State Nurse Practitioner Practice Regulations and U.S. Health Care Delivery Outcomes: A Systematic Review

Abstract

There is a great variation across states in nurse practitioner (NP) scope of practice moderated by state regulations. The purpose of this study was to synthesize the evidence from studies of the impact of state NP practice regulations on U.S. health care delivery outcomes (e.g., health care workforce, access to care, utilization, care quality, or cost of care), guided by Donabedian’s structure, process, and outcomes framework. This systematic review was performed using Medline, CINAHL, PsycINFO, and PubMed according to Preferred Reporting Items for Systematic and Meta-Analysis on the literature from January 2000 to August 2019. The results indicate that expanded state NP practice regulations were associated with greater NP supply and improved access to care among rural and underserved populations without decreasing care quality. This evidence could provide guidance for policy makers in states with more restrictive NP practice regulations when they consider granting greater practice independence to NPs.

Leveraging nurse practitioner capacities to achieve global health for all: COVID‐19 and beyond

“…Also specific specialty NP data show examples of positive outcomes for residents in long‐term care facilities (Kilpatrick et al 2020), patients presenting with chest pain in rural areas (Roche et al 2017), patients in need of morphine to manage serious health‐related suffering in low‐income countries (Knaul et al 2018) and patients needing antiretroviral initiation and re‐prescription in primary care clinics in resource‐poor health clinics (Fairall et al 2012). Systematic analyses suggest NP performance leads to comparable physician outcomes with improved access for rural and remote populations and increased cost‐effectiveness (Horrocks et al 2002; Martin‐Misener et al 2015; Yang et al 2020). NPs also demonstrate high rates of patient satisfaction, spend more consultation time with patients and are likely to have an increased number of return visits when compared to other primary care providers (Laurant et al 2018).…”

State responses to COVID-19: Potential benefits of continuing full practice authority for primary care nurse practitioners

“…Increased access to NP care can expand the primary care workforce and help address the increasing care needs of our aging population. Other studies have shown that granting NPs full practice authority led to reductions in costs in some settings but certainly did not lead to systematic increases in costs ( Yang et al, 2020 ; Poghosyan, Timmons, Abraham, & Martsolf, 2019 ).…”

“…Studies consistently demonstrate that expanding SOP policies to support the full practice authority of NPs helps increase access to high-quality healthcare ( Buerhaus, DesRoches, Dittus, & Donelan, 2015 ; DesRoches et al, 2013 ; Yang et al, 2020 ). When supervision or collaboration is required under law, it creates unnecessary access roadblocks which NPs are forced to address to care for patients ( Xue et al, 2019 ).…”

The Effect of Supervision Waivers on Practice

“…23 – 26 The evidence does not support this position, but rather shows that restrictions are associated with lower access to care, especially for vulnerable populations and are not associated with improvements in quality. 27 …”