The Patient Protection and Affordable Care Act will mean the addition of as many as 35 million Americans with health insurance into a healthcare system already stretched to capacity with overcrowded EDs, shrinking resources, and a dramatic shortage of primary care physicians (PCPs). Even before health reform, the Association of American Medical Colleges estimated that an additional 45,000 PCPs would be needed by 2020 to keep up with demand. Yet, fewer and fewer medical school students are choosing primary care medicine.
Qualified, Experienced Nurses Can Help
The professionals most qualified to fill this physician shortage are nurse practitioners (NPs), registered nurses who have completed graduate-level education, and nurses who have already worked 10 or more years and have accumulated practical, bedside experience that complements what was learned in the classroom. PCPs everywhere would be wise to look at NPs as a natural complement to their practice and a logical partner in caring for their patients. Nurse practitioners are already tasked with delivering some medical care, including:
Prescribing or renewing prescriptions for most drugs.
Ordering blood tests.
Performing routine medical examinations.
Monitoring chronic conditions.
Counseling patients about prevention.
Treating colds, sore throats, and the flu.
Many states have expanded the scope of NP duties and responsibilities. For example, Montana allows NPs to work without any physician supervision. By contrast, Texas requires physicians’ direct, on-site supervision at least 20% of the time. Additionally, 28 states are debating whether to further loosen restrictions that prevent NPs from performing more tasks independently.
The influx of newly insured patients into the healthcare system will also profoundly affect where people receive care. Some patients will prefer to receive treatment for minor conditions in convenient settings like retail clinics. Nurses and NPs will again be called upon to fill this important role so that physicians can focus on areas where their expertise can be best put to use.
Redefined & Expanded Nursing Roles
Currently, nurses make up the largest segment of the healthcare workforce. Without too much fanfare and away from the media spotlight, nurses are redefining and expanding their roles. They are championing quality-of-care improvements, spearheading research innovation, advocating for patient rights, and making contributions in ways that redefine their profession. They’ve been doing all of this while not surrendering their historical role as patient advocates and trusted bedside clinicians.
Today’s shortage of PCPs will be exacerbated unless we look to nurses and NPs to fill the gaps in providing care. By partnering physicians and nurses together and seeking out new ways to care for patients that leverage the best that each profession has to offer, it’s likely that nursing’s greatest role lies ahead.
Readings & Resources (click to view)
Institute of Medicine. The future of nursing: leading change, advancing health. Washington, DC: National Academies Press, 2010.
Kaiser Family Foundation. Improving access to adult primary care in Medicaid: exploring the potential role of nurse practitioners and physician assistants. March 2011. Available at: http://www.kff.org/medicaid/upload/8167.pdf.
Health Resources and Services Administration. The registered nurse population: findings from the 2008 National Sample Survey of Registered Nurses. September 2010. Available at: http://bhpr.hrsa.gov/healthworkforce/rnsurveys/rnsurveyfinal.pdf.
California Health Care Foundation. Scope of practice laws in health care: rethinking the role of nurse practitioners. January 2008. Available at: http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/S/PDF%20ScopeOfPracticeLawsNursePractitionersIB.pdf.
Laurant M, Reeves D, Hermens R, et al. Substitution of doctors by nurses in primary care. Cochrane Database Syst Rev. 2005;2:CD001271-CD001271
DiCenso A, Bourgeault I, Abelson J, et al. Utilization of nurse practitioners to increase patient access to primary healthcare in Canada–thinking outside the box. Nurs Leadersh (Tor Ont). 2010;23:239-259.