In the 1960s when public health nurse Loretta Ford, RN, EdD, FAAN, partnered with a physician to start the nation’s first nurse practitioner master’s-level program at the University of Colorado, the move was met with equal parts enthusiasm and skepticism. In healthcare circles, some considered the program gutsy, others, foolish. Still others saw it as nothing short of genius.
Four-plus decades later, the forward-thinking genius camp can bask in validation. Today more than 220,000 licensed NPs not only deliver high-level care to a variety of patient populations in both inpatient and community settings, but they also do so at lower cost than their physician colleagues. What’s more, they cost less to train than physicians, provide better access to care throughout urban and rural areas, and support consumer choice. NPs practice in all 50 states in specialties ranging from pediatric and family care to women’s health, neonatal care, cardiac acute care, and adult and family psychiatric/mental health care. More than 80% of NPs have achieved certification in a primary care practice area.
Making Strides
NPs’ forward progress since Ford’s trailblazing program has not escaped challenges, though. Then as now, independent nurse practitioner practice has met reluctance, if not outright pushback, primarily from physician groups concerned that expanding the scope of NPs’ practice will jeopardize patient safety. Yet a body of research has clearly demonstrated the safety and effectiveness of primary care provided by advanced practice nurses, including NPs.
Turf skirmishes aside, NPs have made considerable strides in achieving widespread acceptance — and respect. All 50 states and the District of Columbia authorize some level of prescriptive authority for NPs, and 21 states plus the District permit independent nurse practitioner practice without supervision by a physician. Most recently, the Department of Veterans Affairs amended its provider regulations in December 2016 to grant full practice authority to NPs and other APNs regardless of state restrictions (with the possible exception of prescribing controlled substances, depending on state-by-state rules).
Trials and Tribulations
Still, challenges lay ahead for NPs — not the least of which are the increasing clinical complexities of patients and the uncertainty surrounding an American healthcare system in flux. NPs (and those who wish to become NPs) will undoubtedly face frustration in their careers, whether it stems from practice limitations, budget cuts that strain resources, lack of effective communication and collaboration among colleagues, or a host of other trials big and small.
But since when have a few bumps deterred NPs along their path to progress? NPs are known to be tenacious, dedicated professionals who excel in patience and endurance. They’re also visionaries who not only follow in the footsteps of their pioneering predecessors — NPs over the years who Ford called the “lone rangers” — but also possess the grit and determination to become pacesetters for the innovative healthcare delivery systems to come.
They’re Only Speed Bumps
Counter the occasional curbs in your professional practice by remembering these five reasons why it’s great to be a nurse practitioner:
1. You’re Needed
NPs are one of the fastest growing professional groups in healthcare. The Bureau of Labor Statistics projects the number of APNs will expand by 31% by 2024, an increase well above the national average for all occupations.
The agency cites several reasons behind the expected growth, including rising demand for healthcare services, particularly among the living-longer-and-staying-more-active baby boomer population; a healthcare industry-wide emphasis on preventive care; and to some extent, federal legislation, such as the Affordable Care Act, that has increased consumer access to health insurance and provided incentives to raise the number of primary care practitioners.
Add in a looming shortage of primary care physicians — a shortfall of some 20,000 primary care doctors by 2020, according to the Health Resources Services Administration (HRSA) — and there’s solid reason to believe NPs, who can help fill the gap in primary care providers, will continue to enjoy a bright job outlook into the next decade and beyond.
2. Powerful Groups Have Your Back
HRSA, the federal agency responsible for strengthening the healthcare workforce, supports the thorough integration of NPs into the healthcare delivery system and permitting NPs to provide primary care services to their full capacity. The more that NPs are used in primary care settings, the agency says, the higher the demand for their services will become. HRSA continues to support the nurse practitioner workforce with grants and other funding for advanced education programs.
Importantly, the private sector has also taken up the nurse practitioner cause. The esteemed Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJF), for example, have called for the removal of barriers to NP practice that, at state levels, prevent them from practicing to the full extent of their advanced training. RWJF teamed up with AARP to launch the Future of Nursing Campaign for Action, an initiative that seeks to implement the IOM’s recommendations at state and federal levels, with particular emphasis on APN practice. A review of the initiative at its five-year mark showed incremental but promising progress.
3. Your Opportunities Are Growing
The majority of NPs — 60% — work in private group practices, according to the American Association of Nurse Practitioners (AANP); 27% work in hospital outpatient settings.
The high percentages of NPs in non-hospital settings aren’t surprising, given the push to involve cost-effective NPs in primary care services. Evolving care models, however, are attracting more NPs to the acute care environment, especially in academic medical centers where NPs fill gaps resulting from restrictions on medical residents’ shift hours. Drawing on their expertise in collaboration and communications, hospitals are increasingly employing NPs to ease the transition of care of patients with complex conditions between providers and between inpatient and outpatient settings.
NPs can look forward to innovative hybrid roles that place them at the center of patient care throughout the care continuum.
4. Your Hard Work Pays Off
Advanced education, complex skill development, and higher patient care responsibilities translate into higher salaries for NPs than their RN counterparts.
U.S News & World Report has awarded nurse practitioner roles the No. 2 spot in its list of 100 Best Jobs, based in part on salary; and Forbes ranks NPs as No. 3 (behind corporate CEOs and pharmacists) in its top-10 list of Best Paying Jobs for Women in 2017.
The average, full-time base salary for NPs in 2016 was $102,526, according to AANP’s annual sample survey.
5. You Get to Do What You Love
Studies show APNs provide care comparable to physicians; and in some cases, they outperform doctors in clinical outcomes.
Beyond their clinical expertise and cost effectiveness, NPs offer patients an additional benefit: training rooted in the foundations of the nursing model.
As advanced practitioners, NPs enjoy high levels of autonomy, even in states that mandate physician supervision. They’re prepared for intellectual challenges and the management of complex acute and chronic conditions. They assess, diagnose, treat, and prescribe; but they aren’t limited to a disease- or problem-based approach to patient care. NPs stay true to their nursing roots by focusing on patients and their environment as a whole. They meld diagnosis and treatment with an understanding of, and appreciation for, patients’ lifestyle, culture, family, and community.
Patient teaching and advocacy, evidence-based practice, collaboration with others, compassionate care — all the elements of nursing that attracted NPs to the profession in the first place remain steadfastly intact as they advance in their careers.
At Eisenhower Medical Center, we’re committed to helping NPs on our team achieve the highest levels of career satisfaction. Our highly acclaimed academic medical center and 30+ outpatient clinics offer an open, collaborative culture that strongly supports the continuing education and professional development of our clinicians. Visit us online to learn more and search open positions.
Originally posted on 8/5/2017