Nurse Practitioner Scope Of Practice Research Articles

Nurse practitioner scope of practice and patient harm: Evidence from medical malpractice payouts and adverse action reports

AbstractMany states have recently changed their scope of practice laws and granted full practice authority to nurse practitioners, allowing them to practice without oversight from physicians. Physician groups have argued against this change, citing patient safety concerns. In this paper, we use a ratio‐in‐ratio approach to evaluate whether the transition to full practice authority results in harm to patients as proxied by malpractice payouts and adverse action reports against nurse practitioners. We find no evidence of such harm, and instead find that physicians may benefit from the law change in terms of reduced paid malpractice cases against them.

Nurse Practitioner Scope of Practice and Patient Harm: Evidence from Medical Malpractice Cases and Adverse Action Reports

Nurse Practitioner Scope of Practice and Patient Harm: Evidence from Medical Malpractice Cases and Adverse Action Reports

A Pandemic, Not a Panacea

A Pandemic, Not a Panacea

An Update on Billing and Coding for the Psychiatric-Mental Health Nurse Practitioner.

Nurse practitioners (NPs) possess expert clinical knowledge that can be optimized to ensure delivery of high-quality care. In the United States, NP scope of practice is generally expanding. With expanding scope of practice comes increased revenue potential, and in some cases, entrepreneurial opportunities for NPs. Therefore, NPs must be familiar with current procedural terminology codes to ensure appropriate billing and maximize reimbursement from payers. [Journal of Psychosocial Nursing and Mental Health Services, 60(2), 11-13.].

Nurse practitioner scope of practice and the prevention of foot complications in rural diabetes patients.

Diabetic foot ulcers afflict a quarter of type-2 diabetes mellitus patients and are associated with higher mortality rates among people with diabetes. Routine primary and preventive care is essential to both prevent and treat foot ulcers before they can contribute to further adverse outcomes. One approach for expanding this care to people with diabetes in rural communities is increasing the practice authority of nurse practitioners. This study examines whether the presence of nurse practitioner practice authority is associated with fewer foot ulcer complications in rural populations as measured through the incidence of foot debridement-a common procedure for addressing severe diabetic foot ulcers. This study uses medical claims to estimate the incidence of foot debridement for US counties. A multivariable linear regression was performed to examine the association between nurse practitioner practice authority and the county incidence of foot debridement after adjusting for measures of local health care workforce and sociodemographics. Nurse practitioner practice authority was associated with 219.4 fewer foot debridements per 10,000 enrollees (P < .001) in rural counties. Rural health clinics (P < .03) and skilled nursing facilities (P < .03) were also associated with fewer rural debridements. The number of nurse practitioners (P < .69) and primary care physicians (P < .69) per enrollee were not significant. No measure of health care workforce was associated with the incidence of foot debridement in urban counties. Expanding nurse practitioner practice authority may be an effective solution for preventing complications from diabetic foot ulcers in rural communities.

Estimating the Effect of the New York State Nurse Practitioners Modernization Act on Care Received by Medicaid Patients.

The demand for primary care services may surpass the supply of primary care providers, exacerbating challenges with access, quality, and cost in the U.S. health care system. Expanding the supply of, and access to, nurse practitioner (NP) care has been proposed as one method to alleviate these challenges. New York State (NYS) changed its regulatory environment for NPs in 2015. We estimate the impact of expanded NP scope of practice (SOP) regulations in NYS on total care days received by Medicaid beneficiaries from 2015 to 2018 using a model derived from national historical data from 1999 to 2011. We used a longitudinal data policy analysis framework and a generalized difference-in-differences model to identify the effect of changes in NP SOP regulations on total care days. The model included controls for state income and unemployment rates. Our results suggest that the policy change increased total care days provided to patients, but that this difference was not statistically significant and became negligible after computing the number of days per beneficiary. In addition, our results suggest that had NYS moved to a full practice environment, more care days could have been provided to Medicaid patients, and this difference was found to be statistically significant. Our results suggest that states should adopt full NP SOP practice environments to realize measurable benefits of expanded NP SOP.

