Annapolis Declaration
Context Statement

As advanced practice nurses (APNs), nurse practitioners (NPs) are registered nurses who have acquired advanced academic and clinical experience in the care of people of all ages and their families. NPs provide services in community and hospital settings that include preventive care, diagnosis and management of episodic and chronic health problems, counseling and patient education. NPs make important contributions to the nation's health by helping to direct the course and quality of health care in the U.S., not only through practice but also through research and legislative activities.

For more than 35 years, scientific studies have consistently documented the ability of NPs to deliver comprehensive health care services safely and effectively. Such care includes NP-initiated diagnostic and treatment regimens as well as coordination and follow-up of actions taken by other health professionals.

The scope of advanced nursing practice is distinguished by autonomy to practice to the full extent of the expanding boundaries of nursing care. Within this context, an important hallmark of NP practice is the primacy of independent diagnosis and treatment decisions over the more dependent functions of traditional nursing.

The authority for professional nursing practice is grounded in a social contract that ascribes professional rights and responsibilities and assigns mechanisms for public accountability. However, in the past century, the evolution of medically oriented health care regulation has resulted in an environment restrictive to advanced practice nursing. Despite documented quality of care, dedication to accountability, and professional autonomy, NPs' authority to provide care that is solidly within the domain of nursing has not been uniformly reflected in professional practice acts. Hence, scope of practice has been limited in many states by legislative and regulatory mandates for physician supervision or formal collaboration. Such unnecessary requirements contribute to rising health care costs and restrict access to care for all citizens. State-by-state efforts to address these obstacles have consumed valuable resources and yielded disparate rules and regulations that perpetuate practice constraints and create confusion for patients, legislators and insurers.

In response to limitations currently affecting NP practice, Carolyn Buppert, JD, CRNP, convened the Annapolis Think Tank for a daylong meeting on March 25, 2000. NPs from various areas of the profession, including clinical practice, education, research, administration and health policy, gathered with the mission of advancing the course of NP practice and facilitating access to NP care. Toward that end, the undersigned have created the following document, the Declaration of Autonomy.

NP Resolution
On this 25th day of March, 2000, in historic Annapolis, Maryland the participants in the Nurse Practitioner Think Tank declare their continued commitment to quality patient care in the 21st century.


  • Nurse Practitioners are experts in Primary Care and a variety of specialties;
  • Nurse Practitioners are proven to provide high quality, cost effective, ethical, and compassionate care;
  • Nurse Practitioners provide a full range of comprehensive health care;
  • Patients report a high level of satisfaction with care from Nurse Practitioners; and
  • Nurse Practitioners are Nationally Board Certified;

Be it resolved

  • Patients must have access to Nurse Practitioners in the health care delivery system.
  • Nurse Practitioners must be unencumbered from restrictive requirements that restrain their practice.
  • All payers must credential Nurse Practitioners as Primary Care Providers.

