The geographic distribution of nurse practitioners in the United States

This study analyzed the geographic distribution of nurse practitioners in the United States. Primary data on nurse practitioners were obtained from State Boards of Nursing and the District of Columbia in the spring of 1994. At the state level, nurse practitioners were more concentrated in urban areas than their physician counterparts. Of the 33,094 certified nurse practitioners, 85% were in metropolitan areas. Results from the dissimilarity indices between nurse practitioners and general populations showed that a greater supply of nurse practitioners in a state may not necessarily lead to an equitable distribution across counties. At both the state and county levels, the supply of nurse practitioners was positively associated with the supply of primary care physicians. Results from multivariate analyses show that nurse practitioners were more likely to locate in a county where state laws allowed independent practice. States that allow independent practice and direct third-party reimbursement will likely have greater availability and a larger supply of nurse practitioners in rural counties. © 1997 John Wiley & Sons, Inc.