Ranking State NP Regulation: Practice Environment and Consumer Healthcare Choice

Abstract

the regulatory environment for nurse practitioner (NP) practice and consumer healthcare choice in each of the 50 states and the District of Columbia (DC). An expert panel examined the state rules and regulations in three dimensions: (1) the environment affecting consumer access to NPs as providers, (2) the environment affecting reimbursement and NP patients’ access to related healthcare services, and (3) the environment affecting NP patients’ access to prescription medications. Scores in each of these domains were calculated for each state and DC, which were then ranked by the composite scores of the three domains. Findings suggest that wide variations exist in state regulation of NP practice, indicating the strong likelihood that, in some states, NPs cannot reach their full capacity to meet patients’ needs. This wide variation also suggests that regulations for NP practice are not evidence based, have no patient-safety foundation, and appear arbitrary. The study results can be used as an advocacy tool for NPs working with policy makers to identify their state’s or district’s standing relative to the rest of the nation and to propel reform for modernizing nurse practice acts to align with improved consumer choice and evidence-based patientsafety principles.