Advanced Practice Registered Nurse Full Practice Authority, Provider Supply, and Health Outcomes: A Border Analysis

Area of Science:

• Health Policy Research
• Nursing Practice Expansion
• Primary Care Access

Background:

• Growing physician shortages create significant barriers to primary care access for patients.
• Many states are enacting policies to reduce regulatory barriers for advanced practice registered nurses (APRNs) to provide primary care.
• Full Practice Authority (FPA) allows APRNs to practice independently without physician collaboration.

Purpose of the Study:

• To evaluate the impact of Maryland's Full Practice Authority (FPA) policy on the number of APRNs and patient health outcomes.
• To assess the association between FPA and key health indicators at the county level.

Main Methods:

• Utilized a border county comparative analysis between Maryland and Pennsylvania to estimate FPA's effects.
• Analyzed county-level health outcomes including self-reported poor or fair health, poor mental health days, and preventable hospitalizations.
• Examined changes in the number of certified nurse midwives and nurse practitioners per capita.

Main Results:

• FPA implementation was associated with an increase of 0.6 certified nurse midwives and 22.4 nurse practitioners per 100,000 residents.
• A significant association was found between FPA and a 2.8 percentage point reduction in residents reporting poor or fair health.
• FPA correlated with a decrease of 0.354 days per person in monthly poor mental health.

Conclusions:

• The findings suggest that Full Practice Authority in Maryland is linked to increased availability of APRNs.
• The policy change appears to be associated with improved patient health outcomes and enhanced access to primary care.
• Reducing regulatory barriers for APRNs may be a viable strategy to address primary care access issues and improve population health.