Healthcare Workforce Shortages and Job Autonomy: Nurse Practitioners and Entrepreneurship in the United States

The laws governing nurse practitioners’ scope of practice significantly impact the degree of autonomy and independence they have in their professional roles. Lowautonomy environments resulting from restrictions on nurse practitioners’ scope of practice can have long-term adverse effects on their recruitment, training, and retention. These laws directly affect the range of services they can offer, their decision-making authority, and their ability to establish and manage their practices. By lowering both monetary and non-monetary benefits of practice ownership, restrictions on independent practice make it more difficult for nurse practitioners to start a practice. Thus, these regulations potentially exacerbate the shortage crisis in primary care, especially within communities already struggling with access to healthcare. We track sole proprietor nurse practitioners in each US state from 2016- 2023 to analyze how the scope of practice laws influence sole proprietorship among nurse practitioners. Our results help lay the groundwork for future evidence-based policy surrounding nurse practitioner scope of practice. Key Words: Scope of Practice, Entrepreneurship, Nurse Practitioner, Primary Care, Healthcare Workforce