Dean Holzemer

The Dean’s Desk | Thoughts from Rutgers Nursing Leadership

Advanced Practice Nurses Key to Providing Quality Care as Demand Swells

Thursday, November 19, 2015

William L. Holzemer, RN, PhD, FAAN
Rutgers University School of Nursing

Anyone who has waited days – or weeks – to see a physician knows demand for care outstrips supply.  The Association of American Medical Colleges expects a shortage of up to 31,100 primary care doctors and up to 63,700 other physicians by 2025.

With the Affordable Care Act putting more demands on the primary care workforce, it’s time to maximize the role of advanced practice nurses (APNs) – particularly nurse practitioners – in providing the care Americans need and want.  That will demand not only providing advanced nursing education to more healthcare professionals but also overcoming some entrenched opposition to the idea – particularly among physicians and some insurance companies.

APNs already are visible in primary care and family medicine practices, working alongside physicians.  Patients encounter APNs in hospitals in critical care and the emergency rooms, and at the growing number of walk-in clinics. They prescreen patients, make hospital rounds, do follow-up care, monitor treatment and manage chronic conditions, diagnose, prescribe and manage medication, and make referrals for specialist care. In about a decade, the number of licensed nurse practitioners in the U.S. has almost doubled to 205,000.  Recently US News & World Report ranked Nurse Practitioner as the second best job out of the top 100 in the United States (9/24/2015).

The overall impact on the healthcare system is better care, faster, with a hands-on approach that many doctors – overwhelmed by the flood of patients – no longer can provide.

Americans have come to understand the importance of these APNs in their care.  A 2013 Health Affairs study found nearly half of patients either preferred to have a nurse practitioner or physician assistant (PA) as a primary care provider, while about a quarter had no preference between a physician and an advanced practice nurse.

In about 16 states, advanced practice nurses can do most of what doctors do – including heading their own primary care practices, prescribing drugs and performing medical procedures unsupervised.  But many states still restrict APNs from practicing independently, prescribing certain medication, and serving as primary care providers.

Another 2013 survey of nearly 1,000 doctors and nurse practitioners detailed in the New England Journal of Medicine(5,369) showed sharp divisions. Two-thirds of physicians said if a doctor and nurse practitioner provided the same service, the doctor would do it better. Not surprisingly, few nurse practitioners agreed.  And while 82% of nurse practitioners felt nurse practitioners should lead their own practices, only 17% of doctors felt that way.

In 2010, the Institute of Medicine (renamed recently the National Academy of Medicine), an independent panel advising the federal government, said many many states' regulations on APNs were "overly restrictive" and based on politics.  Amen.  It’s time for regulators, politicians, and our physician colleagues, to recognize the critical role already played by advanced practice nurses in providing patients quality care.  It’s time to remove the barriers to full practice and to require insurance companies to include APNs on their recognized panels for full reimbursement.


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