State scope-of-practice (SOP) laws govern the procedures and actions that licensed health-care providers can perform. These laws establish the breadth of health-care procedures and services that health-care providers are licensed to provide under state law. In the case of advanced practice registered nurses (APRNs) (i.e., certified nurse-midwives [CNMs], nurse practitioners [NPs], certified registered nurse anesthetists [CRNAs], and clinical nurse specialists [CNSs]), the rules establish both the range of services APRNs may deliver and the extent to which APRNs are permitted to practice without physician supervision (Gilman and Koslov, 2014). State SOP laws specify, for example, whether APRNs can write certain...

We performed a literature review by searching for peer-reviewed studies in the PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. We also used the Google search engine to find gray literature related to nursing and state SOP laws, and we reviewed nurse associations’ websites (e.g., the American Nurses Association, State of Ohio Board of Nursing, American Association of Nurse Anesthetists) for other documents pertaining to Ohio’s SOP laws. Studies deemed in scope initially were rigorously reviewed for their research designs, provider definitions, data sources, peer-review status, mechanisms of effect, and plausibility of findings. Informed by this...

Though the results in the literature are general and apply to national samples in an earlier time period, we argue that they could be used in an exploratory way to infer the effect of SOP laws for APRNs in Ohio. This can be done by using known characteristics of the population and health-care system in Ohio. We used the point estimates from the literature review studies to assess the changes in quality, access, and costs that result from moving from the most restrictive to the least restrictive SOP laws. We used Ohio-specific population estimates to determine the specific effect on...

APRNs make up the fastest-growing segment of the primary care professional workforce in the United States (Gilman and Koslov, 2014) and are more likely to practice in underserved areas, lower-income areas, and districts with lower scores on the High School Proficiency Assessment (Gilman and Koslov, 2014). States are considering expanding SOP for these APRNs as a potential approach to improve access to care, maintain or enhance care quality, and decrease overall health-care costs. Previous studies have demonstrated that APRNs deliver care that is of equal quality to the care provided by their physician counterparts. Our own review of the literature...