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Expanding Nurse Practitioner Scope of Practice in Michigan

Some forecasts have pointed to a looming physician shortage in the United States, particularly in light of growing demand for health services from the Affordable Care Act and a rising elderly population. One strategy for addressing this issue is to allow nurse practitioners (NPs) to have “full scope of practice”—that is, to autonomously deliver care that falls within their educational preparation: diagnosing and treating conditions, writing prescriptions, and performing minor procedures. Many states have done this. In the state of Michigan, the legislature is considering how to define NP scope of practice. NPs in the state currently function under the same rules as registered nurses, limiting the care that they can provide to patients without the oversight of physicians. Would a more expansive scope of practice for NPs improve health care for the residents of Michigan? To address this question, a team of RAND researchers examined the peer-reviewed literature on the effect of expanded NP scope of practice regulations on several health delivery outcomes: the supply of providers, access to care, utilization of care, costs, quality, and patient outcomes. Researchers used strict criteria to identify only empirically rigorous studies, leading them to eliminate a substantial share of the published literature in this area. They then used results from the literature review to estimate Michigan-specific impacts of full NP scope of practice. The study was commissioned by the Michigan Council of Nurse Practitioners.