The impact of full practice authority on nurse practitioner compensation, collaboration, and billing

BACKGROUND: Although there is a substantial body of evidence regarding full practice authority\u27s (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. PURPOSE: This study examined whether states\u27 implementation of FPA leads to higher pay, business ownership, assigned patient panel, and billing transparency for NPs\u27 and whether NPs\u27 gains from FPA increase over time in states where FPA has been in effect longer. METHODOLOGY: Data from a nationwide survey of licensed NPs (N = 5,770) were used to compare NPs\u27 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. RESULTS: Compared with NPs in non-FPA states, NPs in FPA states had higher mean earnings (p \u3c .05), were more likely to be practice owners or shareholders (p \u3c .01), and billed a greater percentage of their patient visits under their own National Provider Identifier (p \u3c .001). Having FPA in place for ≥10 years was associated with greater improvements in conditions of employment compared with having FPA \u3c10 years. CONCLUSIONS: States\u27 adoption of FPA for NPs is associated with improved conditions of employment among NPs. IMPLICATIONS: 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

Effectiveness of Screen-Based Simulation as a Strategy to Improve Nurse Practitioner Students\u27 Access to Electronic Health Records in Clinical Education

Learning to use electronic health records is essential for family nurse practitioner students to inform practice and clinical decision-making. Limited access to electronic health records during clinical training can lead to suboptimal use. Academic programs often rely on healthcare organizations to provide opportunities for students to learn electronic health record skills. However, clinical experiences are highly individualized, and students may not have access to electronic health records. Alternatives are needed to develop this critical competency. This study compared self-reported ratings regarding comfort and access to electronic health record documentation between students who participated in screen-based simulation and students who completed traditional clinical experiences with a preceptor during the last 70 hours of clinical training in one family nurse practitioner program. There was a significant difference in electronic health record access between students who participated in simulated versus traditional clinical experiences ( P = .002). There were no significant differences in ratings of comfort using electronic health records between groups. Both groups reported limited access to electronic health records in the first 500 hours of clinical experience. However, students who participated in screen-based simulation reported a quarter-fold increase in electronic health record access during their last 70 hours of clinical training