Implementing the ACA: The Influence of Nurse Practitioner Regulatory Policies on Workforce, Access to Care, and Primary Care Health Outcomes

Abstract

The Patient Protection and Affordable Care Act P.L. 111–148 (ACA) was projected to expand health insurance to about 32 million people by 2014. This influx presents significant pressures for primary health care providers (PCP) at a time when there is already a PCP shortage. The associations among prevention, equity, healthy environments, nurse practitioner (NP) regulatory policies, and access to primary care are well documented in the literature. This article presents relationships among NP scope of practice regulations in the 50 states and the District of Columbia and their potential impact on population health outcomes. Utilizing correlation and multiple regression analyses, this study identifies modest but significant associations. In accordance with Institute of Medicine (2011) recommendations, the authors suggest successful implementation of the ACA requires modernization and standardization of existing NP practice regulatory policies in order to build primary care capacity, increase access, and improve population health.

Does State-Level Nurse Practitioner Scope-of-Practice Policy Affect Access to Care?

“…The results of most studies showed a positive association between less restrictive NP SOP policy and NP workforce capacity. However, Sonenberg et al (2015) reported no significant association between NP SOP policy and number of NPs licensed to practice per 100,000 population. And Sonenberg and Knepper (2017) reported more NPs per 100,000 residents in a state with more restrictive NP SOP policies compared with two states with less restrictive NP SOP policies.…”

“…NP SOP and characteristics of the health delivery system. Eight studies addressed the relationships between NP SOP policy and the characteristics of the health delivery system by addressing characteristics of the NP workforce (Barnes et al, 2017;DesRoches et al, 2013;Graves et al, 2016;Kuo et al, 2013;Poghosyan et al, 2015;Reagan & Salsberry, 2013;Sonenberg & Knepper, 2017;Sonenberg et al, 2015). NPs were more likely to work in PC, bill Medicare, or practice in states with the least restrictive NP SOP policies (Barnes et al, 2017;DesRoches et al, 2013;Graves et al, 2016;Kuo et al, 2013;Reagan & Salsberry, 2013).…”

Benefits of Less Restrictive Regulation of Advance Practice Registered Nurses in Florida

“…In 2012 NPs comprised 20% of primary care providers in the United States (Poghosyan et al, 2013). NPs are more likely than physicians to practice in underserved areas (Hansen-Turton, Ware, & McClellan, 2010;Newhouse et al, 2011;Sonenberg, Knepper, & Pulcini, 2015). Between 2006 and 2010 21% of patient visits to community health centers were to NPs (Morgan, Everett & Hing, 2014).…”

The Pursuit of Nurse Practitioner Practice Legislation: A Case Study

“…Full practice authority (FPA) is the “the authorization of NPs to evaluate patients, diagnose, order and interpret diagnostic tests and initiate and manage treatments – including prescribe medications – under the exclusive authority of the state board of nursing” (American Association of Nurse Practitioners [AANP], 2019, p. 1). Empowering NPs to practice to the full extent of their education and training by granting them FPA is one method to help ease projected shortages in primary care and increase access to health care, particularly in rural and historically underserved areas and populations (Ortiz et al., 2018; Sonenberg et al., 2015; Xue et al., 2018). Restrictive regulations limit the efficiency with which states can respond during a declared state of emergency such as the coronavirus disease 2019 (COVID-19) pandemic (Bayne et al., 2020).…”

“…Legislative changes that update and standardize NP scope of practice (SOP) regulations are needed to promote patient choice in health care providers and access to care in the United States (Azar et al., 2018; Institute of Medicine, 2010). Many states have revised nursing practice acts (NPAs) to facilitate FPA for NPs and other APRNs (National Council of State Boards of Nursing [NCSBN], 2020b); however, regulation remains inconsistent across the country (Brom et al., 2018; Sonenberg et al., 2015). Outdated, restrictive SOP regulations for NPs that remain inhibit competition among health care providers and can lead to decreased access to health care services and decreased innovation in health care delivery (Azar et al., 2018; Federal Trade Commission, 2014).…”