Abstract
Background
One proposed strategy to expand primary care capacity is to use nurse practitioners
(NPs) more effectively in health care delivery. However, the ability of NPs to provide
care to the fullest extent of their education is moderated by state scope-of-practice
(SOP) regulations.
Purpose
The purpose of this study was to examine the impact of state SOP regulations on the
following three key issues: (a) NP workforce, (b) access to care and health care utilization,
and (c) health care costs.
Methods
Systematic review.
Results/Discussion
States granting NPs greater SOP authority tend to exhibit an increase in the number
and growth of NPs, greater care provision by NPs, and expanded health care utilization,
especially among rural and vulnerable populations. Our review indicates that expanded
NP practice regulation can impact health care delivery by increasing the number of
NPs in combination with easing restrictions on their SOP.
Conclusions
Findings show promise that removing restrictions on NP SOP regulations could be a
viable and effective strategy to increase primary care capacity.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Nursing OutlookAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The AcademyHealth Listening Project: Improving the evidence base for Medicaid policymaking.2015 (Retrieved from)
- Health care reform and primary care—The growing importance of the community health center.The New England Journal of Medicine. 2010; 362: 2047-2050
- State practice environment: States categorized by type.2015 (Retrieved from)
- Nurse practitioners and primary care physicians: Complements, substitutes and the impact of managed care.Harvard Health Policy Review. 2000; 1: 83-94
- Nurse-managed health centers and patient-centered medical homes could mitigate expected primary care physician shortage.Health Affairs (Millwood). 2013; 32: 1933-1941
- Confronting the growing burden of chronic disease: Can the U.S. health care workforce do the job?.Health Affairs (Millwood). 2009; 28: 64-74
- Economic benefits of less restrictive regulation of advanced practice nurses in North Carolina.Nursing Outlook. 2015; 63: 585-592
- Usual source of care as a health insurance substitute for U.S. adults with diabetes?.Diabetes Care. 2009; 32: 983-989
- It is time to restructure health professions scope-of-practice regulations to remove barriers to care.Health Affairs (Project Hope). 2013; 32: 1971-1976
- Trends in care by nonphysician clinicians in the United States.The New England Journal of Medicine. 2003; 348: 130-137
- The practice boundaries of advanced practice nurses: An economic and legal analysis.Journal of Regulatory Economics. 2005; 27: 309-329
- Trends in state regulation of nurse practitioners and physician assistants, 2001 to 2010.Medical Care Research and Review: MCRR. 2015; 72: 200-219
- How will the Affordable Care Act affect the use of health care services?.The Commonwealth Fund VolNo. (February 2015), 2015 (xx-xx)
- Who is caring for the underserved? A comparison of primary care physicians and nonphysician clinicians in California and Washington.Annals of Family Medicine. 2003; 1: 97-104
- Nurse-managed health centers.The American Journal of Nursing. 2010; 110: 23-26
- Projecting the supply and demand for primary care practitioners through 2020.U.S. Department of Health and Human Services, Rockville, Maryland2013
- Modifying state laws for nurse practitioners and physician assistants can reduce cost of medical services.Nursing Economic$. 2015; 33: 88-94
- Seven million Americans live in areas where demand for primary care may exceed supply by more than 10 percent.Health Affairs (Millwood). 2013; 32: 614-621
- The impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department—A systematic review.International Journal of Nursing Studies. 2015; 52: 421-435
- The effect of state laws on the supply of advanced practice nurses.International Journal of Health Care Finance and Economics. 2004; 4: 271-281
- Understanding APRN distribution in the United States using NPI data.The Journal for Nurse Practitioners: JNP. 2012; 8: 626-635
- The adoption of provider-based rural health clinics by rural hospitals: A study of market and institutional forces.Health Service Research. 1999; 34: 33-60
- Community health centers employ diverse staffing patterns, which can provide productivity lessons for medical practices.Health Affairs (Millwood). 2015; 34: 95-103
- States with the least restrictive regulations experienced the largest increase in patients seen by nurse practitioners.Health Affairs (Millwood). 2013; 32: 1236-1243
- Improving the management of chronic disease at community health centers.The New England Journal of Medicine. 2007; 356: 921-934
- The geographic distribution of nurse practitioners in the United States.Applied Geographic Studies. 1997; 1: 287-301
- Nurse practitioners, physician assistants, and physicians in community health centers, 2006–2010.Healthcare. 2015; 3: 102-107
- The state of state health policy: Governors' state of the state addresses.2015 (Retrieved from)
- America's health centers.2014 (Retrieved from)
- APRNs in the U.S.2014 (Retrieved from)
- The role of nurse practitioners in meeting increasing demand for primary care.2012 (Retrieved from)
- The role of nurse practitioners in reinventing primary care.Health Affairs (Millwood). 2010; 29: 893-899
- Restrictive practice environment and nurse practitioners' prescriptive authority.Journal of the American Academy of Nurse Practitioners. 1997; 9: 9-15
- Improving access to adult primary care in Medicaid: Exploring the potential role of nurse practitioners and physician assistants.2011 (Retrieved from)
- The concept of access: Definition and relationship to consumer satisfaction.Medical Care. 1981; 19: 127-140
- State-granted practice authority: Do nurse practitioners vote with their feet?.Nursing Research Practice. 2012; 2012: 482178
- The rise and impact of nurse practitioners and physician assistants on their own and cross-occupation incomes.Contemporary Economic Policy. 2009; 27: 491-511
- Nurse practitioner role, independent practice, and teamwork in primary care.The Journal for Nurse Practitioners: JNP. 2014; 10: 472-479
- Revisiting scope of practice facilitators and barriers for primary care nurse practitioners: A qualitative investigation.Policy, Politics & Nursing Practice. 2013; 14: 6-15
- Unleashing nurse practitioners' potential to deliver primary care and lead teams.Health Affairs (Millwood). 2010; 29: 900-905
- The effects of state-level scope-of-practice regulations on the number and growth of nurse practitioners.Nursing Outlook. 2013; 61: 392-399
- Practice environment and the employment of nurse practitioners, physician assistants, and certified nurse midwives by community health centers.Journal of Allied Health. 1997; 26: 105-111
- How many nurse practitioners provide primary care? It depends on how you count them.Medical Care Research and Review: MCRR. 2015; 72: 359-375
- Scope-of-practice laws for nurse practitioners limit cost savings that can be achieved in retail clinics.Health Affairs (Project Hope). 2013; 32: 1977-1984
- How does provider supply and regulation influence health care markets? Evidence from nurse practitioners and physician assistants.Journal of Health Economics. 2014; 33: 1-27
- Highlights from the 2012 National Sample Survey of Nurse Practitioners.U.S. Department of Health and Human Services, Rockville, Maryland2014
- Primary care workforce shortages: Nurse practitioner scope-of-practice laws and payment policies.(Research Brief (Vol. 13)) National Institute for Health Care Reform, ; Washington, DC2013
Article info
Publication history
Published online: September 09, 2015
Accepted:
August 30,
2015
Received in revised form:
August 10,
2015
Received:
May 19,
2015
Identification
Copyright
© 2016 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
