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Full Nurse Practitioner Scope of Practice Led to Greater Workforce Diversity

Nurse practitioners in states permitting full scope of practice had better workforce diversity mirroring the diversity of patient populations.

New research out of West Virginia University revealed that granting full nurse practitioner (NP) scope of practice can foster greater workforce diversity that reflects the demographic of patient populations in marginalized communities.

During the COVID-19 pandemic, some federal and state governments expanded NP scope of practice to meet national healthcare needs. But as those temporary expansions started to expire, some state legislators pushed forward, granting NPs full practice authority.

“In every state, NPs may all meet with patients, but that’s where the similarities stop,” Alicia Plemmons, assistant professor at John Chambers College of Business and Economics and coordinator for the scope of practice research at the Knee Center for the Study of Occupational Regulation, said in a press release.

“Some states require physician supervision for NPs, while others simply require collaboration agreements,” Plemmons added. “Some limit NPs in diagnosing patients or developing treatment plans, others limit making specialist referrals or ordering imaging services. Probably the most contentious restriction is prescribing medication.” 

In this study, occupational licensing experts examined how full practice authority impacted the racial and ethnic diversity of the NP workforce focusing on Black, Asian, and Hispanic communities.

While nurse practitioners from marginalized communities are generally underrepresented in the workforce, the researchers found that states with full practice authority had higher concentrations of NPs that align with the demographic of their communities.

“We also found evidence that Black and Asian nurse practitioners serve more Black Medicare beneficiaries after receiving full practice authority,” said Plemmons. “Full practice authority is a costless way of helping communities of color address health care access disparities.”

Overall, the findings showed that Black NPs in states with full practice authority provided care to 2.8 percent more Black Medicare beneficiaries than Black NPs in states that do not grant full practice authority.

Increasing workforce diversity is a critical step in achieving health equity, as studies show that language, cultural perceptions, and biases create barriers to quality care. Mounting evidence suggests that having a racially-concordant physician as a usual source of care can improve patient experience, particularly for patients of color.

Plemmons pointed out that when patients visit a physician of the same race, they are more likely to be engaged in their care, schedule annual check-ups, share relevant information, and follow a treatment regimen.

Additionally, the researchers suggested that cultural misalignment between patients and providers contributes to racial disparities in healthcare outcomes.  

“Black women die in childbirth at staggering rates compared to white women, frequently due to practitioners’ lack of cultural competence and respect,” Plemmons said. “When Black pregnant women receive prenatal care from a Black provider, mortality rates reduce sharply.” 

Even though minorities benefit from having minority doctors, the medical workforce lacks sufficient diversity to support that need.

Recent figures from the Association of American Medical Colleges show that of active physicians, only 6.9 percent were Hispanic, and 5.7 percent were Black or African American.

“The US struggles to provide adequate primary care to its residents. Provider shortages are a key contributor, as is our aging population, and shortages are particularly acute in communities of color,” Plemmons stated. “The Association of American Medical Colleges estimates a shortage of 54,100 to 139,000 physicians by 2033, compounded by the fact that a majority of physicians will specialize in something more lucrative than primary care.”

“However, nearly 82 percent of NPs will specialize in primary care. And while the number of physicians entering the workforce is declining, the per capita supply of NPs has grown significantly.”

Ultimately, these findings add to the literature, suggesting that an expanded scope of practice for NPs may be essential to quell health disparities.

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