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Overall, the articles present some convincing positions, points, and statistics regarding Nurse Practitioner and Advance Practice Nursing practice.  The Pearson Report (2009) clearly presents the up to date information and statistics regarding licensure, practice, autonomy, and effect of care from APNs.  Pearson clearly shows from documented events in the NPDB and HIPDB that APNs, functioning within their scopes of practice among the various states, have provided exceptional safety and prudence in their care.  These statistics clearly refute that APNs practice without the knowledge or skill required of their practice.  The information reviewing the requirements of the various states demonstrates that significant differences in licensing, practice, autonomy, physician involvement, and regulatory board oversight exist.  Interesting to note, some states with the most independence and autonomy for APNs have documented the most encouraging ratios for NPDB and HIPDB filings of NPs.  Sherwood et al. (1997) and the Committee on Pediatric Workforce (2003) both note that APNs have routinely produced increased satisfaction of care from clients when compared to physicians.  Also, they both note and imply that NPs should have increased ability and provision to practice in rural and underserved areas due to the insufficient availability of physicians.  Allowing APNs to function more freely in areas with the greater need only serves to permit certain practices under certain conditions, in specific areas, at specified times.  Provisions like this do not create a profession with definite abilities, regulations, and liability.  Though states have made practice for APNs more defined, variation of practice abilities and regulation maintains from state to state.  This creates confusion for clients as well as providers, a point that is suggested but not specifically stated by each of the reported sources and reviews.  It is evident that Advance Practice Nurses have the ability to practice within scopes of practice, despite significant variation of regulation and autonomy.  It is also clear that Nurse Practitioners provide exceptional, safe, and satisfactory care, frequently beyond that of physicians.  Thus, states that significantly limit APN practice severely reduce the availability to excellent care of their population.  Issues of strict physician oversight or supervision arise due to the documented safety and effective care provided by NPs.  Furthermore, incongruity of practice standards among the states leads to confusion and issues of integrity of practice.  What is a legal and supported practice in one state may be a significant offense in another region.  This does not lead to a respected or effective profession.  Congruity and autonomy for APN practice must be established among the states.