RAND researchers examine the existing literature on the relationship between state scope-of-practice regulations for nurse practitioners and various health care delivery outcomes (provider supply, access to care, utilization of care, costs of care, and quality of care), then estimate the impact in Michigan if its legislature expanded that scope of practice.

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The Impact of Establishing a Full Scope of Practice for Nurse Practitioners in Michigan

by Grant R. Martsolf, Ryan Kandrack

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Research Question

  1. What are the potential effects on various health care delivery outcomes (e.g., provider supply, access to care, and costs and quality of care) of defining an SOP for NPs that allows full practice and prescription authority in Michigan?

Many policymakers and clinicians have argued that expanding the number and utilization of nurse practitioners (NPs) is an important strategy to meet future growth in the demand for health care services in the United States. State scope-of-practice (SOP) regulations, which govern the breadth of services that NPs can independently provide, affect the supply of NPs and their effectiveness in meeting patients' care needs. NPs in Michigan have no defined SOP and currently function under the SOP of registered nurses, which limits their ability to practice and prescribe.

The purposes of this report are to (1) examine the existing literature on the relationship between state NP SOP regulations and various health care delivery outcomes (provider supply, access to care, utilization of care, costs of care, and quality of care) and (2) estimate the impact in Michigan if its legislature defined a full SOP for NPs. To do this, we developed a conceptual framework to guide the research and conducted an extensive literature review. We then applied estimates from the literature to construct Michigan-specific impacts of defining a full SOP for NPs.

Our review of the literature demonstrates that granting NPs full SOP would possibly improve access to care, utilization of care, and provider supply in Michigan. Given limitations in the evidence, we were unable to conclusively estimate the effect of a full NP SOP across a wide range of health care domains.

Key Findings

Establishing a Full NP SOP in Michigan Could Improve Outcomes, but Evidence Is Limited

  • Overall, evidence of the relationship between NP SOP regulations and any specific aspect of health care delivery is relatively limited (in terms of number and quality of studies). We identified only 14 studies.
  • The literature review suggests that full SOP can possibly contribute to improvements in provider supply, access to care, utilization of care, and quality of care (patient-centeredness). The effect of full SOP on costs and health outcomes was largely inconclusive.
  • Our exclusion criteria resulted in only two studies being included in the estimates of Michigan-specific impacts. Using these restrictions, we were able to calculate expected effects on access and quality. Our estimates suggest that establishing full SOP for NPs could lead to potentially meaningful improvements in access and quality (patient-centeredness) in Michigan.

Recommendation

  • Further research is needed to assess the effects of expanding NP SOP on costs and other dimensions of health care quality. We identified only 14 studies, of which only six used longitudinal research designs with control for confounders. The states with less-restrictive SOP regulations tended to be located in the west and northeast. Furthermore, these studies used various definitions of full SOP. In addition, no study has estimated the effect of NP SOP regulations on dimensions of quality of care other than patient-centeredness. Therefore, it is difficult to assess the extent to which the results are fully generalizable to Michigan currently.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Conceptual Framework

  • Chapter Three

    Literature Review

  • Chapter Four

    Michigan-Specific Impact

  • Chapter Five

    Discussion

  • Appendix A

    Literature Review Flow Diagram

  • Appendix B

    Detailed Study Summaries

  • Appendix C

    Study Quality Dimensions

  • Appendix D

    Method Details

  • Appendix E

    Summary of Effect Estimates

The research described in this report was sponsored by the Michigan Council of Nurse Practitioners and conducted by RAND Health.

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