Nurse Practitioner Scope-of-Practice Laws and Preventable Pediatric Hospitalizations

Amid concerns over primary care shortages, many states have expanded nurse practitioner (NP) scope-of-practice (SOP) laws to grant full practice authority (FPA), allowing NPs to practice without physician supervision. While prior research has focused on adult populations and narrow clinical contexts, this study provides the first evidence on pediatric outcomes using hospitalization-based pediatric quality indicators (PDIs). Using inpatient discharge data from 22 states between 2010 and 2019, I estimate two-stage difference-in-differences models to assess the causal impact of FPA on preventable pediatric hospitalizations. FPA reduces hospitalizations for chronic conditions, such as asthma and diabetes complications, by about 10%, but increases hospitalizations for acute conditions, including gastroenteritis and urinary tract infections, by roughly 16%. The results reveal important heterogeneity: expanded NP authority may improve chronic disease management while posing challenges for acute care delivery. These findings inform policy debates on SOP reform and its implications for pediatric health.