Because each state independently determines the APRN scope of practice, vaguely worded SPAs describing the APRN scope of practice, e.g., as acts of advanced nursing practice may undermine the course of action for future practices. Interpreters can manipulate descriptions of what constitutes these acts. It may be construed strictly as providing nursing services and, therefore, will not provide a strong legal basis for arguing that APRNs should be paid a full-service rate for providing medical services. It is apparently difficult to argue to state legislators and politicians that acts of advanced nursing practice parallel acts of medical performance.