NPs on the Front Lines of Change: National Nurse Practitioner Week
November 12-18, 2017, is National Nurse Practitioner Week. Although nurse practitioners have been providing cost-effective care for patients in the United States for more than 50 years, their role remains somewhat underrecognized, and sometimes misunderstood. In spite of this, nurse practitioners are uniquely positioned to provide the kind of comprehensive patient-centered care any idealist would want to provide or receive in our fast-paced, ever-changing healthcare industry.
November 12-18, 2017, is National Nurse Practitioner Week.
I became a nurse practitioner (NP) in part because I received excellent care from one years ago. I imagined myself helping others in a similar way, giving back to society by providing the kind of comprehensive, individualized, health care that had been so helpful to me personally. Little did I know that my work as an NP would put me on the front lines as the healthcare industry experienced a sea change in response to an aging population and the advent of new technologies.
You likely already know that NPs are registered nurses with additional education, at the masters or doctorate level, which allows them to diagnose and manage acute and chronic illnesses, prescribe medications, and order diagnostic tests and treatments. NPs also routinely integrate health promotion, disease prevention, counseling, and patient education to help patients understand the big picture of their overall health. This comprehensive approach to whole-person health is particularly useful in a population that is aging and plagued by chronic disease. Some 75 million baby boomers will become senior citizens over the next decade, and 50 million of them are expected to have multiple chronic conditions.
According to a 2012 Economist article on the future of medicine, the health problems of the 21st century cannot be resolved by 20th-century approaches. The article also points out that because trends in medical education have consistently emphasized treatment of communicable diseases and acute injury, many of today's physicians are often not adequately prepared to care for patients with chronic conditions. An additional factor is that physicians graduating from medical school today do not often choose primary care or family practice as a career focus. Nurse practitioners are filling these gaps. According to the American Association of Nurse Practitioners (AANP), 234,000 NPs are currently licensed in the United States, and some 23,000 NP students graduate each year.
The NP role emerged in 1965, primarily as a response to manage an existing and anticipated physician shortage. Although the role of NP has existed in the United States for more than 50 years, evolving and responding to the needs of a changing population and industry, not everyone in healthcare or the public fully understands the role of a nurse practitioner. Here are some facts about NPs that are worth knowing:
The biggest difference between a medical doctor, a PA, and an NP is educational philosophy and background.
NPs are NOT physicians, nor are they physician assistants; NPs did not go to medical school. Nurse practitioners are nurses first, which means their academic training is based on the nursing model, a fundamentally different way of thinking, distinct from the medical model under which physicians and physician assistants are educated and trained. Accredited nurse practitioner program curricula builds medical model concepts on top of a nursing model foundation.
Some NPs may be doctorally educated.
Nurses who have earned a doctoral academic degree may be referred to as "doctor," even though they are not educated as physicians and did not attend medical school. This is not meant to be confusing to patients or colleagues, but sometimes it can be.
Licensure requirements for NPs vary from state to state.
Although there are national certification exams for NPs, specific licensure requirements for NPs vary widely from state to state. NPs are able to diagnose and prescribe in all 50 states, with the ability to do so independently of physician oversight or prescription sign-off in 22 states and the District of Columbia.
NPs may be specialists.
Beyond primary care, nurse practitioners may choose to further their education in oncology, gerontology, pediatrics, psychiatry and other specialty areas.
NPs represent one type of advanced practice nursing role.
Other advanced practice nursing roles include nurse midwives, nurse anesthetists, and clinical nurse specialists. Each advanced practice role has its own specific educational, licensure and certification requirements.
The fact that the NP role is built on the nursing model is the key to the value of NPs in the changing world of healthcare. The nursing model is holistic and humanistic at its core, providing an ideal foundation on which to integrate the more reductionistic medical model approaches. An integrative approach that marries systemic thinking with mechanistic techniques will be needed to navigate the future trajectory of medicine. Recall that the nursing model is uniquely comprehensive and holistic because it addresses the patient's response(s) to health threats and treatments, both current and potential. As emerging technologies such as genome analysis, artificial intelligence, and wearable digital devices democratize individuals' access to medical data, an educational, humanistic view of how technology impacts health will be in high demand. As such, the nursing model provides an ideal foundation for graduate-level education, positioning NPs perfectly to integrate emerging technologies, such as genome analysis and digital informatics (wearables) into the next generation of healthcare delivery.