Navigating Population Foci and Implications for Nurse Practitioner Scope of Practice

Nurse practitioner (NP) scope of practice is broadly defined by national nursing policies. The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education is the hallmark policy that establishes principles outlining the scope of practice for all APRNs. NPs must be familiar with The Consensus Model and with how professional organizations define the scope of practice for each of the 6 NP population foci. This knowledge is essential to support NPs practicing within their defined scope of practice.

Employing nurse practitioners in general practice: an exploratory survey of the perspectives of managers.

INTRODUCTION Establishing the nurse practitioner (NP) workforce in New Zealand is a viable solution to health and workforce challenges in primary health care. General practices have been slow to implement NP services. Managers of general practices are central to the employment and development of NP roles. AIM To explore the perspectives of managers on employing NPs in general practice. METHODS An electronic survey was used to collect demographic and numerical data, which were analysed descriptively and analytically using SPSS (version 26). Written answers to open-ended questions were analysed qualitatively. RESULTS In total, 143 managers participated in the survey (response rate 39.7%); 54 (37.8%) worked in practices employing at least one NP. Of respondents, 88.9% (n = 127) agreed or strongly agreed that NPs could enhance continuity of care (89/143, 62.2%), improved access to services and medications (89/143, 62.2%) and filled a gap that added value to health care (97/143, 67.8%). Practices employing NPs had statistically significant higher levels of agreement about the advantages of NPs than practices not employing NPs. Challenges and enablers to employing NPs were themed under organisational environment, NP scope of practice and role, and NP workforce development. DISCUSSION This exploratory study revealed that there is little knowledge about the NP workforce in surveyed general practices. Ongoing work is required to improve knowledge for employing general practices, including dissemination of information about NP education and training, scope and models of care, and ability to generate business income.

Impact of Nurse Practitioner Scope of Practice on Treatment for Chronic Pain and Opioid Use Disorder: A Scoping Review

Background Chronic pain affects nearly 50 million Americans, and its treatment is complicated by the opioid epidemic and physician shortage. Nurse practitioners (NPs) have a unique role in expanding access to care while still providing high-quality pain management; however, state restrictions prevent NPs from treating both chronic pain as well as opioid use disorder (OUD). Purpose The aim of this systematic scoping review was to examine the impact of these state-level restrictions on access to effective pain management. Methods In this systematic scoping review, the PubMed and CINAHL (Cumulative Index of Nursing and Allied Health Literature) databases were searched for articles published between 2008 and 2019. Grey literature from the same timeframe was searched via ProQuest, including policy documents, reports, doctoral student capstones and dissertations, and letters. Only peer-reviewed publications or acceptable forms of grey literature addressing either NP scope of practice or prescriptive authority laws and either pain management or opioid use disorder were included. Results Fifteen journal articles and 18 grey literature items met all inclusion criteria. We collapsed our findings into three themes pertaining to our research questions: (1) NP practice authority and chronic pain prescribing; (2) NP practice authority and OUD treatment; and (3) Changes in comprehensive education about chronic pain and OUD. Secondary findings included the trend toward autonomy in chronic pain care and policy initiatives to remove barriers to NP prescribing of medication-assisted therapy for OUD. Conclusion : A complex set of relationships exists between NP scope of practice, chronic pain care, and management of OUD. Findings suggest that scope of practice limitations have not necessarily met their intended goals of managing chronic pain while reducing opioid misuse. Policymakers should consider the impact of nursing regulatory laws on patient access to needed care for both chronic pain and OUD. Furthermore, trends toward NP leadership and autonomy in the management of both chronic pain and OUD highlight the need to further develop educational opportunities for NPs.

Nurse Practitioner Scope of Practice Regulations and Nurse Practitioner Supply.

