Since development of the nurse practitioner (NP) role, NPs have been advocating for policy allowing them to practice to the full extent of their training. The aim of this research was to determine whether passage of the Affordable Care Act (ACA) had an impact on expansion of NPs' scope of practice.
This was a retrospective descriptive study of NPs' scope of practice legislation from 1994 to 2016 using regulatory theory. Data sources included annual reports on NP legislation and state-level legislative and media coverage.
Eight states adopted full practice authority (FPA) from 2011 to 2016, representing a two-fold increase compared with the previous 10 years. Seven states adopted Medicaid expansion. Nursing interest groups and politicians shaped their argument in favor of FPA around the increasingly insured population because of the ACA, provider shortages, and rural health care access issues.
Shaping the discourse of FPA beyond the benefits to the NP profession makes way for broader political interest and participation. Although the future of the ACA is unknown, as the 28 states without FPA continue to advocate for legislative change, they could benefit from the strategies of these newly adapted FPA states.
1Center for Health Outcomes and Policy Research, School of Nursing, and Associate Fellow, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania,
2Community Outreach and Engagement, College of Public Health, Ohio State University, Columbus, Ohio,
3College of Nursing, Ohio State University, Columbus, Ohio
Correspondence: Heather M. Brom, PhD, RN, NP-C, Center for Health Outcomes and Policy Research, School of Nursing University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA 19104. Tel: (215) 898-4908; Fax: 215-573-2062; E-mail: firstname.lastname@example.org
Competing interests: The authors report no conflicts of interest.
Authors' contributions: H.M.Brom performed all data collection and analysis and wrote the initial draft of the manuscript. All authors developed the research project and revised the manuscript for final submission.
Received July 24, 2017
Received in revised form November 20, 2017
Accepted November 29, 2017