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Objectives: A growing number of nurse practitioners (NPs) are employed in nursing homes (NHs) through various NP staffing mechanisms. The purpose of this study was to examine if having NH-employed NPs was associated with nursing staff turnover and resident care outcomes measured as hospital utilization, infection control citations, and substantiated complaints in NHs in 2021-2022., Design: A cross-sectional, retrospective study., Setting and Participants: A total of 13,966 NHs from payroll-based journal (PBJ) and claim-based quality measures published by the Centers for Medicare and Medicaid Services in 2021-2022., Methods: Facilities were identified as having NH-employed NPs if at least 1 employed NP with paid working hours ≥10 per week was reported through the PBJ. We examined if having NH-employed NPs was associated with nursing staff turnover rates, unplanned hospital utilization, infection control citations, and substantiated complaints using doubly robust estimation that combined inverse probability weight representing the NH's likelihood of employing NPs and outcome regression., Results: Approximately, 2.8% of NHs had employed NPs. Facilities with NH-employed NPs tended to be larger, hospital affiliated, and not for profit with greater medical and nursing staff availability. In addition, a significantly higher proportion of facilities with NH-employed NPs were in metropolitan areas or states with full NP practice independence. We found that facilities with NH-employed NPs had significantly lower registered nurse (adjusted β, -5.40; 95% CI, -9.50 to -1.30) and certified nursing assistant turnover rates (adjusted β, -3.35; 95% CI, -6.29 to -0.40). Facilities with NH-employed NPs also had significantly fewer long-stay resident hospitalizations, infection control citations, and substantial complaints compared with those with no NH-employed NPs., Conclusions and Implications: This study highlights the value of NH-employed NPs to improve registered nurse and certified nursing assistant staff retention and NH resident outcomes. NH stakeholders and policymakers may consider various strategies to incentivize NP employment in NHs such as removing regulatory barriers to NP practice., (Copyright © 2023 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Despite the growing involvement of nurse practitioners in mental health services for children and adolescents, little is known about the patterns of mental health service use among youths treated by nurse practitioners compared to those by physicians., Objectives: To identify new users of psychotropic medications initiated by nurse practitioners and physicians among Medicaid-insured youths and to assess if receiving psychosocial services prior to or concurrent with medication initiation differs among youths treated by provider and specialty type., Design: A retrospective cohort study., Settings: We used Medicaid-insurance claims data in one mid-Atlantic state in the US., Participants: A total 12,991 Medicaid-insured youths aged 0-20 years who started psychotropic medications prescribed by nurse practitioners or physicians with primary care or psychiatric specialty during 2013-2014., Methods: Providers were grouped into nurse practitioners and physicians and into primary care and psychiatric specialty. Descriptive statistics were performed to compare each class of psychotropic medications initiated and psychiatric diagnoses of enrollees according to provider type within each specialty. Using multinomial logistic regression with psychiatrists as a reference group, we estimated the odds of having a type of prescriber for psychotropic medication initiation for youths who received psychosocial services prior to a new start of the medication and concurrently, compared to that for those who did not, after adjusting for patients' demographic characteristics and diagnosis., Results: Youths served by nurse practitioners resided in small and non-metropolitan areas significantly more often than those served by their physician counterparts. There was no major difference in a class of psychotropic medications initiated by nurse practitioners and physicians within each specialty type, except a higher proportion of antidepressants (13.5% versus 10.5%) and a lower proportion of attention deficit hyperactivity disorder medications prescribed (68.8% versus 74.0%) by primary care nurse practitioners compared to their physician counterparts. Youths who received psychosocial services prior to medication initiation were less likely to have primary care physicians (Adjusted odds ratio=0.15, 95% confidence interval=0.82, 1.33) or primary care nurse practitioners (Adjusted odds ratio=0.16, 95% confidence interval=0.12, 0.20) as their initiating prescriber than those who did not., Conclusions: Youths treated by nurse practitioners and physicians with or without psychiatric specialty showed unique patterns of mental health service use. Our findings can be used to build effective collaborations among provider and specialty type for quality of mental health services delivered to targeted populations in need., Competing Interests: Conflict of Interest This work was supported by the Southern Nursing Research Society Research Grant Award in 2016 and the Summer Undergraduate Research Institute at the College of Health Professions, Towson University., (Copyright © 2021. Published by Elsevier Ltd.)

There is a great variation across states in nurse practitioner (NP) scope of practice moderated by state regulations. The purpose of this study was to synthesize the evidence from studies of the impact of state NP practice regulations on U.S. health care delivery outcomes (e.g., health care workforce, access to care, utilization, care quality, or cost of care), guided by Donabedian's structure, process, and outcomes framework. This systematic review was performed using Medline, CINAHL, PsycINFO, and PubMed according to Preferred Reporting Items for Systematic and Meta-Analysis on the literature from January 2000 to August 2019. The results indicate that expanded state NP practice regulations were associated with greater NP supply and improved access to care among rural and underserved populations without decreasing care quality. This evidence could provide guidance for policy makers in states with more restrictive NP practice regulations when they consider granting greater practice independence to NPs.

Objective: Little is known about how nurse practitioner independent practice authority (NP-IPA) influences patient care. This study examined the effect of NP-IPA on patterns of mental health-related visits provided by NPs in U.S. community health centers (CHCs)., Methods: State NP regulatory information was linked to National Ambulatory Medical Care Survey data on NP- and physician-provided visits (N=61,457) in CHCs from 2006 through 2011. The proportion of NP-provided versus physician-provided mental health-related visits in states with NP-IPA was compared with the proportion in states without NP-IPA. The adjusted odds of mental health-related visits in CHCs provided by NPs in states with and without NP-IPA were compared by using multiple logistic regression models while accounting for the complex survey design., Results: Between 2006 and 2011, the odds of NP- versus physician-provided mental health-related visits in CHCs were more than two times greater in states with NP-IPA than in states with no NP-IPA (adjusted odds ratio [OR]= 2.43, 95% confidence interval [CI]=1.12-4.60). In contrast, no significant difference between states with and without NP-IPA was noted in non-mental health-related CHC visits provided by NPs. Among all mental health-related visits, the odds of visits in which psychotropic medications were prescribed by an NP were more than three times higher in states with NP-IPA than in those without NP-IPA (adjusted OR=3.14, CI=1.50-6.54)., Conclusions: Compared with physicians, NPs provided proportionally more CHC mental health-related visits in states with NP-IPA than in states without NP-IPA.