Registered Nurses: The Pioneers Of The APRN Movement

The Physician Assistant (PA) and Nurse Practitioner (NP) career fields were the medical fields’ response to the physician shortage that began in the 1960s, but the shortage still exists today. As the population continues to grow, the gap continues to grow as well. Medical schools were having a hard time producing as many doctors that were needed to fill in the gaps in a timely manner, leaving the medical field looking for ways they could have health care providers diagnose and treat patients, but educated in half the time of a doctor. The PA program was then born out of the military. Medical doctors watched as military doctors and medics came back, but they had no formal training except for on-the-job training. The NP program was derived from previous midwifery program. Currently, as the physician shortage is still impending more and more PAs and NPs are being hired to fill in the gaps. This is causing many questions to arise: Are they qualified?, What kind of education do they have?, and Should I feel safe?. Patients want to know that they are getting excellent care, and that their medical providers are qualified to diagnose and treat patients accurately.

Current literature continues to reiterate the indicators of a major shortage of registered nurses (RNs) in the United States. The total RN population has been increasing since 1980, which means that we have more RNs in this country than ever before (Nursing Shortage). Even though the RN population is increasing, it is growing at a much slower rate then when compared to the rate of growth of the U.S. population (Nursing Shortage). We are seeing less skilled nurses “at a time of an increasingly aging population with complex care

Loretta Ford, is commonly known as the pioneer of the nurse practitioner role. The NP role was shaped by Ford, in collaboration with pediatrician Henry K. Silver in 1965, in response to the need for providers for well-child care, in community based settings (Zaccagnini & Waud White, 2017). Though many texts, Zaccagnini included, cite a physician shortage as the impetus for the creation of the role, Ford herself disputes the emphasis on this shortage, as one of several “myths” many of which continue to influence the NP movement (Towers, 2011). This creates a view of NPs as “physician extenders” or substitutes for physicians, and diminishes the role of the NP (Sullivan-Marx et al., 2007). The creation of the NP was in conjunction with nursing leadership, who were focused on creating graduate nurses for clinical specialization (Towers, 2011). The lack of providers simply created an opportunistic environment for nurses to reclaim the role that public health nurses had historically held, focusing on wellness, health promotion and disease prevention (Zaccagnini & Waud White, 2017). The first NPs were certified in the area of pediatrics, but soon began to develop focus on other populations, such as whole families, gerontology, women’s health, or psychiatry.

Healthcare systems and the way safe, quality health care is delivered are continually changing to better serve patients and communities. Professional nursing practice is a large component in the healthcare system today. Back in the 1960s, professional nursing leaders tried to adopt the bachelor degree programs as the only educational track to become a registered nurse (Creasia & Friberg, 2011). Due to nursing shortages and demands this motive did not hold fast. Individuals entering the nursing profession today must first decide which educational pathway to take to become a Registered Nurse (RN).

There is a shortage of all health care professions throughout the United States. One shortage in particular that society should be very concerned about is the shortage of Registered Nurses. Registered Nurses make up the single largest healthcare profession in the United States. A registered nurse is a vital healthcare professional that has earned a two or four year degree and has the upper-most responsibility in providing direct patient care and staff management in a hospital or other treatment facilities (Registered Nurse (RN) Degree and Career Overview., 2009). This shortage issue is imperative because RN's affect everyone sometime in their lifetime. Nurses serve groups, families and individuals to foster

There is a growing trend where physicians are choosing different specialties instead of choosing primary care, primarily due to the low reimbursement rate in primary care. According to Iglehart (2014),” the Association of American Medical Colleges (AAMC) still projects a shortage of 130,000 physicians by 2025, split almost equally between primary and specialty care” (para. 1). With this decline comes an answer, an increase in the number of nurse practitioners providing patient care, reported 154,00 in 2012 and growing every year (Iglehart, 2014). This increase in nurse practitioners’ helps fill that gap, allow greater health care access to the community, especially special populations. By gaining access to healthcare were a nurse practitioner is the provider not only with the special population have high quality affordable health care, a trusting long lasting relationship will develop. This relationship will break the barriers of; lack of trust, lack of health care education and discrimination. Nursing is a trusted profession that provides education and care that no other health care professional

Budzi, Lurie, Singh, and Hooker (2010) state, “Nurse Practitioners’ (NP) interpersonal skills in patient teaching, counseling, and patient centered care contribute to positive health outcomes and patient satisfaction.” According to their research they encourage healthcare systems in the U.S. to hire more NPs to allow for better access affordable, and quality care (Denisco & Barker, 2016). With the demand for primary care providers, The NP role aids in delivering a solution to some of the healthcare issues that exist today. Organizations like the Institute of Medicine (IOM) and Centers for Medicare and Medicaid (CMS) all agree to allow nurses to practice to their full abilities to make healthcare more accessible and affordable, especially for the aging baby boomers and less accessible rural neighborhoods, and densely populated urban areas. Research has proven that NPs that provide primary care have similar health outcomes to primary care physicians (DeNisco et. al., 2016). NPs particularly take pride in their holistic approach, forming therapeutic relationships between other providers of the healthcare team, patients, and their families, aiding the informed decision making process, use of the evidence based practice approach in health management (Brown, 2005). Some of the other actions or qualities that

While the demand of healthcare need increasers the United States facing a physician shortage. In recent years the number of nurse practitioners (NPs) and physician assistants (PAs) has significantly increased and they are taking the part in providing healthcare cervices to the majority of patients. I believe nurse practitioners and physician assistants can practice independently from doctors and be free of oversight. Expanding the scope of NPs and PAs is essential to overcome the healthcare crisis we are facing; it will increase patient satisfaction and stabilizing the healthcare economy.

