Implications of Scope of Practice Reform for Advanced Practice Registered Nurses

Session Submission Type: Panel

Abstract

The United States faces a growing shortage of healthcare providers. A potential policy solution to this problem is to expand the practice authority of nonphysician providers such as advanced practice registered nurses (APRNs). Doing so increases the independence of APRNs in the healthcare system, which has numerous implications for access to care, healthcare delivery, subsequent health outcomes, and general well-being. This panel features four papers that explore the implications of scope of practice reform for APRNs.

In the first paper, Mary Motolenich, Moiz Bhai, and Danny Hughes study the effect of full practice authority (FPA) for certified nurse midwives (CNMs) on delivery of care during a pregnancy episode. They find that FPA for CNMs improves access to prenatal care, and there are no adverse effects on pregnancy health outcomes such as preterm births and maternal mortality.

In the second paper, Mitch Mitchell, Todd Nesbit, Lu Wang document the effect of FPA for nurse practitioners (NPs) and NP school density on dispersion patterns of newly graduating NPs. They find that FPA for NPs and higher NP school density increases the dispersion of NPs into rural and underserved areas, driven by job matching opportunities in states with FPA.

In the third paper, Owen Fleming and Lilly Springer study the spillover effects of FPA for NPs on participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). They find that FPA for NPs increases long-run WIC participation, driven by reductions in information costs and stigma associated with WIC enrollment.

Collectively, these papers explore the effect of scope of practice reform along several dimensions and using a diverse set of data and methods. In general, the authors find that scope of practice expansions yield significant improvements in access to care, health outcomes, and well-being, especially for underserved populations. In that sense, the results inform policymakers as to how scope of practice reform can be an effective policy measure for alleviating healthcare provider shortages.

Policy Area

• Health Policy

Chair

• Bianca Frogner, University of Washington

Discussants

• Victoria Elizabeth Bethel, University of Georgia

• Salpy Kanimian, Rice University

Organizer

• Owen Michael Fleming, Wayne State University

Individual Presentations

• Healthcare Provider Regulations and Maternal Health: Linking Access to Pregnancy Outcomes - Presenting Author: Moiz Bhai, University of Arkansas; Non-Presenting Co-Author: Danny Hughes, Arizona State University

• The Role of State Practice Authority and Educational Infrastructure in Nurse Practitioner Dispersion Patterns - Presenting Author: David Mitchell, Baltimore City Public Schools

• The Spillover Effects of NP Scope of Practice Expansions on Safety Net Participation: Evidence from WIC - Presenting Author: Owen Michael Fleming, Wayne State University; Non-Presenting Co-Author: Lilly Springer, University of Kansas

• Expanding Nurse Practitioner Authority: Effects on Provider Composition, Continuity of Care, and Patient Outcomes in Medicare - Presenting Author: Jessica Lu, Cornell University