Regulatory Barriers Remain on Nurse Practitioners, regardless of their Involvement in Improving Care Outcomes

Regulatory Barriers Remain on Nurse Practitioners, regardless of their Involvement in Improving Care Outcomes
Date: June 6, 2024

Nurse practitioners (NPs) are an integral part of nursing home care. Researchers have found that their involvement in care significantly influences end-of-life care outcomes, especially for those with Alzheimer’s disease and related dementias (ADRD). A new study in the JAMA Health Forum shares that NPs reduced hospitalization rates and increased hospice use for ADRD residents in their last days.

Elizabeth White, PhD, researcher and assistant professor of health services of policy and practice at Brown University, shares that “findings suggest that some of the restrictions that states put on NP scope of practice may influence how NPs provide care to nursing home residents with dementia at end-of-life.” White goes on to explain that “…when a state restricts NPs from signing Do Not Resuscitate orders, that can serve as a barrier to advance care planning and could contribute to unnecessary hospitalizations at the end of life.”

The JAMA Health Forum study focused on over 300k nursing home residents with ADRD. The study discovered that nurse practitioners decreased the number of hospitalizations when they were significantly involved in care. Of course, the reduction varied depending on the state.

In addition, the study revealed that NPs played a significant role in hospice care. NPs increased hospice use rates. For states with fewer restrictions, improved rates were almost 3%; for restricted practice states, rates went up by about 2%.

White notes that “there is a robust body of evidence that NPs provide comparable care to physicians, and within nursing homes specifically, allow for expanded access to high-quality medical care.” White mentions that “there are no studies to [her] knowledge that have demonstrated that regulations restricting NP scope of practice improve patient outcomes.”

Nurse practitioners significantly impact the care of nursing home residents, especially those with ADRD. However, regulatory barriers remain. Health and policy professionals like White feel NPs provide more care and should not be restricted. Long-term care facilities are intended to give residents the best quality of care, and NPs are working to do just that.

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Henreckson, Josh. “Nurse Practitioners Improve Skilled Nursing’s Dementia Care Outcomes, but Regulatory Barriers Remain: Study.” McKnight’s Long-Term Care News, 10 May 2024,

Julia Kourpas