Nurse Practitioner Scope of Practice Laws and Their Effect on Pediatric Ambulatory Care Sensitive Condition (ACSC)-Related Emergency Department Visits

Building on our center's previous work examining the landscape of telehealth laws and recognizing the critical role that nurse practitioners play in the health care workforce, this project explores the extent to which nurse practitioner scope of practice laws have impacted ambulatory care sensitive conditions (ACSC)-related emergency department (ED) visits. There is growing concern about the use of the ED for non-urgent emergency department visits and subsequent hospital admissions as they are costly, inefficient, and may be a hindrance to providing care to patients in truly urgent or emergent conditions.

Previous research has shown that nurse practitioners, by providing health assessments, education, care planning and care coordination, particularly in home-based settings, are associated with less hospitalization and fewer emergency department visits. Nevertheless, it is unclear whether these findings hold for rural residents, who generally have more limited access to care than their urban counterparts. Moreover, ongoing debates and approaches on the extent to which nurse practitioners should be allowed to practice independently have made it difficult to determine the full extent of their effectiveness. Nurse practitioner scope of practice laws dictates the autonomy that nurse practitioners are given by states to treat patients. Currently, there are 27 states that give nurse practitioners full authority to practice without supervision or collaboration with another health care provider. All other states require nurse practitioners to collaborate with, or work under, the supervision of another health care provider.

Studies have found that nurse practitioners tend to practice more autonomously in rural settings and that expanded nurse practitioner scope of practice regulations were associated with greater nurse practitioner supply and improved access to care among rural residents. Despite these findings, little is known about the extent to which jurisdictions with expanded scope or practice laws for rural residents have seen less reliance on EDs for ACSCs. It is estimated that an ED visit costs approximately 12 times more than it costs to be treated in an outpatient setting. Commonly ED-treated ailments such as bronchitis, sore throat, and upper respiratory infections, and conditions referred to as ACSCs which include asthma, hypertension, pneumonia, and urinary tract infections, often do not require emergency care if patients receive timely and effective outpatient care. Since nurse practitioners fill an important role in primary care settings, EDs in jurisdictions that facilitate full autonomy for nurse practitioners may see fewer visits for potentially avoidable visits.