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Articles & Resources

Nurse Practitioners in Primary Care 

American Association of Nurse Practitioners

Compared to other primary care disciplines, NPs are most likely to practice in rural communities. Indeed, eighteen percent of NPs practice in communities of fewer than 25,000 residents. In states with both a favorable regulatory environment and a large percentage of rural residents, NPs are significantly more likely to practice in rural settings.

South Carolina nurse practitioners battle for expanded authority in care

The Post and Courier

January 29, 2017

With South Carolina facing poor health scores — the United Health Foundation ranks the state 42nd for overall health — some nurse practitioners want to be freed from regulations that require them to work under a doctor's supervision. They argue that nurses with advanced degrees can fill the gap left by a lack of primary care providers, especially in rural areas.

Nurse Practitioners Win Direct Access To VA Patients


December 13, 2016

In a victory for the nation’s nurse practitioners, the Department of Veterans Affairs is granting veterans direct access to advanced practice registered nurses. The final regulations come at a critical time for nurse practitioners, which have doubled to more than 200,000 in the last decade and are looking to expand their ability to care for patients across the country. Meanwhile, the VA is working to engineer a turnaround after being accused of mismanagement and not promptly treating veterans who are known to wait days, weeks and even months for treatments and basic primary care services.

Spreadsheet of medicaid spending by diagnosis in South Carolina Emergency Rooms for fiscal years 2014-2016. Take a look at how much money has been spent in South Carolina on patients visiting the ER for issues that could easily be treated by a primary care provider! If legislators would give APRNs a wider scope of practice, these patients would be able to stay out of the ER and still get the care they deserve!

Under the MCO plans, Medicaid paid $31,161,466 for ER visits which resulted in these top 15 diagnoses- the majority of which are primary care issues. Under the FFS (fee for service), Medicaid paid an additional: $7,201,071. Total: $38,362,537 in 2016 paid out by Medicaid for ER visits. That represents: $833,969 per County.

The majority of NPs practice in a primary care setting—expand the scope of APRNs to help keep South Carolinians healthy and Medicaid spending down!

Top 15 Emergency Room Diagnoses by Visits - FY 2016

South Carolina Medicaid

South Carolina Healthy Connections

December 2016

Looking Ahead: Rural-Urban Differences in Anticipated Need

for Aging-Related Assistance

South Carolina Rural Health Research Center

June 2016

The majority of NP's provide office-based procedures, such as suturing, wart-freezing, and skin-lesion biopsy, that are considered minor surgeries. For general surgery, some NP's can serve in the first-assist role after completing NP education while also providing advanced practice nursing care in the preoperative period.

Can a Nurse Practitioner do That?

Barton Associates

August 12, 2016

With the general aging of the U.S. population, activity restrictions and subsequent need for help may become more prevalent. Prior research conducted by the South Carolina Rural Health Research Center (SCRHRC) found that while rural older adults with a disability can anticipate a longer lifespan than urban adults, this is associated with a longer period of time for which support is needed. Recent SCRHRC research has also found that rural areas tend to be served by fewer providers of home health services, services that can keep disabled persons in their homes rather than in institutional care.

How Could Nurse Practitioners and Physician Assistants Be Deployed to Provide Rural Primary Care?

Rural Health Research Center

March 2016

Using PAs and NPs to help meet the needs of newly insured populations in rural areas may be an effective strategy to alleviate the effects of physician shortage, especially in states with less restrictive practice environments for non-physician primary care providers.

Nurse Practitioner Autonomy and Satisfaction in Rural Settings

Medical Care Research and Review

January 29, 2016

Rural primary care shortages may be alleviated if more nurse practitioners (NPs) practiced there. This study compares urban and rural primary care NPs (classified by practice location in urban, large rural, small rural, or isolated small rural areas) using descriptive analysis of the 2012 National Sample Survey of NPs. A higher share of rural NPs worked in states without physician oversight requirements, had a DEA (drug enforcement administration) number, hospital admitting privileges, and billed using their own provider identifier. Rural NPs more often reported they were fully using their NP skills, practicing to the fullest extent of the legal scope of practice, satisfied with their work, and planning to stay in their jobs. We found lower per capita NP supply in rural areas, but the proportion in primary care increased with rurality. To meet rural primary care needs, states should support rural NP practice, in concert with support for rural physician practice.

America's Health Rankings Annual Report

United Health Foundation

December 2015

The United Health Foundation, along with our partner the American Public Health Association, is pleased to present the 26th edition of the America’s Health Rankings® Annual Report: A Call to Action for Individuals and Their Communities. First published in 1990, the Annual Report provides the longest-running state-by-state analysis of factors affecting the health of individuals and communities across America. It delivers an in-depth, trusted view into the status of America’s health that has been used by state and local public health leaders across the country to inform state health priorities and help transform health systems.

