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Health Outcomes Improve in States Where Nurse Practitioners Independently Provide Primary Care

Experts say physician oversight of nurse practitioners is costly, inefficient and reduces access to care

January 14th, 2015

Story Contact: Jesslyn Chew,

By Fran Webber

COLUMBIA, Mo. – As America’s population ages, life spans lengthen and more individuals enroll in insurance plans under the Affordable Care Act, the need for health care professionals will increase. The Association of American Medical Colleges estimates that the health care market will fall short of demand by 45,000 primary care physicians in 2020. Many states do not allow advanced practice registered nurses (APRNs) to perform primary care duties to their full potential; however, University of Missouri researchers say APRNs can help relieve the shortage of healthcare workers and expand access to care for underserved populations. In a recently published study, MU Sinclair School of Nursing researchers, Gina Oliver, Lila Pennington, Sara Revelle and Marilyn Rantz, found that quality of health care is improved in states where APRNs are allowed to practice independently.

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“APRNs have graduate-level educations; when you get APRNs into nursing homes, they help improve the overall quality of care because they have advanced knowledge of the best evidence-based practice,” said Marilyn Rantz, Curators’ Professor and Helen E. Nahm Chair in the MU Sinclair School of Nursing. “In states where APRNs practice independently, health outcomes are better, Medicare and Medicaid outcomes for older adults are better, and costs are lower. Hospitalizations also decrease.”

In states like Missouri, which has some of the most restrictive laws and regulations for APRNs, physicians must oversee nurse practitioners’ work. In unrestricted states, APRNs may manage groups of patients with physicians consulted only as needed. Allowing APRNs to practice independently keeps costs down and improves access to care, Rantz said.

The research team analyzed data from previous studies that evaluated health outcomes and hospitalization rates of Medicare and Medicaid patients by state. In states where APRNs were fully independent in their practice, the researchers found significant improvement in quality of care and health outcomes.

“The movement for unrestricted APRN practice nationwide is happening right now,” Rantz said, “More and more states are changing their laws because they’ve seen the improvements. They’re looking ahead to the future and providing access to care.”

Previous research supports the findings of this study, and a scientific basis for the restriction of APRN practice does not exist, Rantz said.

The study, “Impact of Nurse Practitioners on Health Outcomes of Medicare and Medicaid Patients,” was published in the November-December issue of Nursing Outlook.  The article abstract may be viewed at: