The Influence of Nurse Union Size on Nurse Practitioner Full Practice Authority in the U.S.

The scope of practice for Advanced Practice Registered Nurses (APRNs) is a critical issue in healthcare policy, influenced by both demand for healthcare services and legislative action. This paper examines the impact of nurse union size on a state having full practice authority for nurse practitioners across the United States. Utilizing data from the Nurse Unionization Data Tool and controlling for several variables (right-to-work laws, physicians per capita, and personal healthcare expenditures per capita), this study employs multivariate logistic regression to analyze the relationship between the proportion of unionized nurses and the extent of practice authority granted by state laws. Findings indicate that larger nurse unions are significantly associated with full practice authority for nurse practitioners. The results underscore the importance of nurse unions in advocating for legislative changes that widen APRN autonomy. This study contributes to the broader discourse on the interplay between interest groups and healthcare policy, highlighting the potential of organized labor to influence professional practice boundaries in healthcare. Future research should examine mechanisms in which nurse unions exert influence and the impact of other stakeholders, particularly hospital and physician groups, whose spending may also shape scope of practice laws.