The nation's health care needs are growing. Costs are rising. Access is an increasing concern, especially in underserved rural and inner-city communities. Nurses today can be left wondering what to do and how they can make a difference.
Yet the nursing profession holds a promising solution to the U.S. health care challenge. To increase access to high-quality, comprehensive, and affordable care, there is a growing demand for nurse practitioners. Nurse practitioners will play a vital role in reforming health care. According to the U.S. Bureau of Labor Statistics, the number of positions for nurse practitioners is projected to increase by 23% through 2016.
Are you ready to take on the challenge? Two experts—both nurse educators and advanced practice nurses—can tell you how to get started. We asked them to share their insights about the education, role, and potential impact of nurse practitioners.
MORGAN: Becoming a nurse practitioner provides you with an opportunity to expand your role as a nurse. Nurse practitioners can diagnose and treat a wide range of acute and chronic health problems. Nurse practitioners can provide acute and primary care in a variety of clinical practice settings, including subspecialty areas such as dermatology, gastroenterology, neurology, urology, and hematology. These practice settings include some of the following: women's health, college health, emergency rooms, nursing homes, public health, psychiatric health, and pediatric health. In essence, you will find nurse practitioners in just about all facets of health care now.
Nurse practitioners are also becoming more involved in telehealth. They can evaluate, monitor, and follow up with a patient at home via telecommunication. This is especially helpful in rural areas and for patients with chronic diseases, including diabetes, congestive heart failure, and mental illness, just to name a few. Nurses who become nurse practitioners want to make a difference for their patients at a broader level. They want more autonomy and independence in how they can care for individuals, families, and communities.
TORRES: Our health care system is changing rapidly, and qualified nurse practitioners will play an increasingly important role. Many physicians are choosing specialty practice rather than general practice, and this is creating a shortage of primary care providers. This shortage is magnified given that our aged population is increasing rapidly. Nurse practitioners will be invaluable in filling the gap in providing primary care. This shift in care from physicians to nurse practitioners in the provision of primary care is a goal of the Affordable Care Act; nurse practitioners can provide care that is more accessible and cost effective to patients.
MORGAN: Nurse practitioners are trained to provide safe, competent, comprehensive, and cost-effective health care. You will find many nurse practitioners who provide care in rural and indigent areas where they can serve vulnerable and underserved populations.
Nurse practitioners can prescribe medications. They are also able to provide treatment for acute minor illnesses. That's very important because when you look at the demands on hospital emergency rooms, you see an influx of patients who should be going to an outpatient or acute care clinic instead of the emergency room.
In addition to teaching at Walden University, I work at a retail clinic where nurse practitioners provide care for acute minor illnesses such as strep throat, urinary tract infections, otitis media, and sinus infections. Patients are very grateful to have a clinic like this. When they need care, they don't have to go to the hospital emergency room or take time off from work to go to the doctor's office.
Some patients have reported that they prefer a nurse practitioner as their primary care provider because they say we listen, we're comprehensive, and they like the follow-up care we provide. Of course, some people say they prefer to see a physician because that's what they are accustomed to. As the country seeks to make health care more accessible and affordable, we have an opportunity to educate the public about the roles of nurse practitioners.
TORRES: As the demand for health care services by nurse practitioners increases, it is important that barriers to practice also be removed. The scope of practice for nurse practitioners can vary significantly from state to state. In some states, nurse practitioners have more autonomy to practice, whereas in others, nurse practitioners are not able to prescribe a controlled substance such as pain medication. A key recommendation from the Institute of Medicine's (IOM) 2010 report The Future of Nursing: Leading Change, Advancing Health was that outdated barriers to practice should be removed and nurses should be allowed to practice to the full extent of their education and training.
TORRES: Currently, some nurse practitioner specializations are in higher demand than others. For example, there is a high demand for family nurse practitioners (FNPs). FNPs have the most options as to where they can practice and the populations to which they can provide care. FNPs practice in all types of settings, including private or public clinics and hospitals, and they can provide care across the lifespan. Nurse practitioners who focus on the care of adults and the elderly are also in demand.
MORGAN: There's both a need and a demand. There's a lack of minority representation among nurses across the board. For example, among advanced practice nurses, it's very low because less than 1% of all African American nurses have earned a doctorate. Yet research has provided evidence demonstrating that it helps the patient-provider relationship when a patient who is a member of a minority group has a provider who is a member of the same minority group.
The Health Resources and Services Administration (HRSA), a federal agency, is looking at how to increase workforce diversity in nursing. It's providing funding opportunities for minority nurses— either RNs or advanced practice nurses—to earn graduate degrees, which could help increase minority representation among nurse practitioners.
TORRES: For certification as a nurse practitioner, you need at least a master's degree. Often, someone who already has a master's degree and then decides to become a nurse practitioner will complete post-master's certificate courses to prepare for certification to practice.
If you already have a Bachelor of Science in Nursing (B.S.N.), you can go into a master's program and become a nurse practitioner in two years, or you can go directly into a Doctor of Nursing Practice (D.N.P.) program and complete a degree in three years. The American Association of Colleges of Nursing is proposing a shift that would make the D.N.P. the professional standard for all advanced practice nurses, including nurse practitioners.
Whichever degree program a prospective nurse practitioner chooses, its content needs to include separate courses in the "three Ps" of nursing—pharmacology, physical assessment, and pathophysiology—plus other content based on the population the nurse practitioner will serve. Some degree programs offer specializations in practice related to particular populations, such as family nurse practice and adult-gerontology nurse practice. At least 500 hours under a preceptor in a clinical area is also needed before you take the certification exam through the American Nurses Credentialing Center or the American Academy of Nurse Practitioners.
For those who have jobs and families or who live in remote areas, an online program can be a good option to help make this education more accessible.
MORGAN: Nurse practitioners come from a variety of backgrounds. Among students in Walden's advanced practice nursing program, we're seeing experienced nurses as well as people who are starting a second career. A student might be a health care administrator, someone who's worked as a pharmacist, or someone who hasn't been in health care at all. They've been in marketing or computer science, and they want to give back to society in a different way by incorporating their first career with a new career in nursing. For example, they are combining computer science and nursing and specializing in nursing informatics, or blending business and nursing for a career in nursing administration. It's very individualistic
MORGAN: Experienced nurse practitioners can serve as administrators for hospitals or clinics. Some nurse practitioners work for the National Institutes of Health (NIH). When the NIH conducts clinical trial studies, advanced practice nurses are needed for the clinical protocols or to oversee the research projects. Many nurse practitioners work at four-year institutions, where they teach or serve as project directors for grants funded through NIH.
TORRES: We're starting to see more nurse practitioners open their own practices in collaboration with physicians. There are also nurse practitioners who are able to teach. The beauty of being a nurse practitioner is that you can teach and do clinical practice. There's an opportunity to give back to the profession through both roles.