Nurse practitioner practice under the COVID-19 public health emergency: Did policy change persist?

The COVID-19 public health emergency (PHE) offers opportunities to study legislative and policy changes to nurse practitioner (NP) practice limitations, including factors that affect persistence. We evaluated states with restricted or reduced practice as identified by the American Association of Nurse Practitioners. This analysis 1) identified and correlated key changes in policy during the PHE with state regulatory, governmental, and practice variables; 2) modeled predictive characteristics that facilitate or impede policy persistence; and 3) explored the lived experience of NPs working in eligible states with policy changes during the PHE. Focus group interviews with NP leaders and bivariate correlations with regression analysis from the 2019 to 2021 legislative sessions were conducted. Nurse practitioner identified three types of persistence during the PHE: the power differential between MDs and NPs; the existing day-to-day environment; and barriers to change. In 2019, significantly more legislation was passed in states with sunset laws (Spearman rho: -0.38; p -value = .046). During 2020, 15 states introduced a total of 22 bills focused on NP practice, although only four passed one bill each. In 2021, states with an independent board structure introduced more NP legislation than did those states with a nonindependent board structure (Spearman rho: -0.406; p -value = .032). Few PHE policies persisted, despite robust predictions that this was likely to occur. Independent board structure and sunset laws were associated with legislation introduction and passage. Policy persistence is complex and based on multiple state and environmental variables. We urge persistence in NP advocacy strategies.