Investigation into How State Laws Affect What Hospitals Allow Nurse Practitioners and Physician Assistants to Do

nurse practitioners and physician assistants in action

New research that seeks to understand how hospital policies dictate what nurse practitioners (NPs) and physician assistants (PAs) are allowed to do reveals that there is enormous variations across hospitals, and that, contrary to what might be expected, this variation is not associated with state scope of practice laws for either profession. 

 Health care organizations have expanded their use of NPs and PAs as demand for hospital services continues to grow in the United States, exacerbating a continuing shortage of nearly all types of physicians. Until recently, the policy debate on integrating NPs and PAs into hospitals and health care organizations has focused on reforming state scope of practice (SOP) laws, which were viewed by many as the primary barrier hindering the ability of NPs and PAs to practice at the top of their education. Since the Institute of Medicine published its Future of Nursing report in 2010, which recommended full SOP for nurses, many states have reformed their SOP laws for NPs and PAs.

“As more states reform their SOP laws, the question becomes whether health care organizations are actually changing the way they use PAs and NPs,” says Patricia “Polly” Pittman, co-director of the Health Workforce Institute at the George Washington University’s Milken Institute School of Public Health (Milken Institute SPH). She led a team of researchers from the American Case Management Association, Duke University, and the Milken Institute SPH which investigated the role that state SOP laws play in determining the privileges given to NPs and PAs in acute care settings. They used data from 213 hospitals in 34 states collected by the Center for Advancing Provider Practices (CAP2), which was created in 2014 by the Illinois Health and Hospital Association and Vizient, Inc. and is now solely operated by Vizient. Their information on SOP laws for NPs and PAs came from the Pearson Report and the American Academy of Physician Assistants’ (AAPA) Six Key Elements of State PA Laws.

The team found that the average NP and PA privileging levels in 2014 in the sample they studied “are far below the levels allowable by the education of these professionals” in four clinical areas:  core (which includes general privileges that may apply to all providers), emergency department, cardiology and orthopedics. The team points out that some individual hospital did full privilege their NPs and PAs. The researchers’ comparison of state laws and individual hospital policies did not reveal a relationship between less restrictive SOP and less restrictive privileging policies. Hospitals operating in states with the most-restrictive SOP laws did not have more restrictions on privileging, and those in states with the most permissive SOP laws did not have a higher average number of privileges for NPs or PAs.

“These results suggest the need for additional research to understand the institutional-level variables and human dynamics at the level of medical staffing committees that may explain the dramatic variation in privileging policies and, ultimately, the effects of different privileging levels on costs and quality,” says Pittman, who recently presented the results at the AcademyHealth meeting.

“NP and PA Privileging in Acute Care Settings: Do Scope of Practice Laws Matter?” was published in Medical Care Research and Review.

The link below is to a poster that Pittman presented at the recent AcademyHealth conference.