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Research Question

  1. What are the possible effects on the state of Indiana if the state legislature were to expand SOP for APRNs?

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.

Key Findings

Expanded Scope of Practice Could Have Beneficial Results for Indiana

  • In the state of Indiana, APRNs are able to open their own practices and diagnose and treat patients, but are required by state law to have a collaborative agreement in place with a physician in order to prescribe medications.
  • Despite some limitations of available studies, our review nonetheless suggests that granting APRNs full SOP might contribute to improvements in provider supply, access, utilization, and patient experience with care.
  • In analyzing effects specific to Indiana, our estimates suggest that establishing full SOP for APRNs could lead to potentially meaningful improvements in provider supply, access, and patient experience with care, as well as increases in salaries for NPs, with reductions in physician assistant and physician salaries.

Recommendation

  • Further research is needed to assess the effects of expanding SOP for APRNs on costs and other dimensions of health care quality.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Conceptual Framework

  • Chapter Three

    Literature Review

  • Chapter Four

    Indiana-Specific Effect

  • Chapter Five

    Discussion

  • Appendix A

    Literature Review Flow Diagram

  • Appendix B

    Detailed Article Summaries

  • Appendix C

    Study Quality Dimensions

  • Appendix D

    Methods Details

  • Appendix E

    Summary of Effect Estimates

The research described in this report was sponsored by the Coalition of Advanced Practice Nurses of Indiana and conducted by RAND Health.

This report is part of the RAND Corporation research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

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