By Vineeta Teotia

Nurse practitioners (NPs) in states with full practice authority demonstrated higher levels of education, legal, and work autonomy, with 84% reporting full work autonomy in Maryland, compared with 77% and 67.9% in Delaware/Washington, DC, and Virginia, respectively. NPs working in hospitals across all states had significantly higher odds of experiencing restricted autonomy.

This cross-sectional study included data from the 2022 National Sample Survey of Registered Nurses, focusing on 1230 practicing NPs across Delaware/DC (538), Maryland (321), and Virginia (371), representing approximately 87% of NPs in these regions.

About one third of NPs in all three states were younger than 40 years with diverse races: 57% White, 31% Black, and 5% Asian in Delaware/DC; 49% White, 37% Black, and 8% Asian in Maryland; and 69% White, 17% Black, and 5% Asian in Virginia.

Levels of full work autonomy were evaluated and compared between states with full practice autonomy and those with restricted practice autonomy.

Other outcomes included differences in the levels of education, legal, and work autonomy between states with full practice autonomy and those with restricted practice autonomy, and factors associated with the odds of NPs reporting a lack of work autonomy.

Takeaway:

The proportion of NPs reporting full work autonomy was higher in states with full practice autonomy than in states with restricted practice autonomy, with 84% of NPs in Maryland reporting full work autonomy, compared with 77% and 67.9% of NPs in Delaware/DC and Virginia, respectively. The proportions of NPs reporting partial or no work autonomy were highest in Virginia (22.8% and 9.3%, respectively).

NPs in states with full practice autonomy reported significantly higher levels of education autonomy (mean, 0.95 vs 0.89; P < .001) and legal autonomy (mean, 0.97 vs 0.90; P < .001) and were less likely to report a lack of work autonomy (mean, 0.17 vs 0.32; P < .001) than NPs in states with restricted practice autonomy.

Hospital-based NPs had consistently higher odds of reporting a lack of work autonomy across all states than those working in non-hospital settings (odds ratio [OR], 4.67 in Delaware/DC; OR, 3.97 in Maryland; OR, 1.83 in Virginia; P < .001 for all). The odds of reporting a lack of autonomy among NPs in health professional shortage areas were reduced in Maryland (OR, 0.73; P < .01) but increased in Virginia (OR, 1.51; P < .001).

Black NPs had lower odds of reporting a lack of work autonomy than White NPs in both Maryland (OR, 0.42; P < .001) and Virginia (OR, 0.77; P < .01). In contrast, Asian NPs had higher odds of reporting a lack of work autonomy in Maryland (OR, 7.74; P < .001) but lower odds in Virginia (OR, 0.69; P < .05) than White NPs.

In Practice:

"NPs in states with full practice authority have higher levels of education, legal, and work autonomy," the authors wrote. "However, regardless of scope of practice at the state level, organizational factors are critical," they emphasized, adding that "working in hospital settings was associated with lower likelihood of NPs working autonomously," suggesting that "stakeholders in the four states/district and other US states need to prioritize working with hospital leaders to ensure that NPs are working to the full extent of their scope of practice."

Source:

The study was led by Yetty Shobo, PhD, Healthcare Workforce Data Center, Virginia Department of Health Professions, Richmond, Virginia.

Limitations:

The cross-sectional study design prevented causal conclusions. The findings might not be applicable to individuals outside the included states. Combining data from Delaware and DC could have introduced confounding.