The Michigan Legislature is considering bills to allow nurse practitioners to be independent operators, which they currently can do in most states. Recent research suggests this would lead to fewer malpractice lawsuits, better care that leads to hospital stays being shorter, and fewer preventable deaths.

The nurse practitioner profession began in the 1960s. Nurses had to earn at least a Master of Science in nursing, pass a national licensing exam and obtain a state license. All states initially required nurse practitioners to work under the supervision of a licensed physician. But now more than 30 states allow these medical professionals to operate on their own, which is known as full practice authority.

Some interests in the established medical field, such as the American Medical Association, opposes empowering nurse practitioners to work on their own. Naysayers cite potential poorer care as a reason to oppose such laws. Recently published scholarship, however, undermines this concern.

Sara Markowitz and Andrew Smith of Emory University and the Food and Drug Administration, respectively, analyzed states that changed their laws to allow full practice authority. Twenty states made such a change from 1998 to 2019. The authors looked at malpractice cases to test the impact of these laws. If patient care worsened, malpractice cases should increase.

Markowitz and Smith found that letting nurse practitioners practice independently had no impact on their own malpractice payments. Further, malpractice payouts for physicians declined by a little more than 20%. The number of safety and drug violations committed by medical professionals did not change for the worse. These findings suggest that enabling full practice for nurse practitioners does not result in poorer patient care.

The fact that physicians experienced fewer malpractice cases is possibly due to liability laws. Doctors could be held liable in some cases for an error by one of their supervised nurse practitioners, even if the physician had no contact with the patient. When these nurses become directly responsible for their actions and physicians no longer responsible for them, overall malpractice claims fell. The change does not directly show that full practice authority laws improved levels of care, but it does suggest that they reduce the type of harmful actions that typically lead to claims of malpractice.

Benjamin McMichael of the University of Alabama tested the impact of full-practice laws on the quality of care in a different way. He used data on nearly every hospital discharge in 22 states, including Michigan, from 2010 to 2019. Ten of these states enacted full-practice laws during this time, enabling McMichael to test the effects of changing state policy on medical outcomes. He looked at outcomes related to which hospital admissions could have been avoided with better outpatient care, the type that nurse practitioners often provide.

McMichael found that full-practice laws were associated with a roughly 5% decline in hospitalizations. This has large cumulative effects: Hospital stays declined overall by about 108 days per 100,000 people. For Michigan, that would mean roughly 11,000 fewer stays in hospitals, making medical care cheaper and less disruptive for consumers and freeing doctors’ time and resources for more serious medical issues.

In a separate paper, McMichael assessed the impact that these laws have on “health care amenable deaths,” or “premature death(s) from causes that should not occur in the presence of timely and effective health care.” Looking at data across the United States from 2005 and 2019, McMichael found that allowing nurse practitioners greater freedom to practice reduced amenable deaths by 12 per 100,000 individuals, with the largest impact on underserved, rural areas. This makes sense as nurse practitioners often establish practices in places where health care is in short supply.

If Michigan allows nurse practitioners to offer medical services on their own, the state would simply be mirroring what most states have done. Studies on the impacts of this legal change suggest that malpractice suits would decline, hospital stays would drop because of better earlier medical treatment, and unnecessary deaths would decrease. The Legislature should follow the lead of other states and allow better and more accessible medical care for Michiganders.

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