The American Association of Nurse Practitioners, Austin, Texas.
School of Nursing, Johns Hopkins University, Baltimore, Maryland.
J Am Assoc Nurse Pract. 2023 Nov 1;35(11):691-698. doi: 10.1097/JXX.0000000000000918.
Although there is a substantial body of evidence regarding full practice authority's (FPA) effects on health care access and quality, very little research has examined how nurse practitioner (NP) licensure laws affect the status of NPs as clinicians, employees, and leaders in health care organizations.
This study examined whether states' implementation of FPA leads to higher pay, business ownership, assigned patient panel, and billing transparency for NPs' and whether NPs' gains from FPA increase over time in states where FPA has been in effect longer.
Data from a nationwide survey of licensed NPs ( N = 5,770) were used to compare NPs' employment conditions between FPA and non-FPA states. After balancing the FPA and non-FPA groups on demographic characteristics (e.g., urbanicity, education), adjusted mean differences in outcomes between the groups were estimated using weighted multivariable regression.
Compared with NPs in non-FPA states, NPs in FPA states had higher mean earnings ( p < .05), were more likely to be practice owners or shareholders ( p < .01), and billed a greater percentage of their patient visits under their own National Provider Identifier ( p < .001). Having FPA in place for ≥10 years was associated with greater improvements in conditions of employment compared with having FPA <10 years.
States' adoption of FPA for NPs is associated with improved conditions of employment among NPs.
Untethering NPs from physicians establishes a cascade of modest gains in income and practice ownership that may indicate changes over time. Additional research is needed to determine the trajectory of these increases and if they are consistent.
尽管有大量证据表明完全执业权限（FPA）对医疗保健的可及性和质量有影响，但很少有研究探讨护士从业者（NP）许可法律如何影响 NP 在医疗保健组织中的临床医生、员工和领导者的地位。
本研究考察了 FPA 的实施是否会导致 NP 的薪酬、企业所有权、分配的患者群体和计费透明度提高，以及在 FPA 实施时间较长的州，NP 从 FPA 中获得的收益是否会随着时间的推移而增加。
使用全国范围内执业 NP 的调查数据（N=5770），比较 FPA 和非 FPA 州 NP 的就业条件。在对两组人群的人口统计学特征（例如，城市性、教育程度）进行平衡后，使用加权多变量回归估计两组之间结果的调整后平均差异。
与非 FPA 州的 NP 相比，FPA 州的 NP 平均收入更高（p<.05），更有可能成为实践所有者或股东（p<.01），并以自己的国家提供者标识符（NPI）计费更大比例的患者就诊次数（p<.001）。拥有 FPA 时间≥10 年与 FPA<10 年相比，就业条件的改善更大。
各州对 NP 采用 FPA 与 NP 就业条件的改善相关。
将 NP 从医师中解放出来会导致收入和实践所有权的适度增加，这可能表明随着时间的推移会发生变化。需要进一步研究以确定这些增加的轨迹以及它们是否一致。
