Nurse practitioners could ease the growing primary care physician shortage, but state scope-of-practice laws affect their practice opportunities, according to a Center for Studying Health System Change study.

NPs are registered nurses trained at the graduate level and, according to the American Academy of Nurse Practitioners, 89 percent are trained in primary care and more than 75 percent practice in primary care settings. State scope-of-practice laws vary widely in the level of physician oversight required for NPs, with some states allowing NPs to practice independently and others limiting NPs' authority to diagnose, treat and prescribe medications to patients without supervision.

In states where physician oversight is required, NPs are more likely to have work delegated to them by physicians and to comanage patient panels with physicians rather than acting as the sole, designated care provider. State scope-of-practice laws also were reported to sometimes impede NPs' efficiency, as when oversight of prescribing authority is required and NPs can't prescribe or refill controlled substances often used in treating pain.

Collaborative agreements, which stipulate how a physician will monitor an NP's performance and competency, can limit the range of practice settings for NPs, keeping them from underserved rural communities. Additionally, respondents reported that the agreements do not stimulate meaningful interaction between NPs and physicians.

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