Whether you are already an NP, studying to be one, working with one or receiving care from one, take a moment this week, to consider the role of the NP. Ultimately, as health care continues to change, NPs will continue to provide high quality cost-effective, personalized health care – on the front lines, as part of a collaborative team in partnership with healthcare professionals at all levels.
The AANP is the largest professional organization for NPs of all specialties in the US, and promotes National Nurse Practitioners Week each November to showcase the NP role. The aim of NP Week is to acquaint local citizens with the role of NPs as providers of high-quality, cost-effective, personalized health care and to highlight the value of NPs. NP practice offers a unique combination of nursing and health care service to patients. For more information, visit aanp.org.
Questions for Discussion
What has been your experience with nurse practitioners-working with them, receiving care from them, or even studying to become one?
Sources and Resources
Expanding the Role of Advanced Practice Nurses – Risks and Rewards
National Nurse Practitioner Week Resource Guide (AANP)
The Nursing Site Blog: The Nurse Practitioner Will See You Now
What's an NP?
Why NPs are Important
Squeezing out the doctor | The Economist
The impact of the medical model on nursing practice and assessment - ScienceDirectLast edit by traumaRUs on Nov 14, '17
Lane Therrell is a board-certified family nurse practitioner, an adjunct instructor at Samuel Merritt University, and a health empowerment coach in private practice.
Lane Therrell FNP, MSN, RN, HTCP has '6' year(s) of experience and specializes in 'Family Nurse Practitioner'. Joined Oct '16; Posts: 50; Likes: 160.Nov 15, '17My PCP is a NP - I have chronic health conditions, and I trust her with my life, and the lives of my family. She always can see us same day if necessary (plus, she brings me wild caught shrimp from Mexico). She's the greatest, and I wouldn't go any where else.Nov 15, '17I guess I had been lucky for many years in that I had a couple of awesome psychiatric NPs I was seeing. One quit her practice and I had to stop seeing the other one because I moved.
I have since had a string of 3 psychiatric NPs who were HORRIBLE! So much so that I am now fearful - yes, FEARFUL of ever going to a psychiatric NP again. They obliterated any trust I had prior to seeing them. They were not only incompetent, they were verbally abusive. They made my anxiety, PTSD and depression MUCH WORSE - almost as if I am having to start all over again. I will NEVER trust any NP again with my personal business. In fact, I will never go see another psychiatric NP. I cannot risk what’s left of my mental health. I am disgusted and disappointed.Last edit by rachel10069 on Nov 15, '17 : Reason: to add a couple thingsNov 17, '173ringnursing, it sounds like your NP does a fantastic job of building ongoing relationships with her patients. Thank you for sharing your positive experience with your NP as your primary care provider.Last edit by Lane Therrell FNP, MSN, RN, HTCP on Nov 17, '17 : Reason: My reply was intended to be specific to 3ringnursing's comment, so I added the username to the post for clarificationNov 17, '17Rachel, Verbal abuse is never appropriate in any setting from any type of healthcare professional. Did you report the abuse? Even if you chose not to submit a formal complaint, it's important let the person know how his or her words affected you.
I am sad to hear you did not have a good experience working with 3 out of 5 psych NPs, and I am curious to know if those 3 psych NPs who provided you with sub-standard care had anything in common. Were they perhaps trained in the same specialty program, for example?
I'm a family NP, not a psych NP, so I can only speak from my own experience, but I have noticed that most of today's standard treatment guidelines for psychiatric conditions in primary care are based on pharmacology first and foremost, which is not an effective approach for every patient.
If a particular a plan of care is not working for my patient, I work with my patient to figure out what we might do differently to achieve a better outcome. What I have seen in practice is that most of my patients with psych conditions, including those with anxiety and PTSD, respond well to an integrative approach that extends beyond pharmaceuticals alone. Those who are willing to try new things find they benefit greatly from nutrition analysis and other lifestyle adjustments as well as adjunctive mind-body interventions like yoga, acupuncture, biofeedback, EFT, etc., which I enthusiastically encourage and recommend. Not everything works for every individual, a one-sized-fits-all approach is generally NOT effective, and personalized care is the way to go.
Not all providers are created equal, and that truism applies whether you're talking about NPs, PAs, MDs, RNs or any other type of licensed professional. I sincerely hope you find the right provider for you.Last edit by Lane Therrell FNP, MSN, RN, HTCP on Nov 17, '17 : Reason: I added the word "NOT" to the last sentence of the next-to-last paragraph-- sorry for the typo of omission.
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