John Hood: North Carolina must compete for nurses – Salisbury Post

John Hood

The North Carolina General Assembly has made our state a more attractive place to live, work and do business by reforming our tax code, changing our regulatory system, updating the way we fund infrastructure, and taking some first steps toward a more competitive hospital market.

But when it comes to health care more broadly, lawmakers haven’t been ambitious enough. For example, bills to expand the ability of advanced practice nurses to provide more services at an affordable cost have repeatedly failed to find support in the legislature. As a result, North Carolina is losing some of our best healthcare professionals to neighboring Virginia.

This is the conclusion reached by scientists from the Knee Regulation Research Center at West Virginia University. They examined changes in the number of nurse practitioners in North Carolina and its neighboring states from 2016 to 2023. (Disclosure: The Pope Foundation, of which I am president, provided some funding for the research.)

In most of the country, including states such as Massachusetts, New York, Kansas and Utah, nurse practitioners are free to provide the health care services they are licensed to provide as independent providers, rather than being supervised (and giving away some of their income) j) doctors.

The second category of states, such as Pennsylvania and Illinois, offer nurse practitioners some freedom but limit their independence or service delivery. A third group of states, including North Carolina and its neighbors, have long imposed significant restrictions on one or more elements of nursing practice.

In 2018, Virginia passed a law giving nurse practitioners more independence. This began a “natural experiment” allowing researchers to compare nursing populations and health outcomes in contiguous, otherwise comparable states. Here’s what they found:

• Before the reform, Virginia had significantly fewer nurse practitioners per capita than North Carolina. By 2023, the gap will be approximately halved.
• “Compared with Virginia’s border counties,” the authors write, “inland North Carolina counties experienced a 20 percent decline in the number of nurse practitioners per 100,000 residents.” They found no such difference when comparing North Carolina counties with bordering counties in Georgia, South Carolina, and Tennessee, none of which underwent major scope of practice reform during this period.
• This relative decline in the number of nurse practitioners could have adverse health consequences. While the researchers found no significant differences in vaccinations, mammograms or preventable hospital stays, they did find an increase in the proportion of North Carolinians reporting poor health.

“Previous research suggests that this relationship holds in the opposite direction,” the authors concluded, suggesting that “increasing the number of nurse practitioners and allowing them to practice independently will improve patient health outcomes.” Combined with our findings, this suggests that North Carolina can improve access to primary care and ultimately improve patient outcomes by allowing nurse practitioners to practice to the full extent of their training.”

In the General Assembly, the debate over physician practice reform is often seen as an isolated power struggle between doctors on one side and nurses on the other. But this is not the complete picture.

As these and other studies confirm, patients’ interests are also at stake. Increasing access to primary care is certainly a good thing. And if the predictions of reform opponents had been true—that nurses working without physician supervision posed a significant risk to patients—then there would have been evidence of this in the data. As I noted, a West Virginia University study found no such negative effects following scope of practice reform in Virginia.

Since the government accounts for most of the medical costs, taxpayers also have a stake in the debate. 2019 study in Journal of Nursing Regulation specifically addressed the impact of scope of practice reforms on Medicaid recipients. They found that outpatient costs were 17 percent lower and prescription costs were 11 percent lower in states where nurses exercised full practice authority.

It’s time for North Carolina to follow the example of our neighbor to the north. It’s time to free our nurses to do the work they are well trained to do.

John Hood is a board member of the John Locke Foundation. His latest books: “Mountain people” And “Forest people“, combining epic fantasy with early American history (FolkloreCycle.com).