The Economic Burden and Practice Restrictions Associated With Collaborative Practice Agreements: A National Survey of Advanced Practice Registered Nurses

      The U.S. healthcare system is facing workforce shortages in rural and primary care settings. Despite growing demand for providers and comparable quality metrics, advanced practice registered nurses (APRNs) still face significant barriers to independent practice due to reduced scope of practice regulations. In this study, APRNs working in rural areas and APRN-managed private clinics were one and a half to six times more likely to be assessed Collaborative Practice Agreement (CPA) fees, often exceeding $6,000 and up to $50,000 annually. Similarly, APRNs subject to minimum distance requirements, fees to establish a CPA, and supervisor turnover reported a 30% to 59% uptick in restricted care. Such unnecessary regulation risks diverting health services away from and increasing costs in traditionally underserved areas, contributing to inequities in care. It is incumbent on state legislatures to address these disparities and make their constituents’ access to high-quality care a top priority.


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      Brendan Martin, PhD, is a Senior Research Scientist for Nursing Regulation at the National Council of State Boards of Nursing.


      Maryann Alexander, PhD, RN, FAAN, is the Chief Officer for Nursing Regulation at the National Council of State Boards of Nursing.

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