The Impact Scope-of-practice Laws Have on Urologic Care Outcomes

Raychael Noland, BSN, RN; Peggy Ward-Smith, PhD, RN


Urol Nurs. 2020;40(5):251-255. 

In This Article

Abstract and Introduction


State-specific scope-of-practice laws vary within the united states, which limits access to care for patients and the ability to provide care independently for the nurse practitioner (NP). Exploring state limitations, the role and functions of the urology NP, and barriers to full practice provide a framework for change. in light of the present and forecasted shortage of urology providers, removing practice barriers will allow patients to receive timely, appropriate, and valued care.


The Patient Protection and Affordable Care Act (PPACA) (H.R. 3590), implemented in 2010, extends health insurance coverage to millions of uninsured Americans and prevents insurance companies from denying coverage for pre-existing conditions. This act has improved access to health care and created a higher demand for services, which results in unmet health care needs for many. Data from Robert Wood Johnson Foundation (2020) recommends the use of nurse practitioners (NPs) as one solution for this scenario. Survey data, specific to urology, describe the varied clinical roles and procedures performed by advanced practice providers (Langston et al., 2017). Data from the American Urologic Association (AUA) (2019) Census Report describe a significant increase in the percentage of primary practice urologist that employs at least one advanced practice provider (physician assistant [PA] or NP). This number increased from 62.7% in 2015 to 71.4% in 2019. Despite the need and ability of an NP to provide and guide urology care, individual state scope-of-practice laws mediate the degree to which an NP can practice. The purpose of this article is to provide a state of the science with respect to the clinical roles, specifically for the NP, and how state laws limit both access to and provision of care.