title: Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review.
abstract: BACKGROUND
  One proposed strategy to expand primary care capacity is to use nurse practitioners (NPs) more effectively in health care delivery. However, the ability of NPs to provide care to the fullest extent of their education is moderated by state scope-of-practice (SOP) regulations.
  
  
  OBJECTIVE
  The purpose of this study was to examine the impact of state SOP regulations on the following three key issues: (a) NP workforce, (b) access to care and health care utilization, and (c) health care costs.
  
  
  METHODS
  Systematic review.
  
  
  CONCLUSIONS
  States granting NPs greater SOP authority tend to exhibit an increase in the number and growth of NPs, greater care provision by NPs, and expanded health care utilization, especially among rural and vulnerable populations. Our review indicates that expanded NP practice regulation can impact health care delivery by increasing the number of NPs in combination with easing restrictions on their SOP.
  
  
  CONCLUSIONS
  Findings show promise that removing restrictions on NP SOP regulations could be a viable and effective strategy to increase primary care capacity.
authors.affiliation: University of Rochester, School of Nursing, Rochester, NY. Electronic address: ying_xue@urmc.rochester.edu.
authors.forename: Ying
authors.initials: Y
authors.lastname: Xue
authors.affiliation: Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY.
authors.forename: Zhiqiu
authors.initials: Z
authors.lastname: Ye
authors.affiliation: University at Buffalo, School of Nursing, Buffalo, NY.
authors.forename: Carol
authors.initials: C
authors.lastname: Brewer
authors.affiliation: Philip R. Lee Institute for Health Policy Studies, Department of Family and Community Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA; Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, CA.
authors.forename: Joanne
authors.initials: J
authors.lastname: Spetz
mesh_terms: D002983:Clinical Competence / Q000331:legislation & jurisprudence* / Q000592:standards*; D003695:Delivery of Health Care / Q000331:legislation & jurisprudence* / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D009722:Nurse Practitioners / Q000331:legislation & jurisprudence* / Q000592:standards*; D011320:Primary Health Care / Q000331:legislation & jurisprudence / Q000592:standards*; D014481:United States
keywords: Nurse practitioner; Primary care; Scope-of-practice regulation