A multistate analysis of nurse practitioner delegation regulations.

Background: Nurse practitioners (NPs) are essential to meeting the demand for primary care and improving quality. Variation in primary care work environment has implications for outcomes. One opportunity to better support NP practice includes increasing NP access to support staff. However, given statutory regulation of NP's ability to delegate to unlicensed personnel, there may be limited effect of these interventions.

Purpose: To describe state regulations on NP delegation to unlicensed personnel and consider implications of NP delegation regulations on opportunities to improve NP work environment.

Methodology: We conducted a cross-sectional, six state policy surveillance of state nursing regulations related to NP delegation to unlicensed personnel. Using an iterative data identification process, we review of documents from six state boards of nursing. Analysis included nominal and textual data.

Results: Five states prohibited NPs from delegating medication administration to unlicensed personnel. One state permitted delegation of mediation administration to unlicensed personnel but only in community settings.

Conclusions: Delegation limitations prevent NPs from practicing to the full extent of their education. Nurse practitioners must be aware of the delegation regulations when working with unlicensed personnel to prevent disciplinary actions. Nurse practitioner-specific delegation regulations can facilitate greater use of unlicensed personnel in NP-led primary care.

Implications: Boards of Nursing should consider NP delegation regulations that promote public safety, minimize unintended consequences, and increase access to NP-led primary care.