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Guam Enacts Law Granting Patients Full and Direct Access to NPs

AUSTIN, TX -- The American Association of Nurse Practitioners (AANP) today recognizes the leadership of Governor Eddie Calvo, the Guam Legislature and the people of Guam on the passage of Public Law 34-78, which will expand health care access to patients across the island. Guam joins other US Pacific Territories, 22 states and the District of Columbia in adopting full practice authority legislation, enabling nurse practitioners to practice at the top of their license to deliver the full scope of services they are educated and clinically trained to provide. Passage of this legislation significantly strengthens health care delivery to the territory's citizens.

"Guam has taken a critical step to put patients first and to empower nurse practitioners to deliver the high-quality health care they are trained to provide," said Joyce Knestrick, PhD, APRN, CFNP, FAANP, President of AANP. "Today we celebrate the state legislature and Governor Calvo for recognizing the integral role of nurse practitioners in the health care delivery system. This legislation will help Guam attract and retain highly valued nurse practitioners, and provide citizens better access to quality care," said Dr. Knestrick.

Public Law 34-78 officially retires the requirement that nurse practitioners maintain "collaborative agreements" with physicians as a condition of practice, a barrier that prevents nurse practitioners from fully serving patients. In addition, the legislation adopts the national gold standard framework from the National Council of State Boards of Nursing for NP licensure. This model provides for maximal use of nurse practitioners and ensures patients have full and direct access to the highest level of nurse practitioner care.

"Guam is the latest legislature to embrace a better care delivery model that recognizes nurse practitioners as part of the solution to increasing access, improving outcomes and providing cost savings," said David Hebert, Chief Executive Officer, AANP. "We applaud Guam for enacting truly model legislation and recognizing the need to better utilize its strongest health care providers."

Leading policy groups like the Institute of Medicine have long recommended that states adopt such legislation to improve health care access and outcomes. They cite extensive data showing nurse practitioners, including those with full practice authority, have safety and quality outcomes that are similar to those of physicians and also offer patients a much-needed approach that is highly focused on health promotion and disease prevention. To date, more than 40 percent of states have adopted full practice licensure authority for nurse practitioners.

The American Association of Nurse Practitioners
(AANP) is the largest professional membership organization for nurse practitioners (NPs) of all specialties. It represents the interests of the more than 234,000 licensed NPs in the U.S. AANP provides legislative leadership at the local, state and national levels, advancing health policy; promoting excellence in practice, education and research; and establishing standards that best serve NP patients and other health care consumers. As The Voice of the Nurse Practitioner, AANP represents the interests of NPs as providers of high-quality, cost-effective, comprehensive, patient-centered health care. To locate a nurse practitioner in your community, go to For more information about NPs, visit