Think Tank and Stakeholder Position Statements

Nurse practitioners: A solution to America’s primary care crisis (September 2018)

“Increasingly, researchers, workforce analysts and organizations that influence health policy support expanding the role of nurse practitioners (NPs) to fill the void left by the lack of primary care physicians and to improve the uneven geographic distribution of primary care.”

“Across all five measures, the study found that the cost of PCNP-provided care ranged between 11 percent and 29 percent less than the cost of PCMD-provided care”

“Results also showed that states with restricted NP scope-of-practice had 40 percent fewer NPs compared to those without.”

“State-level NP scope-of-practice restrictions do not help protect the public from subpar health care.”

The Policy Book—AARP Public Policies (2011-2012)

“States should allow all professionals to provide services to the full extent of their current knowledge, training, experience and skills where evidence indicates services can be provided safely and efficiently. States should allow and expect different professions to share overlapping scopes of practice.”

“States should amend current scope of practice laws and regulations to allow nurses, APRNs to perform duties for which they have been educated and certified.”

“Current state nurse practice acts and accompanying rules should be interpreted and/or amended where necessary to allow APRNs to fully and independently practice as defined by their education and certification.”

What Is Driving U.S. Health Care Spending? (September 2012)

“Due to various regulations and restrictions, many professionals are not practicing at the ‘top of their license,’ meaning that they are not performing the work that reflects the fullest extent of their education and training.”

“Scope of practice restrictions vary across the nation, limiting the ability of certain professionals to provide cost-effective care.”

“Physician oversight of work that can be performed autonomously by other physicians can lead to unnecessary repetition of orders, office visits and services, thus increasing total costs without any additional benefit to patients.”

Policy Perspectives—Competition and the Regulation of Advanced Practice Nurses (March 2014)

“Based on our extensive knowledge of health care markets, economic principles and competition theory, the FTC staff reach the same conclusion: expanded APRN scope of practice is good for competition and American consumers.”

“Additional scope of practice restrictions, such as physician supervision requirements, may hamper APRNs’ ability to provide primary care services that are well within the scope of their education and training.”

“Reducing undue restrictions on APRN scope of practice can be one significant way to help ameliorate existing and projected access problems.”

Who Will Provide Primary Care and How Will They Be Trained? (April 2010)

“Variations in scope of practice and regulatory policies affect the primary care workforce differently in different states. Results from recent studies indicate that more restrictive states lose potential NPs to states that have more supportive practice acts and regulations that govern NP practice.”

“State and national policies should be changed to clarify the scope of practice of NPs as independent (albeit collaborative in the true sense) primary care providers.”

The Future of Nursing: Leading Charge, Advancing Health (October 2010)

“Recommendation 1: Remove scope-of-practice barriers. Advanced practice registered nurses should be able to practice to the full extent of their education and training.”

“Now is the time to eliminate the outdated regulations and organizational and cultural barriers that limit the ability of nurses to practice to the full extent of their educations, training and competence.”

“The current conflicts between what APRNs can do based on their education and training and what they may do according to state and federal regulations must be resolved so that they are better able to provide seamless, affordable and quality care.”

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity A Consensus Study from the National Academy of Medicine (2021)

“Recommendation 4: All organizations, including state and federal entities and employing organizations, should enable nurses to practice to the full extent of their education and training by removing barriers that prevent them from more fully addressing social needs and social determinants of health and by improving health care access, quality, and value. These barriers include regulatory and public and private payment limitations; restrictive policies and practices; and other legal, professional, and commercial1 impediments.”

Meeting the Primary Care Needs of Rural American (April 2013)

“Studies examining scope of practice suggest that non-physician practitioners, such as nurse practitioners and physician assistants, play a significant role in providing health care to people living in underserved areas—particularly those living in rural America.”

“A growing body of evidence indicates that the quality of care provided by nurse practitioners and physician assistants in the primary care setting is, in some aspects, comparable to that of physicians.”

“A 2009 RAND study found that, in Massachusetts, visits to nurse practitioners and physicians assistants cost 20 percent to 35 percent less than visits to physicians.”

The Role of NPs in Meeting Increasing Demand for Primary Care (December 2012)

“Existing research suggests that NPs can perform a subset of primary care services as well as or better than physicians. Expanded utilization of NPs has the potential to increase access to health care, particularly in historically underserved areas.”

“NGA’s review of health services research suggests that NPs are well qualified to deliver certain elements of primary care. In light of the research evidence, states might consider changing scope of practice restrictions and assuring adequate reimbursement for their services as a way of encouraging and incentivizing greater NP involvement in the provision of primary health care.”

Health Affairs: Health Policy Brief—Nurse Practitioners and Primary Care (October 2012)

“Studies comparing the quality of care provided by physicians and nurse practitioners have found that clinical outcomes are similar.”

“What’s more, patients seeing nurse practitioners were also found to have higher levels of satisfaction with their care. Studies found that nurse practitioners do better than physicians on measures related to patient follow up; time spent in consultations; and provision of screening, assessment, and counseling services.”

“There is evidence that primary care by nurse practitioners is less costly because they tend to order fewer tests and expensive diagnostic procedures than do physicians. Thus, there still may be cost savings from nurse practitioners even if they are paid on a par with physicians for the same services.”