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Question:
I’m an RN, working on my BSN. I’m interested becoming a nurse practitioner. What do you see as the big issues for NP practice in the years ahead?
Answer:
It’s pretty clear that the demand for NPs will increase in coming years, in part to meet a predicted shortage of primary care providers. While it is common now to find nurse practitioners working in all manner of subspecialty fields, the role originated during the 1960s in response to a shortage of pediatricians. The first NP programstrained public health nurses, who were already experts on nutrition, child development, behavior, and safety, to complete physical exams and treat illness in children. Fast forward to 2012, where physician shortages are again predicted, particularly in primary care. Many groups are addressing this shortage at least in part by recruiting NPs, who now have a proven track record of excellence.
While early NPs struggled with acceptance both by the public and by their physician colleagues, today’s NPs have new challenges. A recent online surveyof pediatric nurse practitioners, published in the Journal of Pediatric Health Care January issue, highlights some of the issues common to NPs.
1. Practice setting
NPs today work both in inpatient and outpatient settings. While most are employees, a small percentage of NPs either own their own practice, or co-own it with other NPs or with physician providers. Most employed NPs report to physicians although many report to a nursing administrator. Most NPs reported having a contract in place with their employer, but only a small percentage had an attorney review the contract before signing it.
2. Malpractice insurance
In this survey, 77% of respondents who worked in outpatient settings relied on employer provided coverage. National organizations encourage nurses and NPs to evaluate the need for individual malpractice policies, and emphasize the importance of knowing the laws and malpractice climate in the state in which you practice.
3. NPI and DEA numbers
The National Provider Identifier number facilitates the ability of NPs to bill under their own name and receive reimbursement from third party payers. The Drug Enforcement Agency number facilitates full prescribing privileges, although state regulations on prescribing vary. More than 90% of PNPs who responded had NPI numbers, 65 % had DEA numbers.
4. Productivity and evaluation measures
The number of patients seen per day (week,month) as well as patient satisfaction are common performance measures. Most PNPs (35%) reported seeing 11-20 patients per day. One wonders if pressure for increased productivity will have a negative effect on patient (not to speak of NP) satisfaction.
5. Education
Most of the PNPs in this survey had MSN preparation. 6.6% had doctoral degrees, a number up from 2.6% in a 2000 survey. This is important because a DNP will be the recommended entry level degree for NPs by 2015. Continuing education and recertification are also ongoing requirements for NP practice.
Demographic changes and new health care legislation are both predicted to increase the demand for primary care providers in future years. NPs have earned the respect of their colleagues in medicine and the confidence of the public, but professional challenges remain to facilitate the full use of NPs skills in meeting the health care needs of the future. If you are thinking about a career as a nurse practitioner, be prepared to be flexible, to be continuously learning, and to be an advocate for both your patients and your role.
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