Nov 6, 2019 in Nursing

Nurse Practitioner Role and Setting

The health care system today is a complex and drastically changing mechanism with its typical peculiarities. It unites different specialists in order to make people’s life better, healthier, and longer. In this research paper, the author tries to reveal the role and settings of one of these specialists, the nurse practitioner. 

The research includes the strong theoretical background of the nurse practitioner profession. It defines what the nurse practitioner profession is, outlines the role of a nurse practitioner, and reveals the main obstacles that the NP must overcome to achieve success.

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The Definition of Nurse Practitioner

To begin with, it is crucial to clarify who a nurse practitioner exactly is. A nurse practitioner is a nurse that acquired specific knowledge and clinical experience, possesses decision-making skills, and performs activities according to the laws of the country in which he/she is credentialed to operate. 

A nurse practitioner plays one of the most important roles in the Advanced Practice Registered Nurses community. The APRNs represent around 8 percent of the nursing personnel in the United States. This health care group usually includes four divergent roles such as the nurse anesthetist, nurse midwife, clinical nurse specialist, and nurse practitioner.

The nurse practitioner profession is often considered to bring the biggest number of misconceptions as people interpret it in a wrong way. Most people believe that a nurse practitioner is the same as a nurse, which is a false assumption. Taking into consideration the nurse practitioner definition stated above, it is clearly seen that there is a striking difference between a nurse practitioner and a nurse. First of all, it is obvious that a nurse practitioner possesses higher education and accreditation to initiate the practices needed. They obtain higher qualifications and skills. Moreover, it is important to outline that a nurse practitioner has appreciably wider practice scope. Nurse practitioners perform laboratory tests and comprehensive physical examination, prescribe therapies and medications, make and interpret tests (X-ray tests, EKG tests, etc.), manage acute and chronic health problems, diagnose common injuries and illnesses, and treat them. They also provide patients and their families with knowledge on how to maintain a healthy lifestyle. In the United States, for example, a nurse practitioner has the authority to prescribe medications in any of all 50 states. In 26 of them, a nurse practitioner has the authority to operate as an independent unit. However, the list of duties is not over yet. Nurse practitioners can perform their typical health care researches and teach people in educational institutions.

The next important issue is the nurse practitioner’s working conditions. A nurse practitioner does not always work in a clinic or hospital only. In addition to those places, a nurse practitioner delivers health care to the rural and suburban areas, worksite health centers, universities, colleges, schools, governmental organizations, and other institutions. The working time of a nurse practitioner varies from the traditional work week only to working on weekends or being available when work calls. 

Nurse Practitioner’s Role

The nurse practitioner role defines itself as being clinical since it directly promotes the patient’s recovery after being under influence of a disease. Another important aspect of the profession is that it plays a crucial role in patient’s safety. Nurse practitioners, possessing needed education and professionalism as well as knowing the healthcare standards and law regulations, prevent the patient from being treated in a wrong way thus ensuring his/her safety. The more important fact is that nurse practitioners not only act right in order to ensure the patient’s recovery and safety but also prevent other medical workers from acting wrong. In this case, nurse practitioners can be perceived as the effective and wise team leaders, knowing the authorities of the medical personnel, its competencies, and tasks that the personnel can perform. As a result, the proper level of control and lead that the nurse practitioner provides the personnel additionally ensures patient’s safety. Another important aspect of the patient’s safety under the nurse practitioner’s supervision is the correct identification of the problem and the proper prescription for its elimination. In many cases, the knowing of the accurate medical terminology and correct identification of the problem is the hardest part of the job. 

The Evolution of Nurse Practitioners

The evolution of the nurse practitioner role began in the late 1960s. At that time, the population of the United States had no sufficient access to the health care services. Today, many experts consider this fact to be the major contributor to the nurse practitioner appearance. However, it was not the one and only factor. In the late 1950s, medicine in the United States became highly diversified with many specialties being included. A considerable number of medical students have started migrating from unpopular specialties to more lucrative and prestigious ones. Such profession as general practitioner, which was the main contributor to the health care in rural and suburban areas and is now considered to be the predecessor of what is called a primary care doctor, started to disappear, leaving people face to face with their illnesses. Moreover, the demographic situation within the United States has aggravated significantly. The main reason for such aggravation was a notable increase in the ageing population and a serious growth of the chronic illness rate. The important fact was that the illnesses upsurge was registered both among children and adults. Over the following decades, the role of a nurse practitioner in the health care system has expanded considerably. Consequently, the nurse practitioner profession itself became different. 

As it has been mentioned before, the nurse practitioner field accumulated additional knowledge, making the professionals as “universal soldiers” of the modern medicine. New training programs and additional federal funding as well as professional education and specialization diversification increase made a notable difference and improved the situation drastically. Today, the number of nurse practitioner training and education programs has been developing extensively. In 1970s, nurse practitioners had a strict specialization in pediatrics, for example, while in 1990, the situation changed. The new programs enabled specialization in cardiology, oncology, neonatology, traumatology, etc.. 

