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The scope of practice for a nurse practitioner identifies the range of skills, procedures, and processes that the individual has been educated, trained, and credentialed to  perform. Scope of practice for nurse practitioners is defined at four levels: 1) professional, 2) state, 3) institutional, and 4) self-determination. At the professional level, nursing organizations such as the AACN and the ANCC regulate nursing certification and publish guidelines for the scope and standards of practice for ACNP’s. At the state level, nurse practice acts and administrative rules and regulations define requirements for licensure. Because of rapid changes in health care technologies, state nurse practice acts rarely define specific tasks that a nurse practitioner may conduct. Many state nurse practice acts still do not define scope of practice based on board certification or educational preparation. In states that require collaborative practice agreements, these documents  can frame the scope of practice for entry-level ACNP’s. Collaborative practice agreements can also include language about future expansion of scope of practice based on continuing education and field experience. ACNP’s with collaborative practice agreements should review them often to ensure that they confer the authority to practice at the full extent of education and training.

At the institutional level, ACNP scope of practice is often outlined in a nurse practitioner privilege form. This document generally lists core privileges that apply to all nurse practitioners in a facility as well as special privileges that represent the individual ACNP’s education and training. The privilege form can specify which practices can be performed autonomously and which practices require physician supervision. For certain practices (eg. intubation, chest tube insertion) the privilege form can also specify how many supervised procedures must be performed before the ACNP can practice autonomously. The specific privileges granted to an ACNP vary by practice setting and the practice specialties of collaborating physicians. Finally, ACNP’s utilize self-determination when determining whether a given task is within a scope of practice. Self-determination requires not only an evaluation of personal competencies, but also an awareness of the capacities of other members of the healthcare team.