Adopting full scope of practice (SOP) for nurse practitioners (NPs) is associated with improved access to care. One possible mechanism for these improvements is increased NP supply. Using county-level data, we fit cross-sectional and panel regression models to estimate the association between adopting full NP SOP and NP supply in general, and in rural and health professional shortage area-designated counties in particular. In cross-sectional analyses, we estimated positive associations between NP SOP and NP supply, though these relationships were only statistically significant when analyzing health professional shortage areas. In the panel regression models with county fixed effects, the estimated effects were attenuated toward zero and sometimes switched signs. Our findings suggest that improvements in access to care following adoption of full SOP may not be driven by increased NP supply but rather by increased capacity of NPs and physicians to provide care.

The Economic Impact of the Expansion of Nurse Practitioner Scope of Practice for Medicaid

Introduction The demand for primary care services may surpass the supply of primary care providers, exacerbating challenges with access, quality, and cost in the U.S. healthcare system. Expanding the supply of, and access to, nurse practitioner (NP) care has been proposed as one method to alleviate these challenges. Aim To estimate the impact of expanded NP scope of practice (SOP) regulations on the costs of total outpatient visits, prescription drugs, and total care days received by Medicaid beneficiaries nationwide from 1999–2011. Methods We used a longitudinal data policy analysis framework and built a fixed-effect model, a generalized form of a difference-in-differences model, to identify the effect of changes in NP SOP regulations on the outcome variables. The models included controls for state income and unemployment rates. Results Compared to states with reduced SOP, states with full SOP had 17% lower outpatient costs (i.e., $160.45 per beneficiary per year) and 10.9% lower prescription drug costs (i.e., $145.44 per beneficiary per year). States with restricted SOP had 11.6% higher outpatient costs (i.e., $107.31 per beneficiary per year) and 5.1% higher prescription drug costs (i.e., $67.89 per beneficiary per year). Annual total care days were 8% (i.e., 819,905.9 days) higher in states with full SOP compared to states with reduced SOP (p = .05). Conclusion States that expand NP SOP may provide greater intensity of care (measured using total care days) to Medicaid patients without increasing total costs of care. The demand for primary care services may surpass the supply of primary care providers, exacerbating challenges with access, quality, and cost in the U.S. healthcare system. Expanding the supply of, and access to, nurse practitioner (NP) care has been proposed as one method to alleviate these challenges. To estimate the impact of expanded NP scope of practice (SOP) regulations on the costs of total outpatient visits, prescription drugs, and total care days received by Medicaid beneficiaries nationwide from 1999–2011. We used a longitudinal data policy analysis framework and built a fixed-effect model, a generalized form of a difference-in-differences model, to identify the effect of changes in NP SOP regulations on the outcome variables. The models included controls for state income and unemployment rates. Compared to states with reduced SOP, states with full SOP had 17% lower outpatient costs (i.e., $160.45 per beneficiary per year) and 10.9% lower prescription drug costs (i.e., $145.44 per beneficiary per year). States with restricted SOP had 11.6% higher outpatient costs (i.e., $107.31 per beneficiary per year) and 5.1% higher prescription drug costs (i.e., $67.89 per beneficiary per year). Annual total care days were 8% (i.e., 819,905.9 days) higher in states with full SOP compared to states with reduced SOP (p = .05). States that expand NP SOP may provide greater intensity of care (measured using total care days) to Medicaid patients without increasing total costs of care.

Factors Influencing Georgia Legislators' Decision-Making on Nurse Practitioner Scope of Practice.

The state of Georgia faces challenges in providing access to care, largely due to rural hospital closures and physician shortages. Although nurse practitioners (NPs) could help address Georgia's urgent health care needs, the state remains restrictive with respect to NP scope of practice (SOP). This study examined factors that influence Georgia legislators' decision-making on NP SOP. In June 2016, after the January through March legislative session, a questionnaire was e-mailed to 49 state legislators on the Committees on Health and Human Services in Georgia's House of Representatives and Senate. The questionnaire was adapted from a legislative questionnaire previously used in research on state educational policy. Nine of 49 (18%) Georgia legislators responded. The majority of nine respondents were Republicans having served less than 15 years in the legislature. The number of respondents was approximately equal between Senate and House of Representatives. The respondents rated expert testimony and hearing from constituents as most likely to influence their decision-making on NP SOP. They reported that media and concerns about reelection were least likely to influence their decision-making about NP SOP. Therefore, nurses who aim to influence state policy should consider legislator preferences, such as speaking personally with constituents and receiving expert testimony. In-person communication could enhance interactions with legislators, potentially improving policy outcomes. Future research is necessary and should be conducted by NPs to determine the forms of communication and content in testimony most effective in influencing state lawmakers about NP SOP and examine if results vary by state political or other contexts.

