Nurse practitioners fill many roles and responsibilities

Thirty million people will soon obtain healthcare coverage due to the Affordable Care Act, yet the United States faces a growing primary care practitioner shortage. One answer to this problem is utilizing more nurse practitioners.

Nurses across the country are celebrating Nurse Practitioners Week, Nov. 10-16. Nurse practitioners are trained to be mentors, educators, researchers, managers and consultants in various capacities in healthcare. They work in hospitals, clinics, hospice and homecare, veteran’s facilities, psychiatric clinics, universities and in healthcare policy.

Nurse practitioners are licensed independent practitioners who provide primary and/or specialty nursing and medical care in ambulatory and acute care settings. This role began due to a physician shortage in the mid-20th century with the first official training occurring in 1965 under the direction of physician, Henry Silver, and a nurse, Loretta Ford. Their vision was that NPs could balance the rising healthcare costs, increase providers and provide better access to care.

Nurse practitioners are nurses with a Master’s or Doctorate degree in nursing who have completed additional graduate-level education. This education consists of advanced coursework in such areas as pathophysiology, care of women and children, and pharmacology. It includes clinical rotations.

A specialty area must be chosen such as adult or family/primary care, psychiatric, neonatal or women’s health. Many choose another post graduate sub-specialty. All NPs must pass a national board certification exam for state licensure and maintain continuing education credits.

Bonnie Bartz is a women’s health nurse practitioner and certified nurse midwife at Alpena Regional Medical Center’s OB/GYN associates.

“I feel privileged to care for women from adolescence to menopause and beyond,” Bartz said. “I have a very rewarding and challenging career.”

More and more consumers are choosing nurse practitioners as their partners in health because they provide high quality care, focus on the whole patient, and provide individualized and comprehensive education and counseling.

Coreen Williams, FNP, of Journey Health Center, said that NPs are guided by nursing models or philosophies that focuses on holistic care mind-body-soul, and that “the healing begins with the story” or history-taking.

Nurse practitioners take time with patients (patient-centric) and are considered “entry point” of care. They can manage chronic disease and alert the physician when additional care is needed.

Nurse practitioners “have a rich history of patient advocacy and excellent listening skills.” said Ellen Buchler, FNP, president of the local MICNP chapter. “They form partnerships with patients and facilitate a mutually agreed upon treatment plan that promotes optimal health outcomes. “

There are over 171,000 NPs practicing across the nation, with 4,700 of those licensed in Michigan. More than 89 percent of NPs are trained in primary care; 75 percent practice in primary care settings. They perform history-taking and physicals, diagnose and treat physical and mental conditions, make referrals, prescribe medications, and order and interpret diagnostic tests.

Their clinical role depends on the scope of practice in each state, which varies widely. Scope of practice laws delineate what tasks that NPs can or cannot perform. In 18 states (and D.C.) NPs are able to diagnose, treat and prescribe medications without physician oversight or collaboration.

Michigan NPs are required to have a collaborating physician to prescribe medications. One of seven states that require this.

The state requirements can “often hinder patient care in some instances due to delays for signatures,”, said Buchler of Thunder Bay Community Health Services.

Twenty-five states still require collaboration or supervision of NPs by physicians including the skill of diagnosis and treatment, but not necessarily on-site.

“The greatest benefit to the healthcare system is the infusion of an additional type of provider who possesses a unique skill set that blends the nursing and medical model of care to enhance care delivery,”said Susan Apold, past president of the American College of Nurse Practitioners). Policymakers are working to liberalize these scope of practice rules in all states to increase the growing demand for primary care providers.

As the ACA draws near healthcare professionals are scrambling to figure out how the increase of new patients will be cared for due to the dwindling number of primary care physicians. By 2025, the country will need an additional 51,880 primary care providers due to 830,000 physicians who will be over 50, nearing retirement, and seeing fewer patients.

“I love what I do,” said Cece Peasley, FNP, “but I would like to finally see our scope of practice bill in Michigan pass so that NPs can practice without the present restrictions. This process has been going on for 17 years.”

The workforce shortage of primary care physicians can be eased by utilizing nurse practitioners who are trained to provide a broad range of services.

Michigan’s Council of Nurse Practitioners has existed for more than 13 years with over 1,300 members in 16 chapters. The mission of MICNP is to promote a healthy Michigan through excellence in practice, education, and research promoting updated healthcare policy for nurse practitioners.

The Alpena chapter of NPs have been visible in the community participating in Concert in the Park activities, Girls on the Run, and Senior Expo, said Kathy Phillips, FNP. “There are positive activities for young girls that build self-esteem.”

More local chapter events are planned for next year to promote healthy lifestyles and provide education about nurse practitioners.

As the ACA takes shape and millions of people will join the insured, it is crucial that the all providers work together.

“Nurse practitioners utilize evidence-based practice treatment guidelines to deliver the most comprehensive, current data for all patients.” said midwife Courtney Witulski. “Team-based models of care are the wave for the future where everyone is utilized to their maximum abilities.”