In this May 2016 article published in the Online Journal of Issues in Nursing, Dr. Nancy Rudner Lugo argues that advanced practicing nursing viewed through a gendered perspective due to nursing's history as a predominantly female profession; because of this, APRNS in states that are less accepting of women's equality have a more narrow scope of practice. There is not currently a national-level evidence based method used to determine APRN scope, and is instead decided at the state level. The author seeks to explain the cause of the discrepancy between differing APRN scopes of practice in different states by comparing the APRN scope of practice between states that did and did not vote to pass the Equal Right Amendment, positing that states with cultural attitudes that are more equitable between genders reflect this at the legislative level, thus explaining the wider or full practice authority given to APRNs in these states. In conclusion, Lugo advocates for increasing the number of women in legislative positions, forming relationships between women's equality organizations and groups working towards expanded health care access, and emphasizing the skills and competency of APRNs in achieving positive patient health outcomes.