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

There is heated debate surrounding policy reform granting full state-level nurse practitioner (NP) scope of practice (SOP) in all U.S. states. NP SOP policy is argued to impact access to care; however, a synthesis of empirical studies assessing this relationship has yet to be performed. Our study fills this critical gap by systematically reviewing studies that examine this relationship. We apply Aday and Andersen's Access Framework to operationalize access to care. We also use this framework to map components of access to care that may relate to NP SOP through concepts identified in this review. Our findings suggest that full state-level NP SOP policy is associated with increases in various components of access to care, but additional work is needed to evaluate causality and underlying mechanisms behind this policy's effect on access. This work is necessary to align research, practice, and policy efforts surrounding NP SOP with healthcare accessibility.

Association of State-Level Restrictions in Nurse Practitioner Scope of Practice With the Quality of Primary Care Provided to Medicare Beneficiaries.

Context: State scope of practice (SoP) laws impose significant restrictions on the services that a nurse practitioner (NP) may provide in some states, yet evidence about SoP limitations on the quality of primary care is very limited. Method: This study uses six different classifications of state regulations and bivariate and multivariate analyses to compare beneficiaries attributed to primary care nurse practitioners and primary care physicians in 2013 testing two hypotheses: (1) chronic disease management, cancer screening, preventable hospitalizations, and adverse outcomes of care provided by primary care nurse practitioners are better in reduced and restricted practice states compared to states without restrictions and (2) by decreasing access to care, SoP restrictions negatively affect the quality of primary care. Findings: Results show a lack of consistent association between quality of primary care provided by NPs and state SoP restrictions. Conclusion: State regulations restricting NP SoP do not improve the quality of care.

Should There be Laws Mandating Nurse Practitioner/Patient Ratios?

Should There be Laws Mandating Nurse Practitioner/Patient Ratios?

Considering disparities: How do nurse practitioner regulatory policies, access to care, and health outcomes vary across four states?

BackgroundHealth disparities persist among morbidity and mortality rates in the United States. Contributing significantly to these disparities are the ability to pay for health care (largely, access to health insurance) and access to, and capacity of, the primary care health workforce. PurposeThis article examines key determinants of health (DOH) including demographics, public and regulatory policies, health workforce capacity, and primary health outcomes of four states of the United States. The context of this study is the potential association among health care disparities and myriad DOH, among them, the restrictive nurse practitioner (NP) scope of practice (SOP) regulatory environment, which are documented to influence access to care and health outcomes. MethodsThis descriptive study explores current NP SOP regulations, access to primary care, and health outcomes of key chronic disease indicators—diabetes, hypertension, and obesity in Alabama, Colorado, Mississippi, and Utah. These states represent both the greatest disparity in chronic disease health outcomes (obesity, diabetes, and hypertension) and the greatest difference in modernization of their NP SOP laws. The Affordable Care Act has greatly expanded access to health care. However, it is estimated that 23 million Americans, 7% of its total population, will remain uninsured by 2019. DiscussionRestrictive and inconsistent NP SOP policies may continue to contribute to health workforce capacity and population health disparities across the country, with particular concern for primary care indicators. The study findings bring into question whether states with more restrictive NP SOP regulations impact access to primary care, which may in turn influence population health outcomes. These findings suggest the need for further research. NPs are essential for meeting the increasing demands of primary care in the United States, and quality-of-care indicator research supports their use.

