Full practice authority and burnout among primary care nurse practitioners

Full practice authority (FPA)22FPA = Full practice authority; NP= Nurse Practitioner; VHA = Veterans Health Administration improves clinical autonomy for nurse practitioners (NPs). Autonomy may reduce burnout. Estimate the effect of changing from reduced or restricted practice authority to FPA on NP burnout. In this quasi-experimental study, we compared NP burnout before (2016) and after (2018) a Veterans Health Administration (VHA) regulation authorized NP FPA. Burnout proportions were estimated for VHA facilities by aggregating responses to the VHA's All Employee Survey from 1,352 primary care NPs. Seventy-seven percent of facilities changed to FPA post-regulation. Burnout was 6 points lower among NPs in facilities which changed to FPA compared to facilities which had FPA prior to the regulation; however, this association was not statistically significant. NPs are increasingly working under independent practice. While changing to FPA did not reduce NP burnout, this association may vary by healthcare setting or when burnout is measured for individuals or teams. •Practice authority regulations guide nurse practitioner professional autonomy.•Full practice authority maximizes day-to-day nurse practitioner autonomy.•Autonomy is a predictor of burnout in health care.•Gaining full practice authority did not reduce burnout in nurse practitioners.