Nurse practitioners providing more primary patient care
Americans are increasingly obtaining their primary medical care from health care professionals who are not physicians. Due to both a shortage of primary care physicians in many areas of the country, a desire to reduce costs and other factors, we are seeing a shift toward alternative care models. And those models often include nurse practitioners.
First of all, what is a nurse practitioner? According to the American College of Nurse Practitioners, “Nurse practitioners (NPs) are registered nurses who are prepared, through advanced education and clinical training, to provide a wide range of preventive and acute health care services to individuals of all ages.” In many states, NPs practice independently, running their offices and seeing patients in much the same way as primary care physicians do. (In some states, NPs are required to work under the direct supervision of physicians.) NPs see patients in a variety of settings, including private offices, hospitals and even retail clinics (found in national chain stores like Wal-Mart and Walgreens). With the recent federal health reform legislation placing a heavy focus on preventive primary care as well as cost reductions, we can expect to see a continued increase in the number of Americans getting their care from NPs.
The number of certified family NPs (CNPs and FNPs) has grown steadily in recent decades, with their numbers more than quadrupling since 1992 (see Figure 1).
Figure 1: Number of certified American nurse practitioners, tracked between 1992–2008 (Source: U.S. Department of Health and Human Services)
A number of factors have led to this marked increase in American NPs. “A lot of patients are looking for alternatives,” says Erich Widemark, PhD, RN, FNP-BC, who currently serves as director of nursing at University of Phoenix, which offers a nurse practitioner certification program. “Nurse practitioners take a more generalized view of the patient,” says Widemark. “We’re more holistic in our care. We partner with the patient over the long term, helping to educate them about their long-term health.”
While many NPs work in primary care settings, some work in medical specialty areas. Regina Jasiewicz, MHA, MSN, FNP, BC, is a South Bend, Ind.–based NP who currently specializes in seeing dermatology patients, though she also has experience in emergency medicine, family practice and psychiatry. “I came to this career because it allowed me to use advanced practice skills that [I gained as an Army nurse], and it put me back in direct contact with patients,” says Jasiewicz. “[Being an NP] allows me to be more independent than a staff nurse, and I have a great deal more responsibility.”
Jasiewicz can speak directly to just how needed NPs are in the community. “I typically have 32 or 33 patients scheduled per day,” she says. “Why do I see that many patients? There is a dramatic shortage of dermatologists in our area. In all types of practices, this is the case. There are not enough physicians for the patients who want to be seen.”
Jane Mohler, RN, MPH, PhD, co-director of Arizona’s Geriatric Education Center, an associate professor at the University of Arizona Colleges of Medicine, Pharmacy, Public Health and Nursing, and a current FNP student at University of Phoenix, agrees that the physician shortage is creating opportunities for NPs. “Right now is a very interesting time [for NPs],” says Mohler. “We’re re-engineering primary care away from a physician-dominated approach into a more interdisciplinary approach.” According to Mohler, 21st-century health care responsibilities will be shared equally across several care disciplines, including physicians, nurses, nurse practitioners, pharmacists and other allied health professionals. “In the interprofessional world, nurse practitioners often work as coordinators of the larger care team,” she says. “Nurse practitioners are the hub of the wheel and the ideal person for coordinating the continuum of care.”
While a tipping point certainly has been reached in terms of the numbers of NPs providing primary care, not everyone is happy about this development. According to Jasiewicz, many physicians are concerned about the increasing role of NPs. “We still do have some physicians who would like to reduce what [NPs] are allowed to do,” says Jasiewicz. “These same doctors would be the first to complain when they get overrun with patients and can’t get everyone in.” Still, Jasiewicz is quick to point out that Indiana is one of the best states in which NPs can work. (Some other states, like Illinois, are not currently friendly to NPs.)
Despite some challenges, the nurse practitioner field is growing by leaps and bounds, and recent changes to national health care policy indicate this trend will continue. “I think being a nurse practitioner is a great field,” says Jasiewicz. “And whether [primary care] physicians like it or not, their numbers are going down, and they are going to need us.”
References
American College of Nurse Practitioners. (2010). What is a nurse practitioner? Retrieved from http://www.acnpweb.org/i4a/pages/index.cfm?pageid=3479.
U.S. Department of Health & Human Services. (1992). The Registered Nurse Population. Findings from the March 1992 National Sample Survey of Registered Nurses. Retrieved from ftp://ftp.hrsa.gov/bhpr/nursing/samplesurveys/1992sampsur.pdf
U.S. Department of Health & Human Services. (1996). The Registered Nurse Population. Findings from the March 1996 National Sample Survey of Registered Nurses. Retrieved from ftp://ftp.hrsa.gov/bhpr/nursing/samplesurveys/1996sampsur.pdf
U.S. Department of Health & Human Services. (2000). The Registered Nurse Population. Findings from the March 2000 National Sample Survey of Registered Nurses. Retrieved from ftp://ftp.hrsa.gov/bhpr/rnsurvey2000/rnsurvey00.pdf
U.S. Department of Health & Human Services. (2004). The Registered Nurse Population. Findings from the March 2004 National Sample Survey of Registered Nurses. Retrieved from ftp://ftp.hrsa.gov/bhpr/workforce/0306rnss.pdf
U.S. Department of Health & Human Services. (2008). The Registered Nurse Population. Initial findings from the 2008 National Sample Survey of Registered Nurses. Retrieved from http://bhpr.hrsa.gov/healthworkforce/rnsurvey/initialfindings2008.pdf
