The Pan American Health Organization released a call to action on May 11, 2026 — the day before International Nurses Day — urging countries across the Americas to dramatically expand advanced practice nursing roles. PAHO's position is explicit: the region's 7.4 million nurses represent the largest health workforce in the Americas, and most of them are operating well below their clinical capacity due to outdated regulatory frameworks that still require physician oversight for tasks nurses are fully qualified to perform independently.
The announcement carries direct relevance for US nurses, particularly nurse practitioners. The US is cited as one of the few countries in the Americas that has already established an advanced practice nursing model — but "established a model" and "fully leveraged it" are two very different things. Full practice authority still varies by state, NP autonomy remains politically contested in many legislatures, and physician-supervised practice requirements in 22 states continue to limit care access in exactly the underserved communities PAHO is trying to reach.
What PAHO Is Specifically Calling For
PAHO's position paper calls on member states to update regulatory frameworks that currently restrict advanced practice nurses to physician-supervised roles. It specifically calls for investment in specialized APRN training programs at scale, and for development of new care delivery models that position APRNs as primary points of contact in underserved communities — particularly rural and remote areas where physician shortages are most severe.
The evidence base cited is not new: over 100 countries have already incorporated expanded nursing roles into their health systems. What's new is the urgency. Post-pandemic workforce data shows that physician-centric care models are increasingly unable to meet demand across Latin America and the Caribbean, where population aging is accelerating and healthcare systems are still rebuilding after COVID-19 attrition. The PAHO call is less about theory and more about a recognition that the alternative — waiting for more physicians — is not a realistic plan.
Evidence cited in the PAHO announcement demonstrates that when advanced practice nurses are given greater autonomy and support, they help improve access to services, strengthen continuity of care, and increase patient satisfaction through more people-centered approaches. Outcomes in countries that have expanded APRN roles are consistently comparable to physician-delivered care for the same scope of practice. That evidence base is now being cited at an international policy level, which carries weight in state-level legislative arguments for full practice authority expansion in the US.
The US Context: 28 States With Full Practice Authority
US nurse practitioners currently operate under full practice authority in 28 states and the District of Columbia. In those states, NPs can evaluate patients, diagnose, interpret diagnostic tests, and initiate and manage treatment including prescribing medications without physician collaboration requirements. The remaining 22 states still require some form of physician oversight — ranging from collaborative practice agreements to formal supervision requirements that constrain where and how NPs can practice.
The PAHO announcement lands at a moment when the NP pipeline in the US is expanding rapidly. HRSA projects NP supply to grow 35% through 2034, driven by growth in psychiatric-mental health, acute care, and primary care NP programs. That growth is outpacing the pace of full practice authority expansion in holdout states, meaning a significant portion of new NP graduates will still be practicing under restricted authority frameworks by the time they enter the workforce. In the states with the most acute primary care shortages — many of which are also restricted practice states — that mismatch has direct patient care consequences.
What It Means for Bedside RNs Considering the NP Track
PAHO's framing of advanced practice nursing as a primary care solution — not just a specialty add-on — reinforces the case for RNs considering the NP track as a career pivot. The global trajectory is toward more autonomy, not less. That doesn't change what the state board says in South Carolina or Georgia today, but it does suggest that practice authority restrictions are a policy lag, not a permanent ceiling.
For RNs weighing the investment in an NP program, PAHO's data on access improvement in rural areas is worth holding onto for the "why does this matter" file. When you're sitting across from a physician colleague who argues that NPs need supervision for patient safety reasons, the PAHO announcement — backed by data from 100+ countries — is a useful rebuttal. The evidence is not ambiguous. Countries and states that have expanded APRN autonomy have not seen adverse outcomes. They've seen improved access.
The practical implication for nurses currently in or considering NP programs: pay attention to where your target state sits on the full practice authority spectrum, and factor that into your program and specialty selection. A psychiatric-mental health NP in a restricted practice state faces a very different practice environment than the same credential in a full practice authority state. PAHO's announcement doesn't change that today. But it adds to the accumulating international evidence that the holdout position is indefensible — and eventually, state legislatures respond to that kind of evidence.