.1097/MLR.0000000000000689
National Academies of Sciences, Engineering, and Medicine. (2021). The future of nursing 2020-2030: Charting a path to achieve health equity. The National Academies Press. https://doi.org/10.17226/25982
Traczynski, J., & Udalova, V. (2018). Nurse practitioner independence, health care utilization, and health outcomes. Journal of Health Economics, 58, 90-109. https://doi.org/10.1016/j.jhealeco.2018.01.001
Reading the DNP 820 Module 4 assignment instructions
Aspen does not publish DNP 820 Module 4 instructions outside the course, so this sample was pinned to the catalog description of policy reform through legal, regulatory, ethical and societal contexts, with a focus on advocacy. A scope of practice paper usually asks you to analyze a bill or regulation affecting advanced practice nurses, present evidence on both sides, and recommend a position or strategy. Check whether your prompt requires a real bill from your state, a stakeholder analysis, or a letter to a legislator. Some instructors ask for a comparison between states. Read the required length and sources carefully, and plan to use both research studies and policy documents, since legislators and graders alike expect both kinds of support.
How the DNP 820 Module 4 example is put together
The example is about 1,065 words under eight headings. It begins with the bill's mechanism and the problems it targets, such as rural shortages and delays caused by collaboration fees. The arguments section gives both sides fairly. Quality evidence and access evidence get separate sections, each with its main study and its limits. The politics section explains who supports and opposes the bill and which amendments might win votes. Policy options follow, from passage as written to a transition period or a narrower rural pilot. A section on the role of doctoral nurses turns the analysis toward action. The conclusion weighs the evidence and the politics together and names the doctoral nurse's specific contribution to the debate.
DNP 820 Module 4 rubric: what earns full marks
Your instructor's rubric will reward balance and evidence above all on a paper like this. The example earns content points by presenting opponents' arguments fairly and by admitting where the evidence is mixed, and the margin notes point to that honesty as a strength. Separate sections on quality and access show that different claims need different evidence. The politics and options sections address analysis and application, which often have their own rubric rows. A clear role for doctoral nurses satisfies the implications criterion. Organization moves from mechanism to argument to evidence to politics to options. APA points depend on accurate citation of studies, reports and the National Academies recommendation, with authors and years matched to the reference list.
Common DNP 820 Module 4 mistakes, and how to avoid them
The biggest mistake on scope of practice papers is one-sided advocacy that ignores the evidence opponents cite. A strong paper states their concerns and answers them. Students also cite surveys of nurse practitioner satisfaction as if they proved quality; use outcome studies instead. Another common problem is describing full practice authority vaguely, without explaining what the bill changes in law, such as transition hours or prescriptive authority. Papers also forget the politics, which is where most such bills succeed or fail. Name the stakeholders and the likely compromises. Finally, keep the recommendation realistic. A phased approach or a transition period often reads as more credible than demanding everything at once, and it shows that you understand how legislatures work.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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DNP 820 Module 4 questions, answered
What does DNP 820 Module 4 usually ask for?
Aspen's DNP 820 description includes policy reform through legal and regulatory contexts, so analyzing a state scope of practice debate is a typical assignment. Check your classroom for the prompt.
What is full practice authority?
A state licensure model in which nurse practitioners may evaluate, diagnose, treat and prescribe without a required collaborative agreement or physician supervision.
What does the evidence say about nurse practitioner quality?
Comparative studies generally find similar quality to physicians on many measures, and studies of state law changes suggest improved access, though effects depend on where nurse practitioners practice.
Where can I find a free DNP 820 Module 4 sample paper?
Here, in full. This page shows a scope of practice policy paper on a nurse practitioner full practice authority bill, from the first page to the reference list, annotated section by section, and reading it is free. A paper on your own state's bill can be requested through the form.
Does DNP 820 Module 4 need a real state bill?
Only if your prompt says so. Many instructors want a bill from your own state, while others accept a composite bill like the one in this example. Either way, describe exactly what the bill changes and cite the evidence on both sides.