Across the United States, nursing practice acts (NPAs) have been revised to include provisions that promote full practice authority (FPA) for nurse practitioners (NPs). Such revisions provide a mechanism to better utilize the full scope of NP services to address growing demands for access to health care. Modernized NPAs that facilitate FPA for NPs are imperative, especially now with the unprecedented health care crisis that the world now faces: Coronavirus Disease 2019. This is the first known study to use an embedded single-case study design, guided by the Kingdon policy stream model, to provide a detailed account of how stakeholders for NP FPA determine the appropriate time to pursue legislative changes to NP scope of practice regulations. Qualitative data analysis revealed four themes which comprised the components considered by stakeholders during their decision-making processes related to NP FPA: participants, problem, policy development, and politics. Themes were further collapsed within concepts from the Kingdon model to form the case description. Study findings can be used to increase the competency among NP FPA stakeholders in determining the timing of legislative pursuits for regulatory change.
Advanced Practice Registered Nurse Consensus Work Group & National Council of State Boards of Nursing. (2008). Consensus model for APRN Regulation: Licensure, accreditation, certification, and education. https://www.ncsbn.org/Consensus_Model_Report.pdf
2.
AltmanS.H.ButlerA.S.ShernL. (2016). Assessing progress on the Institute of Medicine Report: The future of nursing. National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK350166/
BraunV.ClarkV. (2014). Successful qualitative research: A practical guide for beginners.
SAGE.
11.
BromH. M.SalsberryP. J.GrahamM. C. (2018).
Leveraging health care reform to accelerate nurse practitioner full practice authority. Journal of the American Association of Nurse Practitioners,
30(3), 120–130. https://doi.org/10.1097/JXX.0000000000000023
12.
ConoverC.RichardsR. (2015).
Economic benefits of less restrictive regulation of advanced practice nurses in North Carolina. Nursing Outlook,
63(5), 585–592. https://doi.org/10.1016/j.outlook.2015.05.009
13.
DuncanC. G.SheppardK. G. (2015).
The full practice authority initiative: Lessons learned from Nevada. The Journal for Nurse Practitioners,11(6), 610–617. https://doi.org/10.1016/j.nurpra.2015.01.020
HealeR.BuckleyC.R. (2015).
An international perspective of advanced practice nursing regulation. International Nursing Review,
62, 421–429. https://doi.org/10.1016/j.jhealeco.2018.01.001
KingdonJ. W. (2011). Agendas, alternatives, and public policies (2nd ed.).
Longman.
20.
Kleiner, M. M., Marier, A., Park, K. W., & Wing, C. (2014). Relaxing occupational licensing requirements: Analyzing wages and prices for a medical care service. (Report No. 19906). National Bureau of Economic Research.
21.
KrausE.DuBoisJ. M. (2017).
Knowing your limits: A qualitative study of physician and nurse practitioner perspectives on NP independence in primary care. Journal of General Internal Medicine,32(3), 284–290. https://doi.org/10.1007/s11606-016-3896-7
National Council of State Boards of Nursing. (2020a). NCSBN considers pertinent association business with its members at its 2020 annual meeting. https://www.ncsbn.org/14928.htm
OrtizJ.HoflerR.BushyA.LinY. L.KhanijahaniA.BitneyA. (2018).
Impact of nurse practitioner practice regulations on rural population health outcomes. Healthcare,6(2), 65. https://doi.org/10.3390/healthcare6020065
27.
PoghosyanL.BoydD. R.ClarkeS. P. (2016).
Optimizing full scope of practice for nurse practitioners in primary care: A proposed conceptual model. Nursing Outlook,64(2), 146–122. https://doi.org/10.1016.j.outlook.2015.11.015
28.
PrengamanM. V.WelleD. L.RidenourN.MuellerK. J. (2018).
Diverse stakeholder perspectives on rural health care reform in a U.S. state that rejected the affordable care act: A case study. Online Journal of Rural Nursing and Health care,18(2), 65–87.https:// doi.org/10.14574/ojrnhc.v18i2.514
RichardsL.MorseJ. M. (2013). Readme first for a user’s guide to qualitative methods (3rd ed).
SAGE.
31.
RigolosiR.SalmondS. (2014).
The journey to independent nurse practitioner practice. Journal of the American Association of Nurse Practitioners,26(12),649–657. https://doi.org/10.1002/2327-6924.12130
32.
SonenbergA.KnepperH.PulciniJ. (2015).
Implementing the ACA: The influence of nurse practitioner regulatory policies on workforce, access to care, and primary care health outcomes. Poverty & Public Policy, 7(4), 335–356. https://doi.org/10.1002/pop4.119
33.
TraczynskiJ.UdalovaV. (2018).
Nurse practitioner independence, health care utilization, and health outcomes. Journal of Health Economics,
58, 90–109. https://doi.org/10.1016/j.jhealeco.2018.01.001
XueY.KannanV.GreenerE.SmithJ. A.BraschJ.JohnsonB. A.SpetzJ. A. (2018).
Full scope-of-practice regulation is associated with higher supply of nurse practitioners in rural and primary care health professional shortage counties. Journal of Nursing Regulation,8(4), 5–13. https://doi.org/10.1016/S2155-8256(17)30176-X
38.
YinR. K. (2014). Case study research: Design and methods (5th ed.).
SAGE.
