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Key Findings

1. A RAND team examined the potential impact of changing scope of practice regulations in Michigan to allow nurse practitioners to autonomously diagnose and treat conditions and prescribe medications.
2. Researchers estimated that this change could possibly increase access to care, improve favorable utilization of care, decrease unfavorable utilization, and improve patient-centeredness.
3. Data were insufficient to estimate the effects on other outcomes, such as provider supply, health care costs, or patient outcomes.

Some forecasts have pointed to a looming physician shortage in the United States, particularly in light of growing demand for health services from the Affordable Care Act and a rising elderly population. One strategy for addressing this issue is to allow nurse practitioners (NPs) to have "full scope of practice" — that is, to autonomously deliver care that falls within their educational preparation: diagnosing and treating conditions, writing prescriptions, and performing minor procedures. Many states have done this. In the state of Michigan, the legislature is considering how to define NP scope of practice. NPs in the state currently function under the same rules as registered nurses, limiting the care that they can provide to patients without the oversight of physicians. Would a more expansive scope of practice for NPs improve health care for the residents of Michigan?