State-Granted Practice Authority: Do Nurse Practitioners Vote with Their Feet?

Abstract

Nurse practitioners have become an increasingly important part of the US medical workforce as they have gained greater practice authority through state-level regulatory changes. This study investigates one labor market impact of this large change in nurse practitioner regulation. Using data from the National Sample Survey of Registered Nurses and a dataset of state-level nurse practitioner prescribing authority, a multivariate estimation is performed analysing the impact of greater practice authority on the probability of a nurse practitioner moving from a state. The empirical results indicate that nurse practitioners in states that grant expanded practice are less likely to move from the state than nurse practitioners in states that have not granted expanded practice authority. The estimated effect is robust and is statistically and economically meaningful. This finding is in concert with and strengthens the wider literature which finds states that grant expanded practice authority to nurse practitioners tend to have larger nurse practitioner populations.

Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review

“…Consistent with these findings, states with regulations granting NPs independent practice or prescription authority had 30% and 13% higher enrollments in APRN programs, respectively (Kalist & Spurr, 2004). In addition, state SOP regulation has been associated with NPs' migration, with NPs more likely to move from states without controlled substances prescription authority to states with this authority (Perry, 2012).…”

The impact of state nurse practitioner scope-of-practice regulations on access to primary care in health professional shortage areas

“…[8][9][10] NPs can provide many of the basic health services that PCPs provide at similar or even better quality and are effective substitutes for PCPs. 2,[10][11][12] However, NPs face barriers that limit their ability to provide many of the primary care services they have been trained to i "Primary care is first-contact, continuous, comprehensive, and coordinated care provided to populations undifferentiated by gender, disease, or organ system". 3 Primary care services are essential health services and encompass such services as "health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of" common and uncomplicated illnesses.…”

“…NPs are not only effective substitutes for PCPs in that they can deliver similar quality of care, but they are also more cost-effective providers of health services. 2,[10][11][12] Furthermore, despite significant investments in programs to increase PCP supply in primary care HPSAs, 23,24 these programs have had limited success in ensuring the long-term retention of physicians in these areas. 25,26 Unlike these programs, removing NP SOP restrictions as a solution to access issues in HPSAs would not require any significant funding to implement as it only empowers NPs to do what they have already been trained to do.…”

“…[50][51][52] Despite the lower costs associated with NP care, NPs achieve similar or even better care quality and outcomes compared to PCPs. 2,[10][11][12] Although increased use of NPs poses a more cost-effective and long-term solution to PCP shortages, the majority of states in the U.S. continue to limit the ability of NPs to improve access to primary care by imposing various regulatory restrictions on their SOP. These SOP restrictions that prevent NPs from providing services they have been trained to provide hinder the nation's ability to address access to primary care issues in HPSAs through maximization of NP use.…”

“…104 Removing NP SOP restrictions drives NP supply growth through increased enrollment in NP programs and positive net migration of NPs. 12,105 States with less restrictive SOP regulations witnessed higher enrollments in APRN programs compared to states with more restrictive regulations. 105 This increase in enrollment was up to 30 percent greater in states where APRNs had greater autonomy compared to states where APRNs had less autonomy.…”