Signed, The Annapolis Think Tank of Nurse Practitioners
Loretta C. Ford, EdD, RN
Dean Emeritus
University of Rochester School of Nursing
Founder of the profession
Wildwood, FL
Virginia Trotter Betts, RN, MSN, JD, FAAN
Associate Director for Health Policy
Center for Health Services Research
University of Tennessee, The Health Science Center
Memphis, TN
Marie Annette Brown, PhD, FAAN
Professor, Family and Child Nursing
University of Washington, Seattle
Carolyn Buppert, CRNP, JD
President, Better Life Health Care Systems
Attorney, Annapolis, MD
Westley Wright Byrne, MSN, CPNP
Co-investigator, demonstration project
Beaufort, SC
DrPH(c), University of South Carolina, Columbia
Michael Carter, DNSc, FAAN
Professor and Dean
College of Nursing
University of Tennessee, Memphis
Judith B. Collins, RNC, MS, OGNP, FAAN
Director, Women's Health Care, Stoney Point,
Medical College of Virginia, Richmond
Pat Donnelly, MS, FNP
Past President, New York Coalition of Nurse Practitioners, and Clinician,
Northeast Medical Family Physicians, Fayetteville, NY
Marilyn Edmunds, NP, PhD
Nurse Practitioner Association of Maryland
President, Nurse Practitioner Alternatives
Ellicott City, MD
Margaret Fitzgerald, RN, CS-FNP, MS
President, Fitzgerald Health Education Associates;
Clinician, Greater Lawrence Family Health Center, Lawrence, MA
Harriet Hellman, CPNP, FAANP
Director, Hampton Community Health Center,
Water Mill, NY
Margie Koehler, CRNP, MSN
President, M. Koehler & Associates, Inc.
Clinician, Home Based Health Care
Veterans Administration, Baltimore, MD
Donna Behler McArthur, RN, CS-FNP, PhD
Assistant Professor, Vanderbilt University
School of Nursing, Nashville, TN
Liv Peterson, MSN, FNP, MPA
Past president, New York Coalition of Nurse Practitioners
Medical Director, Suffolk County Employee Health Services
Lake Grove, NY
Linda Pearson, RN, FNP, MSN
Editor, The Nurse Practitioner Journal
Springhouse Corporation
Lakewood, CO
Laurie Scudder, RN-C, PNP, MS
Past President, Nurse Practitioner Association of MD
Clinician, Klebanow and Associates
Columbia, MD
Nancy Sharp, RN, MSN
President, Sharp & Associates
Washington, DC
Robert T. Smithing, ARNP, FNP, MSN
President, Nurse Practitioner Support Services, Kent, WA
Clinical Faculty, University of Washington, Seattle
Joan M. Stanley, PhD, RN, CRNP
Director of Education Policy,
American Association of Colleges of Nursing
President, Nurse Practitioner Association of Maryland, Davidsonville, MD
Cheryl Cummings Stegbauer, CFNP, PhD
Associate Professor
Department of Primary Care
University of Tennessee, Memphis
Eileen M. Sullivan-Marx, PhD, RN, FAAN
Assistant Professor, Co-Director
Adult Gerontological Nurse Practitioner Program
University of Pennsylvania, School of Nursing, Philadelphia, PA
Jan Towers, PhD, RN,C, CRNP
Director, Governmental Affairs
American Academy of Nurse Practitioners
Washington, D.C.
Madeline Turkeltaub, PhD, RN, CRNP
Clinician, Potomac, MD
Jan Wyatt, PhD, RN, CRNP
Executive Director,
National Certification Board of Pediatric Nurse
Practitioners and Nurses, Gaithersburg, MD

Supporting State Organizations

Coalition of Arizona Nurses in Advanced Practice
Southern Arizona NP Council
California Coalition of NPs
DNA 30 NP Group of the Colorado Nurses Assn.
Rocky Mountain (Colorado) Chapter of NAPNAP
Delaware APN Council
NP Assn. of the District of Columbia
NP Council of Coastal Georgia
Illinois Nurses Association Council of APNs
Iowa NP Association
Kentucky Coalition of NPs/NMs
Louisiana Association of NPs
NP Association of Maryland
Massachusetts Coalition of NPs
Eastern Massachusetts Chapter of NAPNAP
Michigan Nurses Association
Michigan Chapter of NAPNAP
Mississippi Nurses Association
, NP interest group
New Mexico NP Council
New York State Coalition of NPs
Western NY Chapter of NAPNAP
Oregon PNP Association
NPs of Northeastern Pennsylvania
South Carolina APRN Council
South Carolina Chapter of NAPNAP
South Carolina Nurses Association
Northeast Tennessee NP Association
Tennessee Chapter of NAPNAP
Texas NP Association
Virginia Council of NPs
ARNPs United of Washington State

Supporting National Organizations

AACN American Association of Colleges of Nursing
AACN American Association of Critical Care Nurses
AANP American Academy of Nurse Practitioners
ACCN Association of Critical Care Nurses
ACNM American College of Nurse Midwives
ACNP American College of Nurse Practitioners
AFPNPP Association of Faculties of Pediatric Nurse Practitioner Programs
NANP National Alliance of Nurse Practitioners
NANPWH National Association of Nurse Practitioners in Women's Health
NAPNAP National Association of Pediatric Nurses and Practitioners
NCGNP National Conference of Gerontological Nurse Practitioners
NONPF National Organization of Nurse Practitioner Faculties
ONS Oncology Nursing Society

Updated: January 10, 2001