By Caleb Taylor

Does expanding the scope of practice of nurse practitioners improve mental health outcomes in certain populations?

ACRE Undergraduate Research Fellow Zakree Massey and BTĚěĚĂAssociate Professor of Economics and ACRE Director Dr. David Mitchell answer this question and more in a forthcoming paper entitled “Expanding the Use of Nurse Practitioners and Young Adult Mental Health.”Ěý

Massey is a part of ACRE’s Research Fellowship Program. In this program, students work with a professor or policy analyst to write a publishable research paper.Ěý

According to the abstract of the paper:

This paper examines the impact that expanding Nurse Practitioners’ scope of practice has on the mental health of certain populations. The state of mental health in the United States has been a growing area of concern over the past 30 years, especially in certain areas of the country within specific demographic groups. Unlike other studies, we concentrate on those distinct characteristics of the populations such as rurality and access to care. Using a panel data fixed effects model, and the NLSY97 panel data set, we find a relationship between the economy and anxiety/depression in young people.”

The NLSY97 panel data set refers to a survey of young men and women born in the years 1980-84; respondents were ages 12-17 when first interviewed in 1997, according to the .

Zak Massey is from Perryville, Arkansas. He is a senior majoring in Economics. His current research is considering whether the scope of practice of nurse practitioners in the state is too limited and contributing to the state’s shortage of medical care.

For more of ACRE’s research on nurse practitioners, check out our labor market regulation page.

Mitchell is also the co-author with Jordan Pfaff and Zachary Helms of an ACRE Policy Brief entitled Solving Arkansas’s Primary Care Problems by Empowering Nurse Practitioners.

How can Arkansas improve its access to medical care?

Let nurse practitioners practice to the full extent of their education and training, according to ACRE Economic Policy Analyst Dr. Maryam Almasifard in an op-ed “” published in the Arkansas Democrat-Gazette on March 9.Ěý

Almasifard says:

Residents in rural areas are even more likely to die from preventable causes than those in urban areas, according to the 2019 CDC report “Potentially Excess Deaths from the Five Leading Causes of Death in Metropolitan and Nonmetropolitan Counties–United States, 2010–2017.”ĚýWhy is this happening? One explanation is that we have a serious shortage of primary-care providers, and primary-care shortages disproportionately affect people in poor and rural areas as well as racial and ethnic minorities. That makes getting access to health services more expensive and difficult than it has to be.”

According to Almasifard, Arkansas faces a growing primary care shortage.Ěý

Almasifard says:

What can we do? Increase access to quality health services, health information, and preventive care. Access to primary care reduces health inequalities and health-care costs by decreasing the need for expensive and unnecessary specialized care.ĚýOne way to do this is to let Arkansas nurse practitioners (NPs) practice to the full extent of their education and training. The National Academy of Medicine (2010), National Governors Association (2012), and Federal Trade Commission (2014) all support this proposal. All of these organizations have careful studies pointing toward the clear benefits of removing costly restrictions. This is not a radical idea. In 2017, 22 other states and the District of Columbia allowed NPs full practice authority, which includes the ability to legally provide primary-care services.ĚýNurse practitioners are registered nurses with either a master’s or a doctorate in nursing who practice in ambulatory, acute, or long-term care as primary and/or specialty providers. Right now, they are hamstrung by rules requiring them to work under a supervising physician. Our state regulations require NPs to be in a complicated and expensive collaborative agreement with a physician before they can provide services they are educated and trained to provide.”

You can read the entire op-ed .

Mitchell spoke before both the House and Senate Public Health, Welfare, and Labor committees on February 20 and February 26, 2019 about the need for increased scope of practice for nurse practitioners in Arkansas.

Members of the Senate Public Health, Welfare and Labor committee considered sponsored by Senator Dave Wallace. You can watch the livestream of the committee meeting . Members of the House Public Health, Welfare and Labor committee considered sponsored by Representative Robin Lundstrum. You can watch the livestream of the committee meeting .

Both bills failed narrowly in committee but increasing awareness about this issue may bring positive changes in the future.Ěý For more of ACRE’s research on nurse practitioners, check out our labor market regulation page.

Mitchell is also the co-author with Jordan Pfaff and Zachary Helms of an ACRE Policy Brief entitled Solving Arkansas’s Primary Care Problems by Empowering Nurse Practitioners.