This study assessed individual and state-level factors which affect decisions by Nurse Practitioners (NPs) about whether to practice in primary care. Of particular interest was the impact of state scope of practice (SOP) regulations on elements of NP practice such as patient load, the flow of patient care, and the management of a patient panel decision. Data from the Health Resources and Services Administration 's 2012 National Sample Survey of Nurse Practitioners (NSSNP) were merged with state-level data from a variety of sources to examine and compare the effects of three categories of state SOP laws and regulations: ·restricted practice and prescribing, full practice authority only, and full practice and prescriptive authority.
Findings from multivariate regressions analyses demonstrate that both facets of SOP -practice authority and prescriptive authority -have independent and cumulative effects on the decision to practice in patient care. However, independent prescriptive authority appears to be the key SOP factor affecting the decision to practice in primary care. Moreover, while SOP has statistically significant effects on both outcomes, rural location was a far more potent predictor of working in primary care. The analysis also found evidence that SOP effects on the probability of practicing in patient care are more pronounced in urban areas.
Case study interviews were conducted in Florida, Nevada, New Mexico, Texas, and Washington with NPs as well as a range of individuals who could exert change in how NPs practice and deliver care, such as payers, employers, and representatives of NP schools. Regarding both billing and supervision, case study participants described a wide range of practices, most of which stemmed from organizational culture rather than SOP legislation .For example, it was reported in states of varying SOP restrictiveness that billing in hospitals is generally attributed to a collaborating physician so that proceeds are credited to the clinical area. Additionally, across a wide range of organizations, it was noted at regardless of SOP, the organizational culture dictated the degree to which NPs were permitted to practice autonomously, and which elements of care delivery were reserved for physicians.