Do transition to practice hour requirements make a difference in adverse action and medical malpractice payment reports: An analysis from the National Practitioner Data Bank

Abstract

ABSTRACT Background: The transition to practice (TTP) hour requirement presents a barrier to full practice authority (FPA) for nurse practitioners (NPs). Since 2015, the predominant method of granting FPA entails a TTP hour requirement. Purpose: Adverse action reports (AARs) and medical malpractice payment reports (MMPRs) of NPs were compared in states with FPA on initial licensure and states with FPA requiring a TTP hour period using data from the National Practitioner Data Bank (NPDB). The relationship of TTP hours to AARs and MMPRs was also evaluated. Methodology: A secondary analysis was obtained from a review of retrospective data in the NPDB. States examined were those that grant FPA on initial advanced practice registered nurse licensure and states that require a TTP hour requirement as part of their criteria for granting FPA. Results: In a 5-year period, postimplementation of FPA or 5-year postexpiration of the TTP requirement in 23 states, plus the District of Columbia, revealed that states with FPA granted on initial licensure demonstrated a lower incidence of AARs and MMPRs at the 5-year period compared with states that require a TTP hour period. No relationship existed between the amount of TTP hours and the incidence of AARs and MMPRs. Conclusion: Transition to practice hours remains a barrier to NPs achieving FPA. It is important for nursing to continue to build the body of evidence that refutes or supports the need for TTP hours. Implications: These data can be used when lobbying at the state level in the remaining states seeking FPA.