State-Granted Practice Authority: Do Nurse Practitioners Vote with Their Feet?

Nurse practitioners have become an increasingly important part of the US medical workforce as they have gained greater practice authority through state-level regulatory changes. This study investigates one labor market impact of this large change in nurse practitioner regulation. Using data from the National Sample Survey of Registered Nurses and a dataset of state-level nurse practitioner prescribing authority, a multivariate estimation is performed analysing the impact of greater practice authority on the probability of a nurse practitioner moving from a state. The empirical results indicate that nurse practitioners in states that grant expanded practice are less likely to move from the state than nurse practitioners in states that have not granted expanded practice authority. The estimated effect is robust and is statistically and economically meaningful. This finding is in concert with and strengthens the wider literature which finds states that grant expanded practice authority to nurse practitioners tend to have larger nurse practitioner populations. 1. Introduction Nurse practitioners ( s) are, according to the International Council of Nurses, “a registered nurse who has acquired the expert knowledge base, complex decision-making skills, and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice” [1]. In the United States, s are typically masters-prepared registered nurses and have become an increasingly important part of the health care system. They have over time obtained greater practice authority through state-level regulatory changes which has fundamentally altered what an can do as a caregiver. This has, in turn, altered their role in the health care system. In particular, these changes have allowed s to take a more central, independent role in providing health care. While s were initially seen as “physician extenders” by the wider health care industry in the United States, they have become, in many respects, “physician replacers.” Today, in most U.S. states, s can see, diagnose, prescribe, and in general provide care for patients as a general practice physician would. As such, these regulatory changes in practice authority, and the “rise” of the they have ushered in, have fundamentally changed the labor market. As would be expected in an industry as important as health care, the “rise of the ” has been accompanied by a large body of research. In general, this research can be grouped into four broad categories: their rise as caregivers, the