The geographic distribution of nurse practitioners in the United States

Abstract

This study analyzed the geographic distribution of nurse practitioners in the United States. Primary data on nurse practitioners were obtained from State Boards of Nursing and the District of Columbia in the spring of 1994. At the state level, nurse practitioners were more concentrated in urban areas than their physician counterparts. Of the 33,094 certified nurse practitioners, 85% were in metropolitan areas. Results from the dissimilarity indices between nurse practitioners and general populations showed that a greater supply of nurse practitioners in a state may not necessarily lead to an equitable distribution across counties. At both the state and county levels, the supply of nurse practitioners was positively associated with the supply of primary care physicians. Results from multivariate analyses show that nurse practitioners were more likely to locate in a county where state laws allowed independent practice. States that allow independent practice and direct third-party reimbursement will likely have greater availability and a larger supply of nurse practitioners in rural counties.

Cultivating the Role of Nurse Practitioners in Providing Primary Care to Vulnerable Populations in an Era of Health-Care Reform

“…Little is known about the geographic distribution of NPs, nationally, in relation to vulnerable population areas or the factors affecting this distribution (Everett, Schumacher, Wright, & Smith, 2009; Grumbach, Hart, Mertz, Coffman, & Palazzo, 2003; Morgan et al., 2015). Two published studies have examined the distribution of NPs nationally, and both found great variation in their concentration across states and counties (Lin, Burns, & Nochajski, 1997; Skillman, Kaplan, Fordyce, McMenamin, & Doescher, 2012). State-level NPs per capita ranged from 1.7 to 8 per 10,000 population in urban areas and from 1.2 to 7.7 per 10,000 population in rural areas, with the highest concentrations in states in the New England and West regions (Skillman et al., 2012).…”

Satisfaction With Practice in a Rural State: Perceptions of Nurse Practitioners and Nurse Midwives

“…In rural areas, the ratio of primary care providers to population is lower than it i s in urban areas for both NPs and generalist physicians (Hanson, 1992;O'Neil, Seifer, & Kahn, 1993). However, in some states, the rural NP ratio is slightly higher than the rural physician ratio (Lin, Burns, & Nochajski, 1996). Many factors, such as restraint of trade, low reimbursement, licensing regulations, and the maldistribution of needed colleagues, constrain states from realizing the full potential of NPs and CNMs to meet the needs of all their citizens (Inglis & Kjervik, 1993;Jones 8c Cawley, 1994;Nichols, 1992;Timmons & Ridenour, 1994).…”

“…Regulation of health professions varies from state to state (Burns, 1996;Henderson & Chovan, 1994;Pearson, 1996). Compared with other states in 1993, Maine's practice environment was found to be very restrictive (Lin et al, 1996;Nurse practitioners, 1995;Sekscenski et al, 1994). Regulations were reasonably permissive by allowing prescriptive privileges for eligible NPs and nurse midwives, but restrictive by not mandating reimbursement by third-party payers, requiring regulation by the Board of Medicine (or Osteopathy), and not allowing independent or even collaborative practice.…”

“…They also found that greater restrictiveness was associated with higher death rates and greater health care costs, but this association did not depend on lower or higher NP to population ratios. Rural states have been identified as less restrictive than urban states; however, Maine varied from these patterns by being very rural and very restrictive, but having a higher than average ratio of NPs and CNMs to population (Burns, 1996;Lin et al, 1996;Sekscenski et al, 1994). Many states are in the process of reevaluating their nurse practice acts and regulations, and in Maine, a 1995 law redefined the advanced practice nurse's role and qualifications, providing for independent practice and returning control of the regulations to the Board of Nursing.…”

Geographical thinking in nursing inquiry, part one: locations, contents, meanings

“…A long-term consideration being area-based social determinants of health (Bushy, 1990;Edgecombe, 1999), another being distributive features of nursing workforces, including career movements. With regard to the latter, distributive features include both experiential aspects and the social, political, and economic forces that shape them at local (Brodie et al, 2005), national (Lin et al, 1997;Radcliffe, 1999;Courtney, 2005;Kovner et al, 2011;Andrews et al, 2013;Harris et al, 2013;McGillis Hall et al, 2013;Cho et al, 2014), and international and global scales (Buchan et al, 1997;Buchan, 2001;Kingma, 2001Kingma, , 2006Kingma, , 2007Kingma, , 2008Kline, 2003;Aiken et al, 2004;Ross et al, 2005;Brush & Sochalski, 2007;McGillis Hall et al, 2009;Bach, 2015;George, 2015). A third consideration meanwhile is the distributive qualities and concerns of particular client and population groups nurses have responsibility for (see Gesler et al, 2004;Moss & Schell, 2004;Hodgins & Wuest, 2007;Thomas, 2013a).…”