This is part of the April 2013 issue of Sharing Nursing's Knowledge.

“A nurse practitioner may be in your future — if he or she is not already in your present. This is a kind of super-nurse, who’s gone through four years of nursing school plus at least two more years of training in diagnosing and treating disease. Nurse practitioners may specialize in women’s health, pediatrics or cardiac care … I went to a superb nurse practitioner for years... When I had a complaint she considered beyond her expertise, out came her pad and the name of a specialist to call. Her accessibility was a big plus… Cutting health-care costs—and making health-care services more convenient for consumers—demands moving basic medical services away from hospitals and, in many cases, doctors’ offices. Sometimes we need a doctor; sometimes we don’t. A well-trained nurse practitioner can help point us in the right direction.”
-- Froma Harrop, Nurse Practitioners Can Help Save Big Health-Care Dollars, Columbus Dispatch, March 30, 2013

“I have watched my daughter, Sam, in action several times. She has volunteered for several years during the flu shot clinics at the health department. But her finest moments were the ones taking care of her dad while he was dying.  The tenderness and careful attention she gave him was indescribable … I imagine she gives that kind of care to all her patients. She has sat with families while they waited on their loved one to pass. She has encouraged dying people to go with confidence and poise. Going through it with her dad has given her a special love for helping the dying to die peacefully. Going the extra mile is important in any professional field. In the nursing field, it is the difference between being a nurse and being a great nurse. It just doesn’t hurt to do everything you can for a patient. And it could be the difference between life and death.  Appreciate those hard working nurses. They have tough jobs.”
-- Anita Goza, Those Hardworking Nurses, Waurika News-Democrat, March 27, 2013

In light of concerns about the nation’s shortage of primary care providers—which is likely to be exacerbated as health reform takes effect—many have argued that nurse practitioners (NPs) can help increase capacity. But because state laws about NPs’ scope of practice vary widely, in some places NPs may not be able to help fill the gap and satisfy demand for primary care services.

A new report from the National Institute for Health Care Reform examines the scope-of-practice laws and payment policies that affect how and to what extent NPs can provide primary care. The report examines laws across six states (Arkansas, Arizona, Indiana, Maryland, Massachusetts and Michigan) that represent a range of restrictiveness. The National Institute for Health Care Reform is a nonprofit, nonpartisan organization that conducts health policy research and analysis.

Rather than spelling out specific tasks NPs can perform, scope-of-practice laws generally determine whether NPs must have physician supervision. Requirements for documented supervision—collaborative agreements—are seen “as a formality that does not stimulate meaningful interaction between NPs and physicians,” according to the report. Collaborative agreements can limit how NPs are used in care settings or prohibit them from acting as the sole care provider, and can limit NPs’ range or number of practice settings, which can have serious consequences for underserved rural communities, the report says.

Susan B. Hassmiller, RN, PhD, FAAN, the Robert Wood Johnson Foundation senior adviser for nursing and director of the Future of Nursing: Campaign for Action, will be a featured speaker when the Institute for Healthcare Improvement hosts a webinar this Thursday, January 10. The webinar will explore how nurse practitioners or advanced practice nurses are being deployed and woven into new, interdisciplinary, team-based delivery designs.

Other panelists will include Patricia Gerrity, PhD, RN, FAAN, an alumna of the RWJF Executive Nurse Fellows program and a Raise the Voice Edge Runner. Gerrity is the director of Eleventh Street Family Health Services of Drexel University, and the associate dean for community programs at Drexel’s College of Nursing and Health Professions.

The webinar will be held from 2:00–3:00 p.m. EST.

Register for the webinar.
Read more about Gerrity’s work.

The number of trained nurse practitioners (NP) in the United States is expected to increase by 94 percent from 2008 to 2025, according to a study published in the July issue of Medical Care. Those providing care as NPs will rise 130 percent, from 86,000 in 2008 to 198,000 in 2025.

“Nurse practitioners really are becoming a growing presence, particularly in primary care,” David I. Auerbach, PhD, the study author and a health economist at RAND Corp., told American Medical News.

New care models like patient-centered medical homes and accountable care organizations increasingly rely on nurse practitioners, Auerbach says, and “people have gotten the message that becoming a nurse, and especially an NP, is a very good, solid career choice.”

Read the study abstract.
Read the American Medical News story.

