State Nurse Practitioner Practice Regulations and U.S. Health Care Delivery Outcomes: A Systematic Review

Bo Kyum Yang, Mary E. Johantgen, Alison M. Trinkoff, Shannon R. Idzik, Jessica Wince, Carissa Tomlinson

Research output: Contribution to journalReview articlepeer-review

4 Scopus citations


There is a great variation across states in nurse practitioner (NP) scope of practice moderated by state regulations. The purpose of this study was to synthesize the evidence from studies of the impact of state NP practice regulations on U.S. health care delivery outcomes (e.g., health care workforce, access to care, utilization, care quality, or cost of care), guided by Donabedian’s structure, process, and outcomes framework. This systematic review was performed using Medline, CINAHL, PsycINFO, and PubMed according to Preferred Reporting Items for Systematic and Meta-Analysis on the literature from January 2000 to August 2019. The results indicate that expanded state NP practice regulations were associated with greater NP supply and improved access to care among rural and underserved populations without decreasing care quality. This evidence could provide guidance for policy makers in states with more restrictive NP practice regulations when they consider granting greater practice independence to NPs.

Original languageEnglish (US)
JournalMedical Care Research and Review
StateAccepted/In press - 2020

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was partially supported by Summer Undergraduate Research Institute at Towson University.


  • access to care
  • and workforce
  • health care cost
  • health care utilization
  • nurse practitioners
  • practice regulations
  • quality of care

PubMed: MeSH publication types

  • Journal Article

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