Nurse practitioners’ workforce outcomes under implementation of full practice authority

DePriest, Kelli; D’Aoust, Rita; Samuel, Laura; Commodore‐Mensah, Yvonne; Hanson, Ginger C.; Slade, Eric P.

doi:10.1016/j.outlook.2020.05.008

Cited by 25 publications

(23 citation statements)

References 15 publications

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“…The clinical consequences of living in HPSAs include a higher risk of under-diagnosis and suboptimal management of chronic diseases ( Durant et al, 2012 ). However, in states where full practice authority laws are in place, NPs are more likely to reside within HPSAs and have their own practices there, thus improving access to primary care for underserved populations ( DePriest et al, 2020 ).…”

Section: Impact Of Np Full Practice Authoritymentioning

confidence: 99%

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

et al. 2022

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A sudden growth in the need for health care services during the COVID-19 pandemic has exposed the vulnerabilities of our health care system, particularly a shortage of adequately trained health care providers. Federal and state governments responded by removing the scope of practice restrictions on nurse practitioners (NPs), allowing them to deliver care to patients without restrictions. NP full practice authority could be part of a longer-term plan to address healthcare inequities and deficiencies rather than merely a crisis measure. However, the changes to support full practice authority that were enacted to address COVID-19 are temporary and will be reversed when the executive orders expire. To support policy makers’ efforts to grant full practice authority to NPs beyond the COVID-19 pandemic, this manuscript summarizes the existing evidence on the benefits of permanently removing state-level scope of practice barriers and outline specific recommendations for policy, practice, and research.

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Section: Impact Of Np Full Practice Authoritymentioning

confidence: 99%

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

et al. 2022

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“…NPs are poised to improve primary care delivery in HPSAs for patients whose chronic medical needs are exacerbated by limited primary care access and socioeconomic barriers to obtaining care such as education, housing, or transportation needs (Streeter et al, 2020). Indeed, compared to physicians, NPs are more likely to reside and practice in HPSAs in states with full scope of practice regulation where NPs can independently evaluate, diagnose, interpret tests, and treat patients (AANP, 2021;DePriest et al, 2020;Xue et al, 2018).…”

Section: Optimizing the Nurse Practitioner Workforcementioning

confidence: 99%

“…Further, in states with full scope of practice regulation where NPs can independently evaluate, diagnose, interpret tests, and treat patients, NPs are more likely to practice and reside in HPSAs compared to physicians (DePriest et al, 2020;Xue et al, 2018). Full scope of practice regulation for NPs is also associated with an approximate 30% increase in yearly checkups in HPSAs (Traczynski & Udalova, 2018).…”

Section: Introductionmentioning

confidence: 99%

Primary Care Practice Structural Capabilities and Emergency Department Utilization Among High-Need High-Cost Patients

et al. 2022

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Primary Care Practice Structural Capabilities and Emergency Department Utilization Among High-Need High-Cost Patients Ani Bilazarian BackgroundPrimary care practices in the United States (US) are currently constrained in their ability to deliver high quality care due to population aging, insurance expansion, and an increasing prevalence of chronically ill patients. The nurse practitioner (NP) workforce plays a critical role in meeting the growing demands for primary care, particularly in rural and underserved areas.NPs are also more likely to deliver care to clinically and socially complex populations such as high-need high-cost (HNHC) patients. HNHC patients are adults who suffer from multiple chronic conditions and experience additional functional, behavioral, or socioeconomic needs.Despite comprising only 5% of the US population, HNHC patients account for nearly half of total health care expenditures and over 90% of Medicare expenditures. HNHC patients with behavioral health diagnoses such as depression or substance abuse face heightened challenges managing their conditions and consequentially have higher preventable spending and emergency department (ED) utilization compared to the overall HNHC population.Significant policy attention has been placed on enhancing primary care practices as a strategy to improve outcomes and reduce costs in HNHC patients. Structural capabilities are features of primary care practices (e.g., after-hours care or care coordination) which are needed to deliver high quality primary care and chronic disease management. Yet, to date little research has been done on structural capabilities in primary care practices where NPs deliver care to HNHC patients. The overall purpose of this dissertation is to understand how to enhance primary care delivery and structural capabilities to improve outcomes for HNHC patients. We have achieved the following specific aims: (1) Establish a clear definition of HNHC patients, (2) Identify existing primary care and payment models used among HNHC patients and evaluate their impact on ED utilization and costs, (3) Evaluate structural capabilities in NP primary care practices located in Health Professional Shortage Areas (HPSAs), and ( 4) Analyze the association between NP practice structural capabilities and ED utilization among HNHC patients with behavioral health conditions. Dissertation Chapters and Key FindingsChapter One includes an introduction to the landscape of current primary care delivery, the role of the NP workforce in expanding access, and the unique challenges of delivering care to HNHC patients. This chapter also discusses the conceptual framework guiding the dissertation, the specific aims of each study, and how each study will fill a gap in the literature.Chapter Two (Aim 1) consists of a concept analysis of HNHC patients using the Walker and Avant framework. Three subgroups of HNHC patients were identified: adults over the age of 65 who suffer from multiple chronic conditions with functional or behavioral health needs, the frail elderly,...

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“…The PRIME-NP Model reflects the unique contributions of the NPs' role and objective validation of competency upon program exit. The number of NPs in the U.S. is increasing for several reasons: provider shortages, aging populations, and favorable changes in state practice laws and reimbursement (Auerbach et al, 2018;DePriest et al, 2020). Substantial evidence predicts a 28% increase in the demand for NPs over the next decade (Bureau of Labor Statistics [BLS], 2020) (Bureau of Labor Statistics, U.S. Department of Labor 2020).…”

Section: Introductionmentioning

confidence: 99%

A competency roadmap for advanced practice nursing education using PRIME-NP

et al. 2022

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Nurse practitioners’ workforce outcomes under implementation of full practice authority

Cited by 25 publications

References 15 publications

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

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

Primary Care Practice Structural Capabilities and Emergency Department Utilization Among High-Need High-Cost Patients

A competency roadmap for advanced practice nursing education using PRIME-NP

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