By Tine Hansen-Turton, MGA, JD, FCPP, FAAN, Chief Executive Officer, National Nursing Centers Consortium and Chief Strategy Officer at Public Health Management Corporation

Increased federal and state funding for nurse-managed health clinics (NMHC) would have positive implications for thousands of underserved patients around the nation. As Chief Executive Officer of the National Nursing Centers Consortium (NNCC), a non-profit member association representing more than 200 nurse-managed clinics throughout the country, I have spent close to 15 years advocating for the increased use of nurse practitioners and NMHCs in primary care. Our mission at the NNCC is to advance nurse-led health care through policy, consultation, programs and applied research to reduce health disparities and meet people’s primary care and wellness needs. Although I am not a nurse, I am passionate about NNCC’s mission because I have seen firsthand the life-changing impact NMHCs and nurse-practitioners can have on their patients.

When people ask me why NMHCs are so important, I often tell them the story of a woman with chronic back pain who came to the Public Health Management Corporation Rising Sun Health Center, a large NMHC network in Philadelphia. By the time she came to Rising Sun, the woman had received medication and treatment from health professionals in other settings, but her back pain had not improved. After conducting a thorough interview, the patient’s nurse practitioner found the source of the problem. The woman, who was caring for a large family, had been sleeping in a bathtub so her children could sleep on mattresses. After helping the woman develop better sleeping arrangements, the nurse practitioner referred her to social services. She was able to move to a larger rental unit in public housing, and her health problem improved.

By Kristine M. Gebbie, DrPH, RN, Adjunct Professor, Flinders University School of Nursing and Midwifery, Adelaide, South Australia

The term, "scope of practice," is primarily linked to the legal definition of a profession in the statutes or regulations that define the profession and the niche it fills in the array of health practitioners. As such, the limits (or opportunities) presented by legal language is of primary importance to individuals and organizations considering exactly what a nurse, a physician, a dentist, a veterinarian, a naturopath or a physical therapist can be expected or allowed to do generally. However, the many decisions made by institutions in designing credentialing standards, position descriptions or practice policies may be of even greater importance on a day to day basis.

The research brief on nurse-managed health centers published on the Future of Nursing website1 puts the issue of credentialing into perspective. The authors identify the reluctance of managed care organizations to credential nurse practitioners as providers of primary care, despite the research literature supporting such decisions. Nearly half of responding organizations (47%) do not allow employed nurse practitioners the full legal scope of primary care practice that could benefit both patients and the organization. That credentialing is strongly influenced by geography and history is also evident, for example, in the number of U.S. institutions that limit the role of nurse midwives, while in many other parts of the globe they are readily credentialed and provide an enormous amount of obstetric care.

A further limitation may be imposed by employing organizations in the specifics of position descriptions (PDs) setting out what the employees in a given class or range are being hired to do.

Allison Stevens is a writer based in Washington, D.C. She writes about women’s issues, motherhood, politics and health, and also writes for a firm that works for the Robert Wood Johnson Foundation.

At the beginning of the summer, my family and I took a road trip to the wilds of West Virginia. Owen, our two year old, had a cough, but my husband and I decided to go anyway. If we postponed every outing because of a sick child, we said to ourselves, we’d never get out of the house.

It didn’t take long before we began to regret that decision. Typical, right?

About two hours into the trip, Owen’s cough had gotten much worse. He was coughing non-stop, and couldn’t seem to get a deep long breath in. We decided we had better head to the nearest emergency room. When we finally arrived at the small ER in rural West Virginia (thank you GPS!), we were told that the wait would be several hours long.

So much for our trip, we sighed.

The triage nurse, however, suggested we instead try the new urgent care clinic a few miles down the road. We retraced our steps, driving about a half hour back toward Washington, D.C., and headed into the brand new facility.

We walked into the small, clean white building and found we were the only customers—even though lots of folks were waiting to see the docs down the road. Our boys played in a small play area with children’s toys while I filled out the requisite health forms, and before long we were called in to see the nurse practitioner on call.

Earlier this week, PBS NewsHour aired an important story on the expanding role of nurse practitioners in primary care. The piece includes a look at nurse-run clinics and the state of nursing education, and includes an interview with John Rowe, M.D., who was part of the Institute of Medicine committee that drafted the The Future of Nursing: Leading Change, Advancing Health report.

Watch the video below or read the transcript.