Collaborative Practice Agreements and Their Geographical Impact on Where Nurse Practitioners Can Practice

Document Type


Subject Area(s)

Public Health


Introduction: There is limited information as to whether collaborative practice agreements (CPAs) among states that mandate travel or capitation limits on nurse practitioners (NPs) restrain where they can practice. Objective: To examine the effect of South Carolina’s (SC’s) CPA on the spatial distribution of the NP workforce. Methods: Using composite geocoding methodology of state licensure data for physicians and NPs in SC, the spatial distribution of mandated 45-mile distance limitation and capitation limitations on potential NP workforce distributions was examined. Results: Without considering the similarity in qualifications between the physicians and the NPs, 90% of the NP workforce is within 45 miles of at least 75 potential supervisors. After accounting for the qualifications of the physicians and the specialties of NPs they currently supervise, 10% of NPs who could potentially practice in women’s health are able to choose from only three or fewer obstetrics/gynecology supervisors, whereas 30% of these NPs are able to select from no more than 10 providers. Just under 15% of NPs who could specialize in children’s health must select from 10 or fewer pediatricians. Conclusion: The regulatory requirements for services placed on NPs are geographically restrictive only when the nature of how care is delivered is considered. Geographic distances artificially exacerbate efforts to address health care shortages, particularly among providers who may choose to specialize in children’s or women’s health. Spatially analyzing workforce relationships between physicians and NPs could support efforts to remove the travel and capitation restrictions on practice autonomy.

Digital Object Identifier (DOI)

APA Citation

Bell, N., Hughes, R., & Lòpez-De Fede, A. (2018). Collaborative practice agreements and their geographic impact on where nurse practitioners can practice. Journal of Nursing Regulation, 9(3), 5-14.


© 2018 Elsevier, Journal of Nursing Regulation