Nurse practitioners (NPs) are advanced practice registered nurses who have completed graduate-level education, enabling them to provide a broad range of healthcare services. An invasive procedure is defined as any medical procedure that requires entering the body, such as inserting a needle or making an incision. The question of which invasive procedures an NP can perform depends on multiple factors, including state law, the healthcare setting, and the individual provider’s specialized training and demonstrated competency. The scope of practice for NPs concerning these procedures is not uniform across the United States.
State Laws and Practice Authority
The primary determinant of an NP’s scope of practice, which includes invasive procedures, is the state’s Nurse Practice Act. These laws create a legal framework that dictates the level of independence an NP has in their clinical role. The three recognized models of NP practice authority are Full, Reduced, and Restricted, and the state’s classification directly influences procedural autonomy.
In states with Full Practice Authority, NPs can evaluate patients, diagnose illnesses, order tests, and manage treatments, including procedures, without mandated physician supervision or collaboration. This autonomy allows the NP to practice to the full extent of their education and national certification. States with Reduced or Restricted Practice Authority impose specific limitations, often necessitating a formal collaborative agreement or supervision by a physician for certain procedures.
Routine Invasive Procedures in Outpatient Care
Nurse practitioners working in primary care, urgent care, and other outpatient settings commonly perform a variety of minor invasive procedures. These procedures are integral to managing common health issues encountered in an office environment and allow for timely diagnosis and treatment. Competency for these minor surgical procedures is often established during graduate-level training programs.
Common examples of these procedures include:
- Simple suturing of lacerations to repair minor wounds.
- Incision and drainage of superficial abscesses or cysts.
- Joint injections using a needle to administer medication, such as corticosteroids, to treat inflammation and pain.
- Diagnostic procedures like punch or shave skin biopsies, which involve removing a small tissue sample for laboratory analysis.
Advanced Procedures in Hospital Settings
NPs practicing in acute care environments, such as emergency departments, intensive care units, and specialty surgical services, routinely perform more advanced invasive procedures. These procedures are necessary for the management of critically ill or unstable patients. The ability to perform these actions often requires specialized advanced education, such as a post-graduate fellowship, and specific hospital credentialing.
Examples of advanced procedures include:
- Placing central venous lines, which are catheters inserted into large veins to administer medications or fluids.
- Inserting arterial lines, which are catheters placed in an artery for continuous blood pressure monitoring and repeated blood sampling.
- Endotracheal intubation to secure a patient’s airway for mechanical ventilation.
- Lumbar punctures for diagnostic fluid collection.
- Insertion and removal of chest tubes to drain air or fluid from the pleural space.
How Individual Competency Determines Scope
Beyond state laws and practice settings, the individual NP’s documented competency is the final factor in determining which procedures they can perform independently. Even if a state’s law permits a procedure and the facility grants privileges, the NP must demonstrate specific training and proficiency to the credentialing body. This process ensures patient safety and confirms the provider’s ability to manage the procedure and potential complications.
Demonstrating competency often involves completing specialized continuing education programs, obtaining specific certifications like Advanced Cardiovascular Life Support (ACLS), and undergoing proctoring. Proctoring requires the NP to perform a set number of procedures under the direct supervision of an experienced clinician until their skill and judgment are confirmed. For advanced procedures, the NP’s specialty certification, such as Acute Care Nurse Practitioner (ACNP), is also a significant factor influencing procedural privileges.