By Debra Wood, RN, contributor
The ranks of nurse practitioners and their practice settings have experienced phenomenal growth during the last 40 years, as people have come to accept their ability to care and cure.
“The demand for nurse practitioners continues to increase as people see what they can do and how well they do it,” said Jan Towers, NP-C, CRNP, FAANP, Ph.D., family nurse practitioner and director of health policy for the American Academy of Nurse Practitioners (AANP).
The nurse practitioner role developed in response to a need for primary care providers in rural and underserved areas. The University of Colorado graduated its first pediatric nurse practitioners in the mid-1960s.
Slightly more than 20 percent of nurse practitioners still work in rural settings, but increasingly patients also receive care from nurse practitioners in large urban and teaching hospitals, primary care offices and subspecialty areas. According to AANP data, about 9 percent of nurse practitioners practice in an acute care, inpatient settings, 2.9 percent in emergency departments and 16.4 percent in subspecialties, such as cardiology or orthopaedics.
More than 106,000 nurse practitioners are licensed to practice in the United States. Nursing schools graduate an additional 5,000 to 6,000 nurse practitioners annually.
This year, for the first time, Congress passed a resolution honoring the goals and ideas of National Nurse Practitioner Week, Nov. 7 - 13, 2004. Obstetrician-gynecologist and Texas Republican Rep. Michael C. Burgess, introduced the resolution.
“These health care professionals are critical in my district, especially in areas of Fort Worth, Texas,” said Burgess on the House floor.
Burgess went on to describe how NPs enhance the services provided by 23 clinics for low-income patients in Tarrant County, Texas, and how the clinics could not continue serving as many patients without its corps of nurse practitioners. He also spoke personally about working with nurse practitioners in training programs and in his personal practice.
“I learned a great deal more from them than I was ever able to teach them,” Burgess said. “I rise to commend nurse practitioners for the contribution they make to the health and well-being of our country.”
More than 85 percent of nurse practitioners have earned a master’s degree, and 4.6 percent hold a doctoral degree. The American Association of Colleges of Nursing (AACN) recently voted to move the current level of preparation of advanced nursing practice roles from a master’s degree to a doctorate by the year 2015.
The AACP Foundation provides scholarships for nurse practitioner preparation and awards grants for research relevant to nurse practitioners or projects that will contribute to improved public health.
AANP represents more than 17,000 individual members and 100 group members, approximately 85,000 nurse practitioners around the United States. The organization advocates for the active role of nurse practitioners as providers of high quality, cost effective, personalized health care.
Nurse practitioners diagnose, order and interpret diagnostic tests, treat patients and manage patient care. All 50 states grant nurse practitioner prescriptive authority for most drugs. Some states still do not allow nurse practitioners to order narcotics. AANP is working to change these laws.
Insurers typically reimburse for nurse practitioner care. However, some managed-care companies fail to list nurse practitioners independently on their provider panels. Towers said AANP has been successful in convincing many insurers to add nurse practitioners and the organization continues to work with insurers on this issue.
NPs typically spend extra time treating the whole person and educating them to make smarter decisions about their health and well being.
“Nurses do that, generally, a lot better than physicians,” Towers said. “They can plug in those skills and use them in combination with medical skills to deliver holistic care of patients.”
Towers said the nurse practitioner role appeals to nurses who enjoy autonomy and problem solving, and want to work with patients over a long period of time.
Access to nurse practitioners presents a prime challenge to the profession. In an AANP member survey of 5,000 NPs conducted in 2003, 41.2 percent of nurse practitioners cited recognition as a primary care provider as a difficulty encountered in practice. Nurse practitioners working in adult, family and women’s health and in small towns reported this as a problem much more frequently than those working in acute care or in large cities or in communities with fewer than 1,000 people.
AANP has launched an awareness campaign to try to improve consumer understanding about nurse practitioners, the type of care they provide and how they can obtain care from an nurse practitioner.
“There are people who don’t know about nurse practitioners,” Towers said. “Once they see a nurse practitioner, they are satisfied and want to come back.”
A study reported in the Journal of the American Medical Association, in 2000, and updated in 2004, in the journal Medical Care Research and Review, found that nurse practitioners achieve patient outcomes similar to physicians in primary care practice. Patients made more visits to physicians than nurse practitioners during the second year of the study, and patient satisfaction scores during that time showed no significant differences.
California managed care company Kaiser Permanente conducted a study during the mid-1990s and found patients were equally satisfied with care whether an nurse practitioner or physician provided the service. Patient satisfaction appeared to depend on the communication skills and style of the caregiver more than the type of provider.
A 1995 study reported that patients cared for by nurse practitioners made fewer emergency department visits and resulted in a cost of care half that of physicians. Mary Jo Goolsby, Ed.D., ANP-C, FAANP, director of research and education for AANP, said other studies suggest nurse practitioner care can decrease hospital admission rates and emergency department visits.
During the past 40 years, nurse practitioners have demonstrated an ability to improve access to quality, cost effective care. Yet more remains to be done to raise awareness and acceptance.
“Nurse practitioners should be proud of the progress we have made in a relatively short period of time,” Towers concluded. “We are part of the answer to meeting the health care needs of the country.”
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