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

Practice Barriers for the NP

State scope-of-practice laws dictate the extent and circumstances in which an NP may practice. The specifics of these laws have been previously described in this article. While there have been several retrospective correlational studies describing the impact of scope-of-practice restrictions, none focus specifically on urology care provided by an NP. Thus, practice barriers for the NP will be reviewed generally; conclusions are based on the assumption that these results would be mirrored in urology. Results of research by Graves and associates (2016) suggest that highly restrictive regulations inhibit the productivity of NPs and may decrease access to services an NP is qualified to provide. In their review article, Perloff and associates (2017) describe a trend in recent years toward removal of state-specific restrictions. Each of the synthesis reviews critiqued for this article assessed quality of care, access, hospitalization rates, or health outcomes in any combination. While the research of Perloff and associates (2017) has limitations, its conclusions contribute to the growing body of evidence that practice restrictions negatively impact NP practice in both primary care and specialty settings. These conclusions support other research results documenting that full scope of practice improves access to care.

Results from a synthesis review of 13 research articles, which used primarily retrospective designs, examined the relationship between scope of practice and access to care (Patel et al., 2019). Critiquing of the articles included in this review utilized Aday and Andersen's access framework. The conclusion of this review suggests that when care, provided by an NP, is within full state-level policies, increases in various components of access to care occur. These authors recommend determining the causality of this finding.

In their review of the literature, Yang and associates (2020) included the work of Perloff and associates (2017) and Patel and colleagues (2019) while using additional research to include cost. The structure, process, and outcome of care provided were compared to state practice restrictions using the Donabedian model. Results demonstrated that full practice has a positive effect on the health care delivery system of the United States through building structural capabilities (increase supply of NPs), which improves care processes (better/faster access to care and utilization), with no demonstrated decrease in care outcomes and sustainability (i.e., quality of care, health status, and care costs).

Finally, Krieg (2020) describes the experience of becoming certified to perform cystoscopies in her clinical setting. While not research, this expert opinion article describes the steps, barriers, and navigation techniques encountered during the process.