Primary Care Can't Thrive Without Nurse Practitioners

The debate surrounding healthcare reform has produced many offshoots, not the least of which is the question as to who will provide the care promised to the estimated 32 million people who will become eligible for healthcare coverage under the Affordable Care Act (ACA) as of 2014. Because these individuals were previously uninsured, predictions on the anticipated groundswell in demand for long-delayed primary care are staggering. Couple that with an aging population and it is not an overstatement to say that our nation is at a tipping point if this need is not addressed.

With a projected shortfall of 45,000 primary-care physicians (PCPs) by 2020, it is clear that doctors alone are not the answer. Clearly, alternative solutions must be found. And more and more, the one logical remedy is nurse practitioners.

While primary-care physicians have historically been at the frontline of evaluating and managing patients, 17 states have now enacted legislation acknowledging that nurse practitioners are qualified to handle many primary-care duties without physician oversight. According to the State Nurse Practice Acts and Administrative Rules 2012 published on the American Association of Nurse Practitioners website: "’Full Practice state licensure laws provide for nurse practitioners to evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage treatments including prescribe medications under the exclusive licensure authority of the of the state board of nursing."

In its 2010 report, "The Future of Nursing", an expert panel convened by the Institute
of Medicine noted that studies reveal that outcomes for patients of nurse practitioners are comparable to those of PCPs. The report, issued in part as response to the passage of the ACA, advocates nurses practice without restrictions to the "full extent of their education and training."

Nurse practitioners are prepared to take on this challenge and are uniquely equipped to deliver a broad range of services, including primary, acute, and specialty care. That’s because nurse practitioners are registered nurses who not only have advanced academic credentials (either a master’s degree or a doctoral degree), but on average have already worked 10 or more years as a registered nurse. This gives them practical, bedside experience to complement what they’ve learned in the classroom. These nurse practitioners are conducting routine medical examinations, ordering lab tests, and prescribing medications. They routinely monitor chronic conditions such as diabetes or congestive heart failure and treat minor illnesses such as colds and the flu. And just as important, along with their fellow nursing professionals, they comfort and counsel patients in both inpatient and outpatient settings.

Nurses have always been integral members of the healthcare team in medical offices and the inpatient setting. They work collaboratively in managing patient health, consulting with physician specialists, as well as pharmacists, lab and respiratory technicians, therapists and more. Care coordination is - and always has been - the central role of nurses. Often, they serve as patient advocates as well, ensuring that not only are patients fully informed about their care, but families are too. It is no surprise then that patients routinely report high satisfaction with the care they receive from nurse practitioners.

With the anticipated proliferation of accountable care organizations triggered by the ACA, there is an increasing emphasis on Patient-Centered Medical Homes as American healthcare moves away from episodic care and toward a population health management model. In this new environment, primary care will become more important than ever for maintaining and enhancing patient health.

Nurse practitioners are well prepared to not only treat patients, but to oversee prevention and disease management initiatives that are at the very cornerstone of healthcare reform. As physician shortages become more severe, nurse practitioners are a logical front line in managing overall population health. Facing this reality, and the environmental forces upon us, it is time to embrace the role and contribution of qualified nurse practitioners. The need for primary care has never been greater and the solution to this challenge has never been clearer.

Courtney H. Lyder, ND, ScD (hon), FAAN, is dean of the UCLA School of Nursing, a professor of nursing in the department of medicine and public health, as well as executive director of the UCLA Patient Safety Institute. He is an international expert in gerontology with the focus of his clinical work on chronic care issues affecting older adults. E-mail him here.