State-level scope of practice regulations for nurse practitioners impact work environments: Six state investigation

Q: What was the study investigating about nurse practitioner scope of practice?

It examined how state-level SOP policies are associated with organizational-level NP work environment measures in healthcare settings.

Q: How was the data collected and from how many participants?

A cross-sectional survey collected data from 1244 NPs across six states during 2018–2019.

Sep 21, 2026

Uploaded by Jordan Avery

Nurse practitioner scope of practice policies vary across the United States, and their effects on NP work environment within healthcare organizations were not well established. Using a cross-sectional survey design, the study analyzed responses from 1244 NPs in six states (2018–2019) with different SOP regulations. Results showed higher NP-Administration Relations, Independent Practice and Support, and Professional Visibility scores in full SOP states, while NP-Physician Relations showed no association.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages15

Reading Time38 min

AccessFree to download

Abstract

Introduction and Background

Scope of practice differences across states

Policy barriers and their implications

Study focus and rationale

UCSF UC San Francisco Previously Published Works Title State‐level scope of practice regulations for nurse practitioners impact work environments: Six state investigation Permalink [https://escholarship.org/uc/item/6t08z4x2](https://escholarship.org/uc/item/6t08z4x2) Journal Research in Nursing & Health, 45(5) ISSN 0160-6891 Authors Poghosyan, Lusine Stein, Jordan H Liu, Jianfanget al. Publication Date 2022-10-01 DOI 10.1002/nur.22253 Peer reviewed [eScholarship.org](eScholarship.org) Powered by the California Digital Library University of California Author Manuscript Author Manuscript Author Manuscript Author Manuscript | | HHS Public Access
Author manuscript
Res Nurs Health. Author manuscript; available in PMC 2023 October 01. | | --- | --- | Published in final edited form as: Res Nurs Health. 2022 October ; 45(5): 516–524. doi:10.1002/nur.22253 . State-level scope of practice regulations for nurse practitioners impact work environments: Six state investigation Lusine Poghosyan 1 , Jordan H. Stein 1 , Jianfang Liu 1 , Joanne Spetz2 , Zainab T. Osakwe3 , Grant Martsolf4 1School of Nursing, Columbia University, New York, New York, USA 2School of Nursing, University of California, San Francisco, California, USA 3College of Nursing and Public Health, Adelphi University, Garden City, New York, USA 4School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA Abstract Nurse practitioner (NP) scope of practice (SOP) policies are different across the United States. Little is known about their impact on NP work environment in healthcare organizations. We investigated the association between SOP policies and organizational-level work environment of NPs. Through a cross-sectional survey design, data were collected from 1244 NPs in six states with variable SOP regulations (Arizona, New Jersey, Washington, Pennsylvania, Texas, and California) in 2018–2019. Arizona and Washington had full SOP—NPs had full authority to deliver care. New Jersey and Pennsylvania had reduced SOP with physician collaboration requirement; California and Texas had restricted SOP with physician supervision requirement. NPs completed mail or online surveys containing the Nurse Practitioner Primary Care Organizational Climate Questionnaire, which has these subscales: NP-Administration Relations (NP-AR), NP-Physician Relations (NP-PR), Independent Practice and Support (IPS), and Professional Visibility (PV) . Regression models assessed the relationship between state-level SOP and practice-level NP work environment. NP-AR scores were higher in full SOP states compared to reduced (β = 0.22, p < 0.01) and restricted (β = 0.15, p < 0.01) SOP states. Similarly, IPS scores were higher in full SOP states. The PV scores were also higher in full SOP states compared to reduced (β = 0.16, p < 0.001) and restricted (β = 0.12, p < 0.05) SOP states. There was no relationship between SOP and NP-PR score. State-level policies affect NP work environment. In states with more favorable policies, NPs have better relationships with Correspondence: Lusine Poghosyan, School of Nursing, Columbia University, 560 W 168th St, Office 624, New York, NY 10032, [USA. lp2475@columbia.edu](USA. lp2475@columbia.edu). AUTHOR CONTRIBUTIONS Dr. Poghosyan was responsible for conceptualizing the study. Drs. Poghosyan, Martsolf, and Liu determined the methodology of the study. Dr. Liu conducted the data analysis. Dr. Spetz provided expert methodological expertise and provided feedback on the study methodology. Dr. Poghosyan drafted the manuscript and Dr. Stein assisted with result interpretation. Dr. Osakwe provided NP perspective to be incorporated in the discussion. All authors reviewed the manuscript and contributed to the writing. CONFLICT OF INTEREST The authors declare no conflict of interest. PEER REVIEW The peer review history for this article is available at [https://publons.com/publon/10.1002/nur.

FAQs

What was the study investigating about nurse practitioner scope of practice?

It examined how state-level SOP policies are associated with organizational-level NP work environment measures in healthcare settings.

How was the data collected and from how many participants?

A cross-sectional survey collected data from 1244 NPs across six states during 2018–2019.

Which work-environment subscales were linked to state-level SOP policies?

NP-Administration Relations, Independent Practice and Support, and Professional Visibility were higher in full SOP states, while NP-Physician Relations showed no relationship.

Sep 21, 2026

Uploaded by Jordan Avery