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

Description and State Limitations for the APRN

Nurse practitioners are registered nurses (RNs) who have completed either a master or doctorate-level degree and passed a certifying examination. Additional specialty credentialing is possible from either the professional nursing specialty organization or through the American Academy of Nurse Practitioners (AANP) (n.d.), the American Nurses Credentialing Center (ANCC) (n.d.), or the National Association of Pediatric Nurse Practitioners (NAPNAP) (n.d.).

While the academic and initial certifying requirements for NPs are consistent throughout the United States, scope-of-practice laws, which are state-specific, mediate the degree to which an NP can practice. Scope-of-practice laws for NPs have been partitioned into full practice, reduced practice, and restricted practice, which are state-specific. The AANP (2019a) provides descriptions for each scope of practice. Full practice authority allows an NP to evaluate, diagnose, order, and interpret diagnostic tests, as well as initiate and manage treatment of patients, including prescribing medications and controlled substances under the licensure authority of the state board of nursing. Reduced practice authority limits the NP scope of practice by at least one element. In reduced practice states, the NP must have a collaborative agreement with a physician to be able to treat and prescribe medications. Restricted practice requires a collaborative agreement with a physician and places extenuating restrictions on prescriptive authority. These discrepancies prevent NPs from providing care reflective of the full extent of their education and training. In response to the COVID-19 health crisis, some states have temporarily altered their practice agreement requirements (AANP, 2020). Once the temporary timeframe has ended, state law will require an amendment to make these changes permanent.

This cyclical scenario results in an increased wait time specifically to see a primary or specialty care provider (Merrit Hawkins, 2017), missed care opportunities, and the ability to decrease the cost of care. The AANP (2019b) posits that "NPs in a physician practice potentially decreased the cost of patient visits by as much as one-third, particularly when seeing patients in an independent, rather than complementary, manner" (NP Cost Effectiveness section, para. 2).

Secondary analyses of data maintained by the Centers for Medicare and Medicaid Services (CMS) reflect a 24-fold increase in urology office-based procedures performed by advanced practice providers from 2003 to 2014. These authors (Erickson et al., 2017) conclude that the increased trend toward the use of advanced practice providers demonstrates their evolving role in urology and documents a solution to the relative shortage of urologists.

Mishra and colleagues (2020) analyzed survey data from members of the American Urological Association (AUA) to determine length of stay (LOS) and cost outcomes when an NP was added to the care team. While there was no change in direct cost (p = 0.89), there was an overall decrease in the LOS (p = 0.042).

These articles describe the ability of NPs to provide care and perform various procedures. While these activities meet a care need, the ability to assess the quality of the care provided is lacking. The research literature describes the ability of NPs to provide care, which improves access for many individuals. The presence of state limitations to practice inhibits the ability to directly compare outcomes based on the care provider.