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How are family nurse practitioners changing primary care?

Date: December 5, 2017

More than 2.8 million registered nurses (RNs) are working in U.S. health care facilities, and roughly 150,000 of them are in practitioner roles, according to research from the Bureau of Labor Statistics. A large number of nursing professionals are moving into the primary care arena and catalyzing transformation of primary care as a result. Patients across the country make appointments with family nurse practitioners (FNPs) instead of doctors, trusting these Advanced Practice Nurses to deliver optimal care and facilitate ideal health outcomes.

The Institute of Medicine and the Robert Wood Johnson Foundation predicted this development back in 2010 in a joint report that explored the expanding role of FNPs in health care. “Given their education, experience, and unique perspectives and the centrality of their role in providing care, nurses will play a significant role in the transformation of the health care system,” the report said.

FNPs have indeed sparked innovation in wards, anchoring new-and-improved clinical workflows designed to address long-standing issues plaguing the health care space.

Filling staffing gaps
Health care administrators and others in the industry have watched as the number of primary care physicians has dwindled in recent years. Why? Many doctors are simply aging out of the workforce, leaving behind a vast number of vacancies that cannot be filled rapidly due to the timing and intensity of medical training programs, according to the Association of Medical Colleges (AMC). Medical students are increasingly embracing specialty tracks, rather than internal medicine or primary care programs, Health Affairs reported. Together, these forces have created significant staffing problems at hospital primary care departments and family practices, leading to longer wait times and other issues.

This trend is expected to continue. The U.S. will experience a shortage of at least 15,000 primary care physicians by 2025, analysts for the AMC found. Stakeholders in the health care space have pitched numerous possible solutions, including streamlining medical training programs. Only one proposed fix has seen application in the real world: increased authority for FNPs.

“We have a serious shortage of primary-care physicians in the U.S., and the shortage is only going to get worse as fewer and fewer go into primary care and we expand coverage,” health care economist and Institute of Medicine (IOM) Chairman Stuart Altman told Modern Health Care. “Nurse practitioners have the training to provide this care.”

The IOM and the Robert Wood Johnson Foundation promoted this approach in 2010, lobbying state governments to loosen clinical restrictions pertaining to these health care professionals and grant them prescriptive privileges. As of December 2015, 27 states have made such changes. Access to care is improving in many areas as a result, according to American Association of Retired Persons (AARP).

Creating cost savings
The cost of health care in the U.S. continues to rise. Spending on health services surpassed $3 trillion in 2015, which translates to nearly $10,000 per person, according to the Center for Medicare and Medicaid Services. Many industry experts believe expanding FNPs’ power can help solve this major problem. Multiple studies have shown that this option is far more than a theory, Nursing Economics reported.

One report published in 2009 revealed that patients paid 20 percent less when they visited FNPs for their primary care needs rather than doctors. The Medicare and Medicaid reimbursement rate for these health care professionals is lower than that of physicians, meaning patients pay less while still receiving the best care. The Florida Coalition of Advanced Practice Nurses estimates that increased reliance on FNPs nationwide could result in a 20 percent reduction in the cost of primary care, which translates to roughly $8.75 billion.

In addition to cutting the costs of primary care provider visits, the growing role of FNPs in the primary care space is opening up access to care and, consequently, bolstering preventive practices. This shift leads to further cost savings, as patients can effectively manage their health and avoid costly hospital visits or invasive treatments, the Association of Clinicians for the Underserved found.

Improving care outcomes
Although FNPs may not have the same level of medical education as doctors, FNPs provide nearly equitable services in primary care settings. In 2013, Susan Yox, RN, Ed.D., and medical researcher Julie Stanik-Hutt, Ph.D., compared patient outcomes attributed to FNPs and physicians collected during 71 studies published between 1990 and 2009, Medscape reported. Health care professionals in both categories oversaw patient populations with nearly identical outcomes. Vital sign readings, office visit tallies and hospitalization and mortality rates were uniform across both groups of patients, indicating that FNPs were capable of providing optimal care. Other studies have yielded similar results. In addition to providing quality care to everyday patients, FNPs tend to work in underserved communities, serving individuals who might not have easy access to care.

“Older patients with chronic illnesses may see a doctor once every three months,” Marla Salmon, an RN and nursing instructor, told the AARP. “In between, it’s often the nurse practitioner who follows-up, who makes sure patients comply with treatment, who watches for adverse reactions or new problems.”

Functioning in primary care settings
From a clinical perspective, FNPs have several key duties, from treating minor injuries and performing health diagnostics to managing clients with chronic conditions and prescribing medications. These advanced clinical tasks require more robust credentials. In fact, virtually all FNPs have master’s degrees and special certifications, according to Health Affairs.

RNs can gain the skills and knowledge needed to pursue new roles in primary care settings by enrolling in Bradley University’s online Master of Science in Nursing (MSN) — FNP program. As students, RNs can expand their knowledge on a wide range of topics, from advanced health assessment techniques to health care policy, all without stepping foot on campus. The 67-credit-degree track ends with a capstone research project, followed by five preceptor-supervised clinical practicums, which can be administered locally.

The online MSN-FNP program at Bradley University is the ideal choice for RNs hoping to move up mid-career and expand their skill sets to better serve their patients.

Recommended Readings:
Time management and organizational tips for family nurse practitioners
“What do hiring managers look for in FNPs?”

Sources:

http://content.healthaffairs.org/content/29/5/893.full

http://nursejournal.org/family-practice/role-scope-of-practice-of-a-family-nurse-practitioner/

https://bhw.hrsa.gov/health-workforce-analysis/primary-care-2020

http://www.modernhealthcare.com/article/20160220/MAGAZINE/302209981

https://www.acponline.org/system/files/documents/advocacy/current_policy_papers/assets/np_pc.pdf

http://www.ajmc.com/journals/issue/2015/2015-vol21-n6/the-role-of-nurse-practitioners-in-primary-healthcare

http://www.aarp.org/health/doctors-hospitals/info-10-2010/doctor_cant_see_you_but_nurse_can.html

https://www.bls.gov/oes/current/oes291141.htm

https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html

http://www.floridanurse.org/arnpcorner/ARNPDocs/CoalitionAPNsWhitePaper2008.pdf

http://clinicians.org/images/upload/wessel_nurse_practitioners.pdf

http://www.medscape.com/viewarticle/865779

http://onlinedegrees.bradley.edu/nursing/msn-fnp/

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