81 Emergency Physician Evaluation of Physician Assistant and Nurse Practitioner Scope of Practice and Quality of Care in United States Emergency Departments

81 Emergency Physician Evaluation of Physician Assistant and Nurse Practitioner Scope of Practice and Quality of Care in United States Emergency Departments

Factors Associated With Seeking Physician Care by Medicare Beneficiaries Who Receive All Their Primary Care From Nurse Practitioners.

A shortage of primary care physicians has led to the alternative strategy of nurse practitioners (NPs) as primary care providers for the growing elderly population. Many states have implemented policies that allow NPs to practice independently with no physician oversight. Little is known about the continuity of primary care provided by NPs. To examine rate and correlates of switching from exclusive NP primary care to receiving some or all primary care from physicians. A retrospective cohort study. Medicare beneficiaries (n = 38 618) with diabetes, congestive heart failure, or chronic obstructive pulmonary disease who received all their primary care from NPs in 2007. Multivariable logistic regression model was used to assess patient and disease characteristics associated with switching from sole NP primary care in 2007 to receiving some or all primary care from physicians between 2008 and 2010. Of elderly patients receiving all their primary care from NPs in 2007, 53.8% switched to receiving some or all primary care from physicians in 2008-2010. The switching patients had less comorbidity before the switch and were more likely to reside in metropolitan areas, ZIP code areas with high education or states with the most restriction on NP scope of practice. In multivariable analyses, significant predictors of switching included one of the following within 30 days before the switch: emergency room visits (odds ratio [OR] = 1.55, 95% confidence interval [CI] = 1.44-1.68), hospitalization (OR = 1.13, 95% CI = 1.02-1.25), new diagnosis of heart attacks (OR = 5.52, 95% CI = 4.33-7.02), pneumonia (OR = 4.84, 95% CI = 3.71-6.32), atrial fibrillation (OR = 3.99, 95% CI = 2.93-5.44), stroke (OR = 2.94, 95% CI = 2.31-3.74), or cancer (OR = 2.65, 95% CI = 1.94-3.63). About half of Medicare patients under exclusive NP primary care switched to physicians for some or all primary care over a 3-year period. Future study is needed to understand the reasons for switching.

Certification and education as determinants of nurse practitioner scope of practice: An investigation of the rules and regulations defining NP scope of practice in the United States.

In 2008, a consortium of advanced practice nursing organizations authored the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education. The document's aim is to provide guidance for states to adopt uniformity in the regulation of advanced practice registered nurse roles. Despite a target date to complete that work by 2015, there remains an extensive amount of variation in how states define the scope of practice (SOP) for nurse practitioners (NPs). Based on the National Council of State Boards of Nursing online database, state (N = 51 [includes the District of Columbia]) NP practice acts and/or rules and regulations documents were examined for language describing SOP for NPs consistent with the language of the advanced practice registered nurse (APRN) Consensus Model. Results indicated that 18 states and the District of Columbia (37%) had specific regulations defining NP SOP by certification and/or educational preparation while 23 (45%) did not. The remaining nine states (18%) had SOP regulations that were interpreted as being ambiguous in relation to certification and/or educational preparation. The findings suggest much work is needed to ensure NP SOP accurately reflects NP board-certification and graduate educational preparation.

Revisiting Scope of Practice Facilitators and Barriers for Primary Care Nurse Practitioners

Revisiting scope of practice (SOP) policies for nurse practitioners (NPs) is necessary in the evolving primary care environment with goals to provide timely access, improve quality, and contain cost. This study utilized qualitative descriptive design to investigate NP roles and responsibilities as primary care providers (PCPs) in Massachusetts and their perceptions about barriers and facilitators to their SOP. Through purposive sampling, 23 NPs were recruited and they participated in group and individual interviews in spring 2011.The interviews were audio recorded and transcribed. Data were analyzed using Atlas.ti 6.0 software, and content analysis was applied. In addition to NP roles and responsibilities, three themes affecting NP SOP were: regulatory environment; comprehension of NP role; and work environment. NPs take on similar responsibilities as physicians to deliver primary care services; however, the regulatory environment and billing practices, lack of comprehension of the NP role, and challenging work environments limit successful NP practice.