Association for Public Policy Analysis & Management

At this time, a small but growing literature has examined the impact of stronger versus weaker regulations for various health care workers. We build on these prior studies and specifically focus on one of the largest components of the US health care workforce: nurses. Nurses span a variety of training and skill types and are also a highly regulated occupation where existing laws precisely define the menu of tasks that they can perform – and hence determine their level of clinical independence. The laws range from being fully liberal (i.e., granting practice autonomy to qualified nurses) to being fully restrictive (i.e., requiring joint production of care between nurses and a supervising physician), and given these disparate regulatory environments, it seems plausible that scope of practice would have implications for the employment opportunities and career prospects of affected nurses. However, we currently have limited empirical evidence as to if and how these regulatory regimes impact relevant nurse labor markets.

To help address this gap in the literature, we leverage detailed nursing workforce data spanning all US states from 1992 – 2008. We then examine two separate policy changes targeting different, high-skilled components of nursing labor. The first relaxes the regulatory burden for nurse practitioners (NPs), while the second focuses on certified registered nurse anesthetists (CRNAs). Using differences-in-differences analyses, we assess the effects of moving to more accommodating policy environments on a host of labor market outcomes for the relevant nursing group. Our evidence suggests that both nursing types benefit from lighter regulation. NPs are roughly a third less likely to be in a part-time position and demonstrate greater job mobility after the policy change. Granting full practice autonomy is also a strong positive shock to NPs’ labor supply and wages, with suggestive evidence that it affects the practice setting for some. CRNAs are more likely to migrate to a state when it liberalizes its scope of practice, especially among the most mobile workers. Inexperienced CRNAs are also less likely to accept a part-time position. There is an increase in CRNA wages, but the estimate lacks precision. For NPs and CRNAs, the policy effects are typically strongest among women and those who are relatively new to their respective clinical field.