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April 1, 2016 and describes some of the common elements of these state laws, and describes changes in state law since May 1, 2015. Data Collection and Methods Using the policy surveillance research method developed by the Center for Public Health Law Research, Temple University,16 we systematically collected, reviewed and redundantly coded NP SOP laws (statutes, legislation, and regulations) in the 50 states and District of Columbia (collectively referred to as “states”) impacting NP practice authority in effect from May 1, 2015 through April 1, 2016. The team used the Westlaw search engine (Thomson Reuters, Eagan, Minnesota) to identify all relevant SOP laws. Findings were cross-referenced with Internet legislative and administrative code sites for each state. Search terms included “advanced practice nurs!,” “nurse practitioner!,” “‘nurse practitioner!’ /p scope,” and “nurse! /p scope.” One hundred percent of state law records were redundantly coded and all divergences were resolved and recoded to the agreed upon response. A supervisor Table 1. State Law Practice Classification Frequencies, in effect April 2016* Practice Classification # of States Full Practice (ALL) 22 Full Practice, No transition period 14 Full Practice w/transition period; authorizes NP/APRN collaboration 6 Full Practice w/transition period; authorizes physician only collaboration 2 Limited Practice (ALL) 29 Only prescribing authority limited 9 More than prescriptive authority limited 20 * Includes Washington, D.C. also performed quality control by downloading all coding data into Microsoft Excel and examined the data for any missing answers, incorrect citations or other issues. Prior to conducting a final analysis of the data, any missing responses or incorrect citations were corrected by the researchers. State Laws Full Practice Authority As of April 1, 2016, all 50 states and the District of Columbia have NP SOP laws (Table 1). Twenty-two (43%) states provide full practice authority to NPs. Of these, fourteen states (27.5%) provide full practice authority without a transition period, six (11.8%) provide full practice after a transition period with another NP or a physician (Colorado, Maryland, Maine, Minnesota, Nebraska and Vermont) and two (3.9%) provide full practice with a transition period which requires collaboration with or supervision by a practicing physician only (Connecticut and Nevada). The length of transition to practice period varied across states, with some codified in hours (range: 1,000 to 2,400 hours) and others in months (range: 18 to 36 months). Limited Practice Authority Twenty-nine (57%) states limit NP practice authority. Of these, 9 (17.6%) states limit prescriptive authority only, while 20 (39.2%) states limit NP’s authority to conduct more than just prescribing unless performed in collaboration with or under the supervision of a physician. Page 2 of 5 States that limit prescriptive authority only require NPs to collaborate with a physician when prescribing medications, including when prescribing all legend drugs or only for controlled substances. States that limit more than prescriptive authority require NPs to enter into a collaborative or supervisory agreement with a physician to perform other activities that are explicitly codified in state law, including: making diagnoses, performing exams, ordering tests, prescribing and administering medications, initiating/managing patient treatment, making referrals, counseling patients, and/or interpreting patient medical information. Recent State Law Changes Between May 1, 2015 and April 1, 2016, three states made changes to their NP SOP laws. Colorado reduced the required transition to practice hours from 1,800 to 1,000 hours. Maryland and Nebraska moved from requiring collaboration with a physician for all activities to requiring a transition to full practice period in which an NP may collaborate with another NP. For more maps and tables on state NP SOP laws please see the Nurse Practitioner Scope of Practice Laws dataset page at lawatlas.org.17 Implications Demand for timely access to primary care is projected to continue to increase.18 Removing NP SOP practice limitations has been shown to increase patient access to primary care.1, 6, 7 Three states recently expanded NP SOP, while more than half the states continue to require NPs to practice in collaboration with or under the supervision of a physician in order to prescribe medication or conduct other clinical activities. For those states that limit NP practice authority, full or incremental reductions in existing requirements could expand access to primary care services. Further research on NP SOP laws, health care access and patient care outcomes could provide necessary contextual information to inform future decision making. In an era of impending physician shortages and increasing patient need, more information is necessary to explore feasible, effective methods for ensuring accessible, affordable, high quality health care.). The Pearson Report: A National Overview of Nursing Practitioner Legislation and Healthcare Issues. The American U.S. Department of Health and Human Service OBJECTIVES 1. To determine the extent to which nursing facilities: a. reported allegations of abuse or neglect in 2012; b. had written policies that address reporting allegations of abuse or neglect as required by Federal regulations; and c. complied with Federal regulations related to
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