Full Scope-of-Practice Regulation is Associated with Higher Supply of Nurse Practitioners in Rural and Primary Care Health Professional Shortage Counties

Introduction: Access to quality primary care is challenging for rural populations and individuals residing in primary care health professional shortage areas (HPSAs). The ability of nurse practitioners (NPs) to provide full care is governed by state scope-of-practice (SOP) regulation, which is classified into three types: full SOP, reduced SOP, and restricted SOP. Understanding how legislative and regulatory decisions can influence supply of NPs in underserved areas can help guide effective health policies to reduce disparities in access to care. Objective: To investigate the trends in NP supply in rural and primary care HPSA counties and their relationship with SOP regulation. Methods: The authors conducted longitudinal data analyses using an integrated county-level national data set from 2009 to 2013. A hierarchical mixed-effects model was performed to assess the relationship between state SOP regulation and NP supply in rural and primary care HPSA counties. Results: The number of NPs per 100,000 population increased in rural and primary care HPSA counties across states with various types of SOP regulation between 2009 and 2013. Compared with the NP supply in rural or primary care HPSA counties in states with reduced or restricted SOP regulation, NP supply in those counties in states with full SOP regulation was statistically significantly higher. Conclusions: State full SOP regulation was associated with higher NP supply in rural and primary care HPSA counties. Regulation plays a role in maximizing capacity of the NP workforce in these underserved areas, which are most in need for improvement in access to care. This information may help inform state regulatory policies on NP supply, especially in underserved areas.