Impacts of state time-in-practice requirements on practice agreement use

<h2>Abstract</h2><h3>Background</h3> Although full practice authority (FPA) laws are often framed as offering nurse practitioners (NPs) full autonomy from physicians, several recently enacted FPA laws include time-in-practice (TIP) rules that require NPs to maintain a supervisory practice agreement with a physician for a specified period. <h3>Purpose</h3> This study sought to estimate the policy impacts of TIP requirements on the proportion of NPs who retained practice agreements after FPA laws became effective in states with TIP rules (TIP group) and those with no TIP rules (No TIP group). <h3>Methods</h3> Survey data from 2016 to 2024 for 7251 full-time NPs from all 27 FPA states and the District of Columbia were obtained from the American Association of Nurse Practitioners. Inverse probability of treatment weighting and regression was used to adjust for measured differences between the TIP group (<i>n</i> = 3226) and the No TIP group (<i>n</i> = 4025). <h3>Results</h3> Practice agreements were 11.2 percentage points more prevalent among NPs in the TIP group compared with those in the No TIP group after adjusting for covariate differences between groups (48.7 % versus 37.5 %, <i>p</i> < 0.001). The impact of TIP rules on practice agreement use was found to be larger in states where FPA laws had been in effect longer and in states that required more supervised practice hours, whereas employer mandates for practice agreement use attenuated the impacts of TIP requirements. <h3>Conclusions</h3> Although TIP requirements were found to delay many NPs from practicing without practice agreements after an FPA law went into effect, the percentage of NPs for whom TIP requirements affect practice agreement use is limited by the fact that many healthcare employers continue to require practice agreements despite having no legal mandate to do so. States with TIP requirements for NPs should reconsider whether such requirements are necessary and consistent with other goals of health policy, such as addressing provider shortages in underserved areas. Healthcare employers should regularly review institutional requirements for practice agreements after FPA laws are implemented.