By Rebecca Turley
Like countless other Americans, I value my healthcare. I take comfort in knowing that my family and I have access to high-quality care in the event that something unexpected happens; whether it’s a broken bone or something far more serious, like cancer. It’s also comforting knowing that preventive medicine is not a luxury, but instead a given. And I appreciate that healthcare today is accomplishing things we never thought possible even a few years ago, thanks to the brilliant minds in research and development that are advancing pharmaceutical science and medical technology.
But healthcare delivery in the U.S. is strained, raising the concern that certain factors may threaten to chip away at our ability to freely access the healthcare amenities and services we have come to expect and rely on. A massive Baby Boomer population growing older and requiring more advanced and frequent care, the introduction of national healthcare reform, and a large number of healthcare workers on the verge of retirement. The convergence of these factors has created a perfect storm in which the demand for healthcare is outstripping the supply of primary care providers and specialists, creating a situation in which patient-physician ratios are higher than ever before.
According to the Association of American Medical Colleges, the U.S. will face a shortage of some 90,000 physicians by 2025. In response to this, a number of national organizations, including the Institute of Medicine, the Federal Trade Commission, and the Veteran’s Health Administration, support a national call to remove all barriers preventing nurse practitioners and other advanced practice registered nurses (APRNs) from practicing independently to the full extent of their knowledge and training. Nurse practitioners, who specialize in specific patient population focus areas that run the gamut from women’s health to neonatology to family practice to adult-gerontology, make up the majority of nurses classified as APRNs. However, the implications of this proposal extend to the other APRN roles as well: nurse-midwives, nurse anesthetists, and clinical nurse specialists.
Currently, the practice rights for nurse practitioners and other APRNs remains fractured throughout the U.S. Some states greatly limit their ability to diagnose medical conditions and prescribe medication, while other states grant them full practice privileges, including unencumbered prescriptive authority. As of now, fewer than half the states grant nurse practitioners and other APRNs full autonomy by recognizing them as independent healthcare providers.
Allowing these advanced clinicians to practice and prescribe independently within the full scope of their training and knowledge in advanced health assessment, pathophysiology, and pharmacology without the burdensome and often onerous task of consulting with physicians, gaining consent and maintaining collaborative practice agreements, would allow them to better contribute to a real solution to the growing shortage of physicians in the U.S. But still, a number of physician groups and state legislative bodies push back, arguing that nurse practitioners and other APRNs cannot provide the same level of care that physicians do.
Here’s what we know: A growing body of evidence reveals that nurse practitioners and other APRNs provide safe and cost-effective care; in many instances rivaling and even surpassing the level of care that physicians provide. An array of case studies described in The Future of Nursing: Leading Change, Advancing Health published by the Institute of Medicine (IOM), reveal that nurse practitioners and other APRNs have historically provided compassionate, patient-centered care, resulting in a high level of patient satisfaction. For example, studies have shown that APRNs spend more time with their patients and are more likely to schedule follow-up visits than physicians.
Nurse practitioners and other APRNs are required to hold a Master of Science in Nursing (MSN) or higher degree from an accredited college or university. They are nationally certified in their advanced practice role and patient population focus, and they are vetted through a state Board of Nursing before qualifying for a state board-issued APRN license. These highly educated and experienced healthcare professionals teach and counsel patients, deliver both primary and specialty care services, coordinate care, and advocate for patients in a complex healthcare system. As such, the IOM recommends that nurse practitioners and other APRNs be eligible for admitting privileges, hospital clinical privileges, hospital admission assessments, and hospital medical staff membership.
If we support an integrated workforce where nurse practitioners and other APRNs can establish themselves as primary and specialty care providers, everybody wins. Nurse practitioners and other APRNs can – and do – deliver high quality care to millions of Americans. Relieving the burden of restrictive practice requirements for these healthcare providers will not only address the growing physician shortage and fill gaps in healthcare delivery, but will also give Americans more choices in selecting a provider, and may very well improve the care we receive.
Yes, I value my healthcare. But I also value greater access to care, more choices as a consumer, and seamless, continuous care from a provider that knows me– all of which can be accomplished through a healthcare system that allows nurse practitioners and other APRNs to practice independently without barriers.
Rebecca Turley is a freelance writer and editor with a BA in Journalism and Communications. As the primary contributor to MSNedu.org and other high-profile websites and blogs related to healthcare, she has gained a unique and thoughtful perspective on careers in nursing.