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Increased access to nurse practitioner care in rural Nebraska after removal of required integrated practice agreement

Holmes, LeAnn R. DNP, APRN, FAANP (Clinical Assistant Professor); Waltman, Nancy PhD, APRN (Professor)

Journal of the American Association of Nurse Practitioners: May 2019 - Volume 31 - Issue 5 - p 288–292
doi: 10.1097/JXX.0000000000000153
Brief Report

ABSTRACT Nebraska is a largely rural state with many communities defined as medically underserved by primary care providers. In 2014, the state legislature voted to eliminate the requirement for an integrated practice agreement (IPA) between nurse practitioners (NPs) and physicians. This report describes changes in access to primary health care in rural and underserved areas of Nebraska after removal of the IPA barrier to practice. The report compares the number of primary care NPs working in medically underserved areas before and after the legislation that ended the required IPA. In addition, anecdotes will be provided of NP and patient experiences in rural, NP-owned practices in Nebraska after IPA requirements were eliminated.

College of Nursing, University of Nebraska Medical Center, Lincoln, Nebraska

Correspondence: LeAnn A. Holmes, DNP, APRN, FAANP, UNMC College of Nursing, Lincoln Division, 550 N 19th St, HCCN 310L, Lincoln, NE 68558; E-mail:

Competing interests: The authors report no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Authors' contributions: The analysis of data was performed by Holmes with significant editorial input by Waltman.

Received August 08, 2018

Accepted September 26, 2018

© 2019 American Association of Nurse Practitioners
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