One more important topic is the economic impact of the nurse practitioner role on the patient and the overall economic efficiency of the care delivered. The RAND Corporation along with the Commonwealth of Massachusetts identified that the average cost of visiting a nurse practitioner or any other APRN is by 20-35 percent lower than visiting a physician. In total, substituting physician visits for practitioner visits can save up to $8.4 billion within the years 2010-2020. Moreover, the considerable growth in numbers of retail clinics and their use will significantly contribute to the cost saving strategy. The contribution is estimated to be about $6 billion for a ten-year period. 

The Challenges Ahead

However, there is also a number of potential and actual problems, making the future of nurse practitioners rather uneven. Over the last 30 years, the physician community of the United States has grown more rapidly than the actual population itself. Nevertheless, according to the Association of American Media Colleagues, the United States nation will be hit by a massive shortage of physician workforce. It is estimated that by the end of 2015 the health care industry will lose 62,100 physicians. This number includes 33,100 primary care specialists and 29,000 other practitioners working in the industry. Nonetheless, if the physicians and practitioners number had equal distribution over the country, it would be easier for most people to obtain professional help. For example, a significant number of physicians being concentrated in urban areas often leads to the suburban and rural communities being without practitioners; however, these regions feel the need the most. 

Another important drawback of the situation today is the legislative base. The point is that nurse practitioners actions today are often restricted by the state laws. The so called scope-of-practice laws, for example, restrain practitioners from providing primary care services that they are intended to provide. The state authorities rarely become engaged in the case, worsening the situation even more. Nurse practitioners community often considers the legislative base to be the most severe constraining force on the improvement path. The lack of authority to prescribe drugs, for example, is one of the biggest entanglement preventing NPs from making health care better. Over the recent years, the situation improved to a certain extent. NPs succeeded to remove the restriction and expand their scope-of-practice in Colorado, Hawaii, Massachusetts, Maryland, Vermont, and North Dakota. The scope-of-practice expansion in other states will make a considerable contribution to the health care system overall.    

The third issue is the compensation problem. The point is that, in most cases, NPs receive only part of what is paid to physicians for providing the equal service. There are some exceptions, such as Medicare, but it has its own peculiarities. In this case, NPs can receive full compensation if only being under physician’s supervision and acting under his/her provider number. The sum of the compensation is another topic. In year 2011, the sum of the total annual compensation of nurse practitioners was $93,977. Comparing it to $215,689 of general internists, $200,114 of family practitioners, and $92,635 of physician assistants, the disparity is obvious enough.

The next obstruction to overcome is the professional tensions within the medical personnel. Despite the legislative impediments and state policies, making a negative impact on the nurse practitioners, the tensions within the personnel also plays a significant role in that process. The physicians, physician assistants, and other medical workers consolidated in a weird way and started forming opposition to the increasing number of quests for NPs “independence”. Many specialists see the reason for such opposition in the fear of competition from the side of practitioners since many primary care doctors have lost the width of operations they have been involved in. Moreover, units like managed health care organizations, health care systems, and professional media groups often vote for restricting the nurse practitioners’ activity and decreasing their scope-of-practice, which is already not that wide. However, there is no understanding that creating strict opposition to the NPs authority will only worsen the situation as the overall health care system sustains considerable losses. The best decision here will be an increase in teamwork efficiency and promoting correct relationships within the system. 

The practitioners’ position strengthening program will require time, money, and efforts. According to Donna Shalala, former Health and Human Services Secretary, there are basic points to achieve in order to fully implement the program. First, it is the scope-of-practice extension, disregarding all the historical, economical, or any other obstacles on record. The second point is the complete system change in order to achieve complete cooperation among practitioners, physicians, and other medical workers. The next important factor is the education and training quality increase. Finally, the effective planning of medical workforce as well as correct policymaking through the right information infrastructures will make a significant contribution to the overall health care system improvement.   

As it has been mentioned before, the nurse practitioners’ role in the modern medicine has evolved drastically. The education and practice provided them with knowledge needed to perform some of the tasks that physicians are doing. Strengthening the nurse practitioner’s position, giving them more authority, and letting act independently can notably relieve the pressure experienced by many patients as well as the emergency rooms in particular. 

Conclusion

To conclude the paper, it is vital to outline that the modern U.S. health care industry is facing huge challenges. The old population growth, simultaneous increase of chronic illnesses among the young, health care supply decrease, laws deficiencies, and other factors are aggravating the situation the most. The development of nurse practitioners programs in the U.S. can become an effective solution to the case, after the main controversies on their way to success have been covered.

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