Jill Tucker, RN says:

“To combat a primary care shortage, legislation giving more responsibility and oversight to Nurse Practitioners has been passed in many states. But a recent study from the Columbia University School of Nursing shows that long-standing organizational policy in hospitals and care groups still trumps changes introduced by government.”
Full Utilization of Nurse Practitioners: Helped by Laws, Hindered by Health Care Culture

RWJF.org  January 16, 2014