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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
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Strategy. Nurse Practitioner Scope of Practice

Approach. Encourage regulations allowing Nurse Practitioners to provide the full scope of care to children

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Overview. Nurse Practitioners (NPs) have graduate-level nursing education and must complete national board certification exams. The NP scope of practice is regulated by state-level Nurse Practice Acts and Boards of Nursing and varies by state, ranging from requirements to collaborate with or be supervised by physicians to autonomy to provide care to the full scope of NP training and skills without physician oversight (e.g., independent practice and prescription authority). NPs frequently specialize in primary care, acute care, or mental healthcare.[1] There is strong evidence that NPs provide high quality routine care that is equivalent to and sometimes better than, comparable care provided by physicians.[2,3,4]

Evidence. Scientifically Rigorous Evidence. Strategies with this rating are most likely to be effective...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • NP-to-Patient ratios
  • Provider satisfaction and workforce surveys
  • Patient satisfaction surveys

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.
  • Quality of Care. This strategy promotes the degree to which healthcare services meet established standards aimed at achieving optimal health outcomes.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Direct Care (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Individual/Family-Focused

Examples from the Field. There are currently no ESMs that use this strategy. Search similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of NPs who are newly authorized and trained by Title V to provide comprehensive well-child care, including developmental screenings, anticipatory guidance, and chronic condition management. (Measures workforce expansion and capacity building to support full scope of NP practice)
  • Number of professional organizations, health systems, and payers partnered with Title V that formally support NP full practice authority in pediatric care. (Measures level of partner buy-in and alignment)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of families who are aware of and comfortable with NPs as qualified providers of comprehensive primary care for their children. (Measures public knowledge and acceptance of NP care model)
  • Percent of pediatric care services and procedures that are successfully performed by NPs without the need for physician supervision or consultation. (Measures efficiency and appropriateness of NP care delivery)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of pediatric primary care delivery models and innovations promoted by Title V (e.g., team-based care, telehealth) that leverage the full scope of NP practice to improve access and quality. (Measures care model transformation and advancement)
  • Number of local health jurisdictions partnered with Title V that use NP full practice authority in pediatrics as a strategy to address workforce shortages. (Measures use of policy lever for health system improvement)
  • Number of communities, especially those in rural and under resourced areas, that experience sustained improvements in pediatric health outcomes under NP full practice authority. (Measures long-term population health impact)
  • Number of NPs who take on leadership roles, influence policy decisions, and drive innovations in pediatric care delivery as a result of expanded scope of practice. (Measures impact on workforce advancement and transformation)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent of pediatric primary care delivery models and innovations promoted by Title V (e.g., team-based care, telehealth) that leverage the full scope of NP practice to improve access and quality. (Measures care model transformation and advancement)
  • Percent of local health jurisdictions partnered with Title V that use NP full practice authority in pediatrics as a strategy to address workforce shortages. (Measures use of policy lever for health system improvement)
  • Percent of communities, especially those in rural and under resourced areas, that experience sustained improvements in pediatric health outcomes under NP full practice authority. (Measures long-term population health impact)
  • Percent of NPs who take on leadership roles, influence policy decisions, and drive innovations in pediatric care delivery as a result of expanded scope of practice. (Measures impact on workforce advancement and transformation)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] Xue 2016 - Xue Y, Ye Z, Brewer C, Spetz J. Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review. Nursing Outlook. 2016;64(1):71–85.
[2] Stanik-Hutt J, Newhouse RP, White KM, et al. The quality and effectiveness of care provided by nurse practitioners. The Journal for Nurse Practitioners. 2013;9(8):492–500.e13.
[3] Buerhaus PI, DesRoches CM, Dittus R, Donelan K. Practice characteristics of primary care nurse practitioners and physicians. Nursing Outlook. 2015;63(2):144–153.
[4] Martínez-González NA, Djalali S, Tandjung R, et al. Substitution of physicians by nurses in primary care: A systematic review and meta-analysis. BMC Health Services Research. 2014;14:214.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.