Sep 15, 2016
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.
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.
Literature Review Flow Diagram
Detailed Study Summaries
Study Quality Dimensions
Summary of Effect Estimates