Research Article| Volume 66, ISSUE 4, P379-385, July 2018

The impact of nurse practitioner regulations on population access to care


      • People living in states with independent nurse practitioner (NP) regulations had <30-min drive to their primary health care practice.
      • In states with restrictive NP practice, NPs are geographically colocated with supervising MDs.
      • Restricted NP practice limits their ability to provide care in areas that lack access to primary health-care providers.
      • In states with restrictive NP regulations, NPs are not practicing to their full scope of practice.



      By 2025, experts estimate a significant shortage of primary care providers in the United States, and expansion of the nurse practitioner (NP) workforce may reduce this burden. However, barriers imposed by state NP regulations could reduce access to primary care.


      The objectives of this study were to examine the association between three levels of NP state practice regulation (independent, minimum restrictive, and most restrictive) and the proportion of the population with a greater than 30-min travel time to a primary care provider using geocoding.


      Logistic regression models were conducted to calculate the adjusted odds of having a greater than 30-min drive time.


      Compared with the most restrictive NP states, states with independent practice had 19.2% lower odds (p = .001) of a greater than 30-min drive to the closest primary care provider.


      Allowing NPs full autonomy to practice may be a relatively simple policy mechanism for states to improve access to primary care.


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