Michigan Would Benefit from Independent Nurse Practitioners — Here's What the Research Shows

The Michigan Legislature is currently considering bills that would allow nurse practitioners to practice independently — something more than 30 states already permit. For NPs in Michigan, and for the patients who depend on them, the stakes are significant. Recent peer-reviewed research suggests the change would lead to fewer malpractice lawsuits, shorter hospital stays, and fewer preventable deaths.

Here's a breakdown of the evidence — and what it could mean for Michigan NPs, new graduates, and the communities they serve.

Background: What Is Full Practice Authority?

The nurse practitioner profession began in the 1960s. NPs earn at least a Master of Science in Nursing, pass a national licensing exam, and obtain a state license. For decades, all states required NPs to work under physician supervision — but that model has been shifting rapidly.

Today, more than 30 states have granted NPs what's called full practice authority (FPA): the legal right to evaluate, diagnose, treat, and prescribe for patients without a mandatory physician oversight agreement. Michigan is not yet among them.

Opponents, including some in organized medicine, have argued that removing oversight requirements could compromise patient safety. New scholarship directly tests that claim — and the results are hard to dismiss.

Study 1: Malpractice Claims Don't Rise — They Fall

Sara Markowitz of Emory University and Andrew Smith of the Food and Drug Administration analyzed what happened in the 20 states that moved to full practice authority between 1998 and 2019. They used malpractice data as a proxy for care quality: if patient care worsened after FPA adoption, malpractice filings should increase.

The findings were striking:

• Malpractice payments by nurse practitioners showed no significant change after FPA adoption.
• Malpractice payouts by physicians in those states declined by more than 20%.
• Safety violations and drug violations by medical professionals did not worsen.

The likely explanation for the drop in physician malpractice: under traditional supervision models, physicians could be held liable for errors made by NPs they supervised — even if they had no direct contact with those patients. Once NPs became directly accountable for their own care, that exposure disappeared, and overall malpractice claims fell.

Study 2: Fewer Hospitalizations, Better Outpatient Care

Benjamin McMichael of the University of Alabama studied hospital discharge data from nearly every inpatient admission across 22 states — including Michigan — from 2010 to 2019. Ten of those states enacted full practice authority laws during that window, giving McMichael a natural experiment to assess the real-world effects.

His focus: hospitalizations that could have been prevented with timely, high-quality outpatient care — exactly the kind of care NPs frequently provide in primary care and community settings.

For Michigan specifically, the author estimated the change would result in roughly 11,000 fewer hospitalizations. That translates directly to lower healthcare costs, freed-up hospital capacity, and less disruption for patients and families — while freeing physicians to focus on the more complex cases that genuinely require their specialized training.

Study 3: Fewer Preventable Deaths, Especially in Rural Areas

In a separate paper, McMichael looked at "healthcare-amenable deaths" — premature deaths from conditions that should not occur given timely, effective medical care. Using national data spanning 2005 to 2019, he found that states granting full practice authority to NPs saw a reduction of 12 deaths per 100,000 individuals.

The effect was largest in underserved, rural communities — which is exactly what you'd predict. Nurse practitioners are disproportionately likely to establish practices in areas with limited access to physicians. When regulatory barriers are removed, NPs can fill those gaps more readily and without requiring a supervising physician to be physically accessible in areas where they often aren't.

What the Research Tells Us, Side by Side

What This Means for Michigan NPs

For nurse practitioners practicing in Michigan — or new graduates considering where to establish their careers — the policy environment matters enormously. States with full practice authority offer more flexibility in where and how NPs can practice: independent rural clinics, telehealth practices, community health settings, and more.

The current Michigan model requires a written supervision agreement with a collaborating physician — an administrative requirement that adds cost, limits geographic flexibility, and creates a dependency that doesn't exist in most of the country. For new NP graduates considering a post-graduate residency followed by independent practice, the ability to operate without a mandatory collaboration agreement directly affects career optionality.

Full practice authority doesn't mean NPs practice in isolation. Interprofessional collaboration remains a core value in NP training and practice. What changes is the legal requirement — the state mandating a supervisory structure regardless of the practice setting or the NP's experience and competence.

What's Next in Michigan

The Michigan Legislature is actively considering FPA legislation. Similar bills have been introduced and debated in previous sessions. Advocacy organizations including the Michigan Association of Nurse Practitioners (MANP) continue to push for alignment with the majority of states that have already removed mandatory collaboration requirements.

As research continues to mount — and as states with long-running FPA laws accumulate more data — the evidence base against independent NP practice continues to erode. The question for Michigan's Legislature is increasingly not whether NPs can practice safely without mandatory supervision, but how much longer Michigan will wait before catching up to the rest of the country.