There are certain geographic areas where more advanced nurse practitioners have multi-state licenses, but compared to the RN world, where compact licensures exist for as many as 25 states at a time, on the advanced practice side that doesn't exist, and according to Knybel this is a challenge to recruiting and placing nurse practitioners in positions that require a move across state lines.
"Our pools of nursing candidates are traditionally more mobile. So we can take people from Massachusetts and provide them with a temporary home in the state of California and give them an assignment for three months. This same process can verify them to secure licenses in other states, but for advanced practitioners that's not as easy—the regulations that oversee their practices vary so much more."
When you line up the ratio of nurse practitioners to state population and the state's scope of practice laws, a picture emerges of the impact restrictive and heavily regulated state policies have on the APRN population.
Alabama scores an 'F' from the The American Journal of Nurse Practitioner's 2011 Pearson Report for the scope of patient access to nurse practitioners, and it also has the fifth lowest ratio of nurse practitioners to state population (40 per 100,000 people). Meanwhile, New Hampshire scored an 'A+' with no restrictions on nurse practitioners' scope of practice and has the second highest ratio of nurse practitioners to patient population (114 per 100,000 people).
"Are the patients different in different states? What's the big deal?" says Smolenski.
Isn't the common goal to treat the sick and heal those who are suffering? This hierarchical culture of medicine needs to shift—it's not about who is in charge, it's about treating the overflowing waiting rooms.