To What Extent Are State Scope of Practice Laws Related to Nurse Practitioners’ Day-to-Day Practice Autonomy?

Abstract

We explore the extent to which state scope of practice laws are related to nurse practitioners (NPs)' day-to-day practice autonomy. We found that NPs experienced greater day-to-day practice autonomy when they had prescriptive independence. Surprisingly, there were only small and largely insignificant differences in day-to-day practice autonomy between NPs in fully restricted states and those in states with independent practice but restricted prescription authority. The scope of practice effects were strong for primary care NPs. We also found that the amount of variation in day-to-day practice autonomy within the scope of practice categories existed, which suggests that factors other than state scope of practice laws may influence NP practice as well. Removing barriers at all levels that potentially prevent NPs from practicing to the full extent of their education and training is critical not only to increase primary care capacity but also to make NPs more efficient and effective providers.

Understanding Why Nurse Practitioner (NP) and Physician Assistant (PA) Productivity Varies Across Community Health Centers (CHCs): A Comparative Qualitative Analysis

“…The interviews revealed that health care organizations are still learning how to manage their increasingly diversified clinical staff and are open to learning better practices. This is consistent with a growing body of research showing that organizational practices are key to determining how APCs are used (Park et al, 2018; Park et al, 2020; Pittman et al, 2018; Poghosyan, Nannini, Smaldone, et al, 2013, Poghosyan, Nannini, Stone, et al, 2013).…”

“…Research has shown that organizational factors matter more than the SOP regulations in both hospitals (Pittman et al, 2018), and in CHCs (Park et al, 2020). This is consistent with an increasingly strong theme emerging from recent research that organizational policies are essential to how NPs and PAs are utilized (Park et al, 2018; Poghosyan, Nannini, Smaldone, et al, 2013, Poghosyan, Nannini, Stone, et al, 2013).…”

Trends in Primary Care Provision to Medicare Beneficiaries by Physicians, Nurse Practitioners, or Physician Assistants: 2008-2014

“…The rate of incident billing was lower in these states compared to states with reduced or restricted NP practice authority. 31 We found consistent results. Third, we were unable to calculate patient panel size due to the limitation that the data is a 5% random sample, which would otherwise provide a more thorough picture of the capacity of the primary care model.…”

Barriers to the Implementation of the Advanced Practice Nursing Role in Primary Health Care Settings: An Integrative Review

“…The APN role implementation is complex and requires prior planning in order to introduce the role and clarify the difference between their role and other professionals. Removing the barriers that prevent APNs from practicing to their full scope is very important to expand services of PHC and to make them more effective and efficient providers of care (Park et al, 2016). Whittemore and Knafl's (2005) integrative review framework was chosen to guide this review.…”