Date of Award

Spring 5-27-2023

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Briony DuBose, PhD, MHI, RN


Purpose: The purpose of this evidence based practice Doctor of Nursing Practice (DNP) project was to investigate barriers to colorectal cancer screening in young Latinos living in California. The goals of this project included examining current trends in colorectal cancer in young Latinos, factors which affect access to care, and the current and future state of the California primary health care provider workforce. The aim of this project was to make recommendations regarding strategies to improve access to colorectal cancer screening among Latinos in California.

Background: Early onset colorectal cancer (EO-CRC) is increasing in Latino communities, with colorectal screening rates estimated as low as 47%. The inability to gain access to primary care, coupled with the decreasing primary care workforce supply in California exacerbates this problem. Nurse practitioners are well positioned to combat this issue; however, state restrictions significantly limit this solution. The recent passage of AB-890 allows for full practice authority for nurse practitioners; however, stipulations attached to this bill, including mandatory transition to practice hours, significantly delays entry into the workforce.

Methods: Kingdon’s health policy model provided the framework for this project. The conceptual model used to guide the literature review was Penchansky and Thomas’s 5 dimensions of access. Nursing theorist Madeline Leininger’s theory of culture care diversity and universality was used to guide this project.

Results: There is an expected increase in supply of primary care nurse practitioners by the year 2030 and a continuing decline in primary care physicians in the state of California. Primary care physicians are less likely than nurse practitioners to accept patients without insurance or Medi-Cal and to practice in underserved areas. In states where nurse practitioners had full practice authority, there was concomitant 100% Medicaid reimbursement and patients were 20% less likely to drive 30 minutes or more to see a provider. Nurse practitioners demonstrated equal to improved outcomes when compared to other providers and provided high quality care to patients when emergency full practice authority was granted during the COVID-19 pandemic. Cultural concordance and the elimination of implicit bias increases the likelihood of improved patient access.

Evaluation: The removal of transition to practice hours for full practice authority for nurse practitioners in California is critical to ensure adequate access to healthcare for young Latinos living in California. Future studies should examine the impact of nurse practitioner implicit bias education on culturally concordant care and access to care

Keywords: nurse practitioner full practice authority, access to healthcare, Latinos, colorectal cancer screening

Included in

Nursing Commons