Skip Navigation

Strengthen the Evidence for Maternal and Child Health Programs

Sign up for MCHalert eNewsletter

Evidence Tools
MCHbest. Medical Home: Referrals.

MCHbest Logo

Strategy. Nurse Practitioner Scope of Practice

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

Return to main MCHbest page >>

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 based on scientifically rigorous evidence are proven effective across multiple robust studies. While success is highly likely, local impact may vary. Monitor outcomes and use data to tailor these strategies to the community's unique needs.

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 trained by Title V to effectively manage referral process, including identifying need, communicating with specialists, and coordinating follow-up care. (Measures workforce capacity for referral management)
  • Number of specialty care providers partnered with Title V who establish referral agreements and care compacts with NPs under expanded scope of practice. (Measures cross-sector collaboration for referrals)

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

  • Percent of NP training curricula that include content on effective referral practices, care coordination, and collaboration with specialists. (Measures workforce preparation for referral management)
  • Percent of referrals placed by NPs that include comprehensive and accurate clinical information, clear care goals, and mechanisms for bidirectional communication. (Measures quality of NP referral process)

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

  • Number of health systems that utilize technology platforms and data-sharing agreements promoted by Title V to facilitate closed-loop referrals between NPs and specialists. (Measures infrastructure for referral coordination)
  • Number of regional networks and learning collaboratives led by Title V formed to share best practices and address common challenges in NP-led referral process. (Measures peer learning and support for referral improvement)
  • Number of communities that experience reduced wait times, increased specialty care utilization, and improved health outcomes through streamlined NP referral process. (Measures population-level impact on referral access and effectiveness)
  • Number of partnerships led by Title V between primary care, specialty care, and community-based services that are strengthened and sustained through NP care coordination and referral management. (Measures broad system integration impact)

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

  • Percent of NPs who receive training and support on care coordination who report and increase in knowledge and/or skill. (Measures comprehensive referral workforce practices)
  • Percent of specialty care referral networks and resources that are mapped and allocated to ensure access across the community. (Measures intentional planning for referrals)
  • Percent of communities that experience reduced wait times, increased specialty care utilization, and improved health outcomes through streamlined NP referral process. (Measures population-level impact on referral access and effectiveness)
  • Percent of partnerships led by Title V between primary care, specialty care, and community-based services that are strengthened and sustained through NP care coordination and referral management. (Measures broad system integration impact)

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.