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The Practice Boundaries of Advanced Practice Nurses: An Economic and Legal Analysis

  • Michael Dueker
  • Ada Jacox
  • David Kalist


  • Stephen Spurr


The purpose of this study is to examine the effects of State regulation that determines the extent of professional independence of advanced practice nurses (APNs). We find that in States where APNs have acquired a substantial amount of professional independence, the earnings of APNs are substantially lower, and those of physicians’ assistants (PAs) are substantially higher, than in other States. These results are striking since PAs are in direct competition with APNs; the only real operational difference between these groups is that PAs are salaried employees who must work under the supervision of a physician. The implication is that physicians have responded to an increase in professional independence of APNs by hiring fewer APNs and more PAs. The finding that earnings of APNs decline when they attain more professional autonomy vis-à-vis physicians reinforces work by Sass and Nichols on physical therapists. Copyright Springer 2005

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Article provided by Springer in its journal Journal of Regulatory Economics.

Volume (Year): 27 (2005)
Issue (Month): 3 (01)
Pages: 309-330

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Handle: RePEc:kap:regeco:v:27:y:2005:i:3:p:309-330
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  1. George J. Stigler, 1971. "The Theory of Economic Regulation," Bell Journal of Economics, The RAND Corporation, vol. 2(1), pages 3-21, Spring.
  2. Sass, Tim R & Nichols, Mark W, 1996. "Scope-of-Practice Regulation: Physician Control and the Wages of Non-Physician Health-Care Professionals," Journal of Regulatory Economics, Springer, vol. 9(1), pages 61-81, January.
  3. LaVonne A. Booton & Julia I. Lane, 1985. "Hospital Market Structure and the Return to Nursing Education," Journal of Human Resources, University of Wisconsin Press, vol. 20(2), pages 184-196.
  4. Edward J. Schumacher & Barry T. Hirsch, 1997. "Compensating differentials and unmeasured ability in the labor market for nurses: Why do hospitals pay more?," Industrial and Labor Relations Review, ILR Review, Cornell University, ILR School, vol. 50(4), pages 557-579, July.
  5. Edward J. Schumacher, . "Relative Wages and the Returns to Education in the Labor Market for Registered Nurses," Working Papers 9720, East Carolina University, Department of Economics.
  6. Sherwin Rosen, 1991. "The Market for Lawyers," University of Chicago - George G. Stigler Center for Study of Economy and State 72, Chicago - Center for Study of Economy and State.
  7. Breslaw, Jon A. & McIntosh, James, 1998. "Simulated latent variable estimation of models with ordered categorical data," Journal of Econometrics, Elsevier, vol. 87(1), pages 25-47, August.
  8. Edward J. Schumacher & Barry T. Hirsch, 1997. "Compensating Differentials and Unmeasured Ability in the Labor Market for Nurses: Why Do Hospitals Pay More?," ILR Review, Cornell University, ILR School, vol. 50(4), pages 557-579, July.
  9. Stephen T. Mennemeyer & Gary Gaumer, 1983. "Nursing Wages and the Value of Educational Credentials," Journal of Human Resources, University of Wisconsin Press, vol. 18(1), pages 32-48.
  10. Chang-Jin Kim & Charles R. Nelson, 1998. "Business Cycle Turning Points, A New Coincident Index, And Tests Of Duration Dependence Based On A Dynamic Factor Model With Regime Switching," The Review of Economics and Statistics, MIT Press, vol. 80(2), pages 188-201, May.
  11. A. Frank Adams III & Robert B. Ekelund Jr. & John D. Jackson, 2003. "Occupational Licensing of a Credence Good: The Regulation of Midwifery," Southern Economic Journal, Southern Economic Association, vol. 69(3), pages 659-675, January.
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