A nationwide shortage of physicians in the mid-1960s gave way to the development of the nation’s first master’s degree curriculum in Nurse Practitioner at the University of Colorado’s School of Nursing in 1965 (Egenes & Burgess, 2001). The nurse practitioner movement was greatly influenced by the social movements of the 1960s and 70s, including the women’s and civil rights movements. By the 1970s, nurse practitioner preparation increased in graduate programs nationwide and the provision of primary care by nurse practitioners became widely accepted. Women of various racial and ethnic groups were finally allowed entry into nursing education programs after the Nurse Training Acts of 1975 and 1980. The physician shortages of the 1970s became a surplus in the 1980s, and Nurse Practitioners and APNs felt the need to increase scientific rigor to establish their continued value as PCPs (Frellick, 2011). In 1993, The American College of Nurse Practitioners was formed to further lobby and advocate for the needs of Nurse Practitioners (Egenes & Burgess, 2001).

Since the inception of the Nurse Practitioner (NP) role in the 1960s, NPs have thrived in the delivery of primary healthcare and nurse case management. Despite patient satisfaction with NPs ' style of care, nurses have been critical of NPs, while physicians have been threatened by NP encroachment on MD practice. Balancing assessment, diagnosis, and treatment with caring defines NPs ' success as primary care providers. Understand the role and Scope of Practice of NPs is sometimes difficult for some to understand. The purpose of this paper is to define the role and history of NP, compare and contrast licensure versus certifications, understand NP Scope Of Practice and Standards of Care, discuss how the State Practice Acts regulate FNP practice, discuss credentialing and privileging, and differentiate between legislative and regulatory processes.

As resistant as some states’ legislative and regulatory bodies are to grant APNs autonomy of practice, the damage being done by over-regulation is clear (Safriet, 1992). Physicians are forced into a position to either supervise the APN’s practice or be constantly consulted for approval of their practice decisions. Safriet (1992) described that in and of itself, this constant supervision may appear to patients that the APN is not competent to provide adequate or care equivalent to that of a physician. If the role of the APN is to bridge gaps in health care by relieving the medical establishment of some of the patient load by performing the same function as a physician in a primary care setting, it seems wholly unnecessary to restrain their scope of practice in those areas. This type of restrictions affect cost and patient care accessibility (Safriet, 1992). This was a problem stated in the article, however 25 years later, populations of patients remain unseen or cared for and APNs continue to be underutilized (Safriet, 1992). Rigolosi and Salmond (2014) cite the American Association of Nurse Practitioners (AANP) when they state that not utilizing nurse practitioners due to practice restrictions costs $9 billion annually in the US (p. 649).

Challenges to overcome with this issue may be that physicians could feel as though the nurse practitioner (NP) is not adequately equipped as the doctor would be when dealing with patient care. According to the American Medical Association, “physicians have longer and more rigorous training than NPs, nurse practitioners are incapable of providing quality, safe care at the same level of physicians” (Hain & Fleck, 2014). This statement reflects negatively upon nurse practitioners but also coincides with the inability of a nurse practitioner to practice “to the fullest extent of their education and training” (Hain & Fleck, 2014). Only roughly “one-third of the nation has adopted full practice authority licensure and practice laws for NPs” (Hain & Fleck, 2014). This is another dilemma in and of itself within the health care setting and could be one of the reasons as to why NP are not reimbursed one-hundred percent for their

The rise of nurse practitioners is the direct result of a shortage in primary providers. The passage of the Patient Protection and Affordable Care Act and Americans’ demand for quality and affordable health care in the 21st century also are contributing factors. The shortage of physicians is still problematic today, as there has been a steady decline in medical students and residents responding to the need for primary-care providers in family practice and internal medicine. However, the number of NPs continues to increase; their “per-capita supply is projected to increase annually by an average of 9 percent” (Naylor & Kurtzman, 2010, p. 894). This physician-shortage trend and increase in NPs are also observed in education. Naylor and Kurtzman (2010) found there was a 3 percent decrease in

Primary care practice will be greatly impacted by health care reform. To provide better health care, the country will see a trend away from specialty to primary care and the avoidance of acute issues by delivering this care in the community setting. As a result, primary care physicians will be overwhelmed with the patient load as the number of the insured increases exponentially. The committee recognizes the scope of nursing practice that remains untapped and therefore the profession

The role that nurse practitioner (NP) plays within the increasing complex health care system is a constant changing role with the Consensus Model and the introduction of the Affordable Care Act in 2010. The scope of the nurse practitioner (NP) includes the care of the young, the old, the sick and the well. The educational needs of a nurse practitioner vary greatly from that of a Registered Nurse (RN), in the amount of education as well as the focus of the education. NPs provide coordinated primary care with the use of comprehensive health histories and physical examinations, diagnosing and treating acute and chronic illnesses, the management of medications and therapies, ordering and interpreting tests results, and educating and