Nurse Practitioner Practice: Full Scope, Better Outcomes

Tom G. Bartol, NP


October 08, 2014

In This Article

Impact of Nurse Practitioners on Health Outcomes of Medicare and Medicaid Patients

Oliver GM, Pennington L, Revelle S, Rantz M
Nurs Outlook. 2014 Aug 1. [Epub ahead of print]

Nurse Practitioner Level of Practice

There is a need to address the high costs and often poor quality of healthcare in the United States. Many studies show that nurse practitioners (NPs) provide safe and high-quality care when compared with other healthcare providers. Yet there are different levels of NP practice in this country as a result of the differences in state licensing laws. Some states have restrictive practices, whereas others allow full scope or independent practice for NPs.

In this study, the researchers analyzed data to determine the impact that level of practice (full, reduced, or restricted) of NPs in the United States has on the outcomes of Medicare and Medicaid patients, focusing on avoidable hospitalizations, readmission rates, nursing home resident hospitalizations, and health outcome rankings.

Full practice was defined as absolute independent practice in which the NP is responsible exclusively to a state board of nursing. Reduced practice was defined as a collaborative practice agreement with a physician specifying the scope of practice allowed. Restricted practices were those that required a physician to oversee all care provided by the NP.

Oliver and colleagues obtained data from the Centers for Medicare and Medicaid Services (CMS) and other organizations that had data ranked by state; health outcomes were then studied. Potentially avoidable hospitalizations for Medicare and Medicaid beneficiaries were reviewed from 2007 to 2009. Thirty-day rates of readmission to hospitals from post-acute rehabilitation were reviewed from 2006 to 2011. Nursing home resident hospitalizations were reviewed from fiscal year 2011. Finally, health outcome rankings by the state were obtained from the United Health Foundation report on America's 2012 health rankings.


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