- Between increasing patient panels, evolving and often difficult-to-use technology, and the complications of federal quality reporting requirements, healthcare provider burnout is rampant. But as more providers suffer from burnout and even leave the profession, nurse practitioners have emerged to fill those care gaps.
The role of the nurse practitioner is growing, with more clinicians choosing that career path than ever before. A 2018 study from the American Association of Nurse Practitioners (AANP) has found that there are nearly 248,000 licensed nurse practitioners nationwide. This is an increase from 2007, where there were about 120,000 nurse practitioners across the country.
While there are many compounding factors that may have led to the rise in nurse practitioner licensure, Christy Dempsey, Chief Nursing Officer at Press Ganey, explained that the growing physician shortage may be one of the biggest drivers.
“The fact of the matter is there is a physician shortage and so having enough physicians to provide primary care is a problem,” Dempsey said in an interview with PatientEngagementHIT.com. “Nurse practitioners are in a perfect position to provide primary care, so we are seeing more and more nurses take that route and get their DNPs to be a nurse practitioner.”
To be clear, nurse practitioners have not been universally tapped to fill care gaps in this clinician shortage. There is variability about the extent to which nurse practitioners are allowed to practice at the top of their licensure. Some states have more lenient autonomy policies, meaning nurse practitioners in those states are better positioned to fill the care gaps left by an increasing physician shortage.
Some experts say that states that allow more nurse and nurse practitioner autonomy have better strategies for closing patient care access gaps caused by the physician shortage. It is a supply and demand issue, and nurse practitioners can be a part of the supply that meets that demand.
However, critics have argued that nurse practitioner care is not sufficient enough to cover the complex care needs of certain patient populations.
In 2016, when the VA considered granting full treating autonomy to nurse practitioners to close some care gaps, the American Medical Association asserted that an interdisciplinary team led by a doctor was the most effective means by which patients can receive treatment.
“Physicians bring tremendous value to the health care team. All patients deserve access to physician expertise, whether for primary care, chronic health management, anesthesia, or pain medicine,” said Stephen R. Permut, JD, an AMA board chair at the time.
But it is that emphasis on team-based care that makes nurse practitioners so ideal for filling care gaps caused by a physician shortage, Dempsey countered.
“We have seen good outcomes when nurse practitioners are able to be autonomous,” Dempsey said. “There is also broad understanding that when we are educated and trained as nurses, we understand the value of an interprofessional team and that none of us can do this by ourselves. Because interprofessional teamwork it is so ingrained in nurses and then therefore nurse practitioners, autonomy does not mean that we won’t work without interprofessional colleagues to take care of patients.”
Nurse practitioners are more than just a number on a care team or in the supply of clinicians who can meet with patients, Dempsey, a nurse herself, added. By way of training, nurse practitioners bring different elements to the care encounter that other clinicians may not.
“Nurses are very much holistic in their thinking,” she noted. “Nursing is not a medical model and so nurse practitioners bring things like connected care, relationship-based care, empathy, and compassion to the table as well as their real deep knowledge of disease and pathophysiology and treatment modalities.”
The literature shows that nurse practitioners deliver care that is equal in quality to other provider types when nurses serve as primary care providers. Additionally, data shows that nurse practitioners are cost-effective providers for filling care gaps.
And as the healthcare industry continues to focus on population health management and overall patient wellness, the role of the nurse is slated for continuous growth, Dempsey stated.
“As we think about population health management and the movement of our patients out of the hospital, we will see nurses,” she explained, noting that nurses are instrumental in preventive care management. “Hospital care is the most expensive venue for care so being able to move patients to and keep them in their homes is in everybody’s best interest. It reduces cost and certainly improves the quality of life.”
The hiring of nurse practitioners is a phenomenon seen across the healthcare continuum, but most prevalent in accountable care organizations (ACOs). ACOs take on a certain amount of risk for their patient populations, meaning that keeping patients out of high-cost care encounters is essential. Nurse practitioners, with their holistic medicine approach, are active in those goals.
Of course, there are challenges to nurse practitioner work. Nurses experience job burnout just the same as other clinicians, with nurse burnout currently at an all-time high. And although the physician shortage may be receiving more national attention, there is in fact an overall clinician shortage that is impacting nurse practitioners and other non-physician clinicians.
For Dempsey, keeping nurses in the healthcare space is essential to patient care. An emphasis on burnout is not always helpful, she explained. Instead, framing the issue in a positive light and focusing on nurse resiliency may keep more nurses in the profession.
“We must look at resilience as nurse activation, so when people feel like they make a meaningful contribution or they feel like they make a difference,” Dempsey said.
“If nurses don’t feel like they are making a difference, then this very difficult job with very long hours becomes task-driven and checklist-oriented rather than a calling to help people,” she concluded. “We need to understand that to then be able to direct improvement efforts.”