FTC Staff Guidance on Active Supervision of State Regulatory Boards Controlled by Market Participants

Federal Trade Commission

October 2015

Earlier this year, the U.S. Supreme Court upheld the Federal Trade Commission’s determination that the North Carolina State Board of Dental Examiners (“NC Board”) violated the federal antitrust laws by preventing non-dentists from providing teeth whitening services in competition with the state’s licensed dentists. N.C. State Bd. of Dental Exam’rs v. FTC, 135 S. Ct. 1101 (2015). NC Board is a state agency established under North Carolina law and charged with administering and enforcing a licensing system for dentists. A majority of the members of this state agency are themselves practicing dentists, and thus they have a private incentive to limit competition from non-dentist providers of teeth whitening services. NC Board argued that, because it is a state agency, it is exempt from liability under the federal antitrust laws. That is, the NC Board sought to invoke what is commonly referred to as the “state action exemption” or the “state action defense.” The Supreme Court rejected this contention and affirmed the FTC’s finding of antitrust liability.

The North Carolina State Board of Dental Examiners v. Federal Trade Commission

American Nurses Association

June 2015

The American Nurses Association (ANA) joined with the American Association of Nurse Anesthetists, American College of Nurse Midwives, American Academy of Nurse Practitioners and National Association of Clinical Nurse Specialists (Nursing Organizations) to file a friend of the court or amicus brief in support of the FTC’s position.

Nursing Most Trustworthy Profession


December 18, 2014

In 2014, Americans say nurses have the highest honesty and ethical standards. Members of Congress and car salespeople were given the worst ratings among the 11 professions included in this year's poll. Eighty percent of Americans say nurses have "very high" or "high" standards of honesty and ethics, compared with a 7% rating for members of Congress and 8% for car salespeople.

The Case for Letting Nurse Practitioners Do More


June 4, 2014​

What is a Nurse Practitioner?

The University of North Carolina at Chapel Hill, School of Nursing

April 18, 2014​

Conquering the Doctor Shortage

USA Today

February 8, 2014

Expanded roles for nurse practitioners and physician assistants could ease the manpower void, experts say. Waiting weeks to see a doctor. Scrambling to find one. Foregoing care altogether. Is this our future? America already doesn't have enough doctors, with a shortage of 45,000 forecast by 2020. 

Officials hope to cure SC's doctor shortage

The State

January 15, 2014

In parts of South Carolina, a doctor can be as elusive as a Bluetick Coonhound with insomnia. Many counties and parts of many others are designated health care provider shortage areas. And while there have been efforts to change that, progress is slow because it can take many years to produce a doctor, and there are only so many slots available in medical schools and hospital residencies needed to complete training. Now the state Department of Health and Human Services is stepping in with a couple of ideas it hopes will blunt the impact of the shortage and improve access to health care in parts of the state where doctors are particularly hard to find.

Leveraging Graduate Medical Education to Increase Primary Care

and Rural Physician Capacity in South Carolina

South Carolina GME Advisory Group

January 2014

Despite South Carolina’s sizable contribution to medical education, the state is facing an overall physician shortage. Perhaps more pressing for the state, however, is the maldistribution of primary care physicians in rural and low-income areas. Of the 46 counties in South Carolina, all have shortages in primary care and/ or pockets of medically underserved populations. Although South Carolina boasts strong medical schools and high resident retention rates, the state has struggled to attract and retain physicians to serve in these areas. Current inadequacies in the physician workforce in South Carolina highlight gaps in the “physician pipeline,” beginning from pre-medical school programs through incentives for physicians to work in rural and underserved counties of the state after residency.

Expanding the Role of Advanced Nurse Practitioners — Risks and Rewards

New England Journal of Medicine

May 22, 2013

As the 2014 expansion of coverage mandated by the Affordable Care Act (ACA) looms larger, one question with no ready answer is how health care providers, policymakers, and payers will cope with an expected surge in patient demand for services. A shortage of primary care physicians to treat newly insured persons is the most immediate health workforce issue, but when added to the nation's population growth and more aging patients who require treatment, finding a practitioner may become an even more daunting challenge.

Free the Nurses


April 18, 2013

One answer to our health care crisis: Let nurse practitioners do primary care on their own.

White Papers

August 12, 2011

A brief snapshot of the state of healthcare in SC with descriptions of the roles of APRNs and solutions for the future

The Future of Nursing: Leading Change, Advancing Health

Institute of Medicine (now called the National Academies of Sciences, Engineering, and Medicine)


Nurses should practice to the full extent of their education and training. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States. Effective workforce planning and policy making require better data collection and information infrastructure.

Scope of Practice FAQs for Consumers

September, 2010

An excellent primer on the roles and scopes of practice of APRNs

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