The Impact of Establishing a Full Scope of Practice for Advanced Practice Registered Nurses in the State of Indiana

For many policymakers and clinicians, an important strategy for meeting the growing demand for health care services in the United States is to make better use — and increase the number — of advanced practice registered nurses (APRNs). APRNs include nurse practitioners (NPs), certified nurse midwives, certified registered nurse anesthetists, and clinical nurse specialists. However, scope-of-practice (SOP) regulations at the state level, which govern the breadth of services that APRNs can independently provide, may affect not only the supply of APRNs but also their ability to meet patients' care needs. Legislators in Indiana are considering the expansion of SOP to include full prescriptive authority, but APRNs are currently required to have collaborative agreements with physicians to prescribe medications, and they are limited in terms of the scope of services they can provide patients. Drawing on a prior literature review and a previously developed conceptual framework to guide the research, this report examines the literature related to the relationship between state APRN SOP regulations and health care delivery, and it estimates the effect on the state of Indiana if the legislature were to define a full SOP for APRNs. Based on estimates from the literature, we constructed estimates specific to Indiana of the effect of a full SOP for APRNs. Although the evidence from the small number of high-quality studies we identified was relatively limited overall and largely limited to NPs in particular, our review of the literature nonetheless demonstrates that allowing APRNs full SOP has the potential to improve access to care, utilization, and provider supply. Given the limitations in the evidence, however, we were unable to estimate the effect of APRN SOP across a wide range of health care domains or for APRNs other than NPs.