Date of Conferral



Doctor of Nursing Practice (DNP)




Deborah A. Lewis


Rising medical costs and increasing shortage of qualified primary care providers has left hundreds of thousands of Texans with limited or no access to primary care services. One way to bridge the gap is to use advanced practice registered nurses who function as nurse practitioners (NPs). Current evidence indicates that by expanding the scope of practice (SOP) of NPs, access to care and patient outcomes improve. The aim of this DNP project was to analyze the current health care policy and examine the relationship and impact SOP has on patient outcomes and health care costs associated with hypertension and diabetes. Gail and Jacqueline's conceptual model for nursing and health policy acted as a guiding framework for understanding how health policy impacts quality, access, and costs. This systematic review of the literature was conducted by searching the Cumulative Index to Nursing and Allied Health Literature, Medline, EmBase, ProQuest, and PubMed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram and the Revised Standards for Quality Improvement Reporting Excellence tool were used to record, track, organize, and evaluate the relevant studies. Four of the 168 identified articles analyzed the effect NP SOP on patient outcomes. The analysis of articles did not indicate any observable differences in patient outcomes, regardless of SOP. Expanding SOP appeared to have a substantial financial impact, significantly decreasing health care costs. The results of the systematic review and practice recommendations will be presented to Texas legislators to influence NP SOP policy and impact social change by allowing full practice authority to NPs and leading to increased access to cost-effective, quality health care without compromising patient safety.

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Nursing Commons