States that allow nurse practitioners full practice authority find that doing so might encourage Black Medicare beneficiaries to use healthcare services more often, according to a study in Policy, Politics and Nursing Practice.
Occupational licensing experts with West Virginia University (WVU) focused on Black, Asian and Hispanic communities across the U.S. and compared the backgrounds of those patients with the NPs that serve them.
They found that racial and ethnic minorities are underrepresented in the NP field, which is the case with most professional healthcare fields. However, the researchers found that NPs better reflect the diversity of patient populations in states permitting full practice authority, and that Black and Asian NPs serve more Black Medicare beneficiaries after being granted that authority.
“It is important to note that these results are correlative estimations and are not meant to imply a causal relationship, more years of data would need to be collected to investigate cause and effect linkages,” the study said. “The representation of racial and ethnic minority providers within healthcare is critical to ensuring that patients from communities of color feel safe, comfortable, and able to better communicate with their healthcare provider.”
According to the American Association of Nurse Practitioners, full practice authority allows NPs “to evaluate patients, diagnose, order and interpret diagnostic tests and initiate and manage treatments—including prescribing medications—under the exclusive licensure authority of the state board of nursing.”
Alicia Plemmons, Ph.D., said in a press release that “full practice authority is a costless way of helping communities of color address healthcare access disparities.” Plemmons, an assistant professor in the department of general business at WVU, is a co-author of the study along with Edward Timmons, Ph.D., a service associate professor of economics at the university.
Plemmons and Timmons decided to not use data from AANP surveys or the data in the National Sample Survey of Registered Nurses as non-respondents might skew the results. Instead, they mined data from the Centers for Medicare & Medicaid Services (CMS) Physician Compare Data to find practitioners who served Medicare beneficiaries from 2014 to 2020. They also used the National Provider Identifier (NPI) to find active NPs.
They noted that “nurse practitioners may be recorded and counted at each of their active practice locations. Hence, we implicitly calculated specialty rather than a unique NP, and the NPI dashboard website uses a similar strategy to measure the number of healthcare providers.”
They found that Black NPs in states with full practice authority served 2.8% more Black Medicare beneficiaries. That’s significant, Plemmons said, because many studies have shown that patients of color prefer primary care providers who come from similar backgrounds.
“Black women die in childbirth at staggering rates compared to white women, frequently due to practitioners’ lack of cultural competence and respect,” Plemmons said. “When Black pregnant women receive prenatal care from a Black provider, mortality rates reduce sharply.”
NPs in states that allow them full practice authority can perform their range of services without having to enter into a contract with a supervising physician that can cost anywhere from $75 to $4,000 a month.
“In every state, NPs may all meet with patients, but that’s where the similarities stop,” Plemmons said. “Some states require physician supervision for NPs, while others simply require collaboration agreements. Some limit NPs in diagnosing patients or developing treatment plans, others limit making specialist referrals or ordering imaging services. Probably the most contentious restriction is prescribing medication.”
Communities of color won’t be the only ones served by allowing NPs to practice at the top of their licenses, the study states. Relatively sparsely populated states such as New Mexico and Wyoming that have large rural areas would also benefit from better NP autonomy.
As far as communities of color are concerned, though, “meaningful change may not happen for many states until they begin to empower nurse practitioners as providers of primary care to narrow racial and ethnic health disparities by contributing to NP workforce diversity.”
They suggest efforts to better diversify healthcare fields should be tied to strategies that make nursing schools and NP programs more accessible for ethnic and racial minorities.
A Q&A With Alicia Plemmons, Ph.D.
Fierce Healthcare: Do think that PCPs on a personal level would welcome the FPA for nurse practitioners, even if their representative organizations don’t?
Alicia Plemmons, Ph.D.: We prefer not to speculate on this—probably better to ask physicians for their opinions.
FH: Do you see any movement among those physician organizations to welcoming FPA for nurse practitioners?
AP: While the American Medical Association has been concerned with potential effects on quality and safety when nurse practitioners are granted full practice authority, there is a growing body of research empirically assessing these claims that find little evidence of negative effects on the quality of services, while simultaneously experiencing decreased costs for patients and increased access to healthcare professionals.
FH: Do you see public policy makers perhaps stepping in and granting nurse practitioners FPA whether the physician organizations want that or not?
AP: Twenty-six states and D.C. have enacted full practice authority.
FH: Especially given that doing so would help ease racial and ethnic disparities in health care?
AP: Our study finds that states with full practice authority have better representation of nurse practitioners from marginalized racial and ethnic groups relative to the population that they serve. This represents an important step for addressing disparities in healthcare access.
FH: What surprised you the most about your findings?
AP: Overall, I believe the study was not surprising to us as three of the co-authors on this study are from nursing programs that have noticed this trend emerging over time. We are excited to release this study to help further this discussion of representation and access in healthcare.
FH: Is there something I’ve neglected to ask that you think is pertinent and that you’d like professionals and the public to know about your findings?
AP: Full practice authority provides nurse practitioners with autonomy over their job tasks without expensive collaborative agreements that may cost upwards of thousands of dollars a month and force nurse practitioners from marginalized communities to work near hospitals or neighborhoods which may not align with their geographic and community preferences. Full practice authority gives nurse practitioners control over their mobility and practice decisions which empowers people to uplift the communities that they want to work in.