Global regulatory and Policy pathways for Nurse practitioners and their health system contributions: a systematic review

Abstract

Nurse Practitioner (NP) roles are promoted to address workforce shortages and improve care access. Variation in regulatory authority, financing structures, and system-level integration mechanisms influences how NP roles are implemented across health systems. Purpose To synthesize empirical evidence on how NP roles are regulated and operationalized across policy environments and how regulatory design, financing alignment, and integration mechanisms influence health system contributions. Methods A systematic review following PRISMA guidelines was conducted. PubMed, CINAHL, Scopus, and Web of Science were searched for studies published between 2015 and 2025 examining NP regulation, implementation processes, or outcomes. Discussion Twenty-seven studies met the inclusion criteria, with most evidence originating from the United States and limited representation from other countries. Regulatory liberalization, particularly full practice authority, was associated with improved access indicators, NP presence in shortage areas, and fewer hospitalizations. However, these benefits appeared unlikely to result solely from regulatory reform and instead depended on whether legal authority was supported by integration mechanisms, such as credentialing and privileging, billing and reimbursement, workforce deployment, and organizational governance. Conclusion Policy reforms expanding NP authority should be designed as integrated reform packages rather than stand-alone regulatory changes. Alignment of scope-of-practice authority with credentialing and privileging, billing and reimbursement, workforce deployment, and organizational governance is necessary for legal authority to translate into measurable health system contributions.