The ranks of nurse practitioners (NPs) are growing at a fast pace.
In 2014, there was one nurse practitioner for every five physicians and surgeons in the United States. By 2033, there will be one NP for every two physicians and surgeons.
Whereas the number of physicians and surgeons is projected to increase by 4 percent between 2023 and 2033, the number of nurse practitioners will grow by 46 percent over the same period.
As with all drastic changes, this trend has sparked great controversy with heated arguments on both sides.
Criticism of nurse practitioners
According to one side, the problem with nurse practitioners is that they are poorly trained yet are increasingly replacing physicians.
The Bloomberg nurse practitioner story cites numerous examples of unprepared NPs and tragic patient outcomes.
Unprepared nurse practitioners
The Bloomberg article, titled “The Miseducation of America’s Nurse Practitioners,” argued that many NPs do not have sufficient knowledge and experience to qualify for their roles. The authors warned about the risks of poorly trained NPs.
Here are some of the arguments supporting the miseducation of nurse practitioners:
Online education
Many NPs receive entirely online education. Lectures are often recorded and, therefore, often outdated. Interaction with professors is frequently limited to emails and message boards.
Short education
Many nursing schools offer direct-entry nurse practitioner graduate programs for candidates with bachelor’s degrees in unrelated fields. Therefore, it is possible to complete NP education in three years, including a Bachelor of Science in Nursing (BSN) and a Master of Science in Nursing (MSN).
Questionable clinical hours
NP students must complete 500 clinical hours to graduate. That is less than 5 percent of what medical students must complete before practicing medicine.
Furthermore, whereas medical schools pair students with residencies at vetted healthcare institutions, NP students typically must find their own preceptors to supervise their clinical hours.
Nurse practitioners with either MSNs or Doctor of Nursing Practice (DNP) degrees can overshadow NP students. These preceptors may be NPs with limited experience themselves.
Inadequate preparation for the role
Even though nurse practitioners’ education and clinical experience are more limited, they often treat patients in much the same way as doctors. Many nurse practitioners can prescribe meds and diagnose patients.
Less favorable patient outcomes
The concerns regarding the miseducation of nurse practitioners are also based on research showing that “NPs use more resources and achieve less favorable patient outcomes than physicians.” This finding was originally published in the National Bureau of Economic Research in 2022.
Defense of nurse practitioners
As is often the case with controversial topics, the same issues can be argued both ways.
Those who support the growing reliance on NPs—including the American Association of Nurse Practitioners—argue that these advanced practice nurses are adequately prepared to fulfill their roles.
Furthermore, proponents argue that NPs are essential healthcare providers who respond to an urgent need. Moreover, there is also evidence that nurse practitioners have led to improved patient outcomes and that many patients choose NPs over physicians.
Nationally accredited education
Although shorter direct-entry programs exist, most nurse practitioners have completed at least six years of nursing education.
Typically, a candidate completes a BSN (which includes clinical rotations) and obtains registered nurse (RN) licensure. Then—often after years of experience working as an RN—a nurse may complete a two-year MSN (including clinical rotations) and pass national board certification to become a licensed nurse practitioner.
NP programs prepare candidates to diagnose, manage patient care, and prescribe medications and other treatments independently. Over half of US states and territories have adopted full practice authority (FPA) licensure laws for NPs. FPA laws authorize NPs to evaluate and diagnose patients, order and interpret diagnostic tests, educate patients about disease prevention, and initiate and manage treatment plans, including prescribing medications. All of these tasks can be within an NP’s scope of practice, depending on the state.
NPs must pass national certification board exams, such as the Family Nurse Practitioner (FNP) examination, and retain board certification throughout their careers. They only graduate and become licensed after demonstrating the required knowledge and skills.
The national accreditation bodies that accredit these programs are held accountable to the U.S. Department of Education (DOE).
Solutions to the physician shortage
One fact is undeniable: There are not enough physicians in the United States to provide the required primary care services.
Advanced practice registered nurses (APRNs) and physician assistants comprise about one-third of the nation’s primary care workforce. In rural areas, this percentage rises to approximately 50 percent.
Nurse practitioners are essential in providing high-quality, cost-effective care, especially in rural areas and areas of lower socioeconomic and health status.
Improved outcomes
Although concerns have been raised regarding less favorable patient outcomes, numerous sources argue NPs have helped improve patient outcomes.
In 2018, the American Enterprise Institute’s studies indicated that Medicare beneficiaries receiving primary care from NPs consistently received significantly higher-quality care than physicians’ patients in various respects.
The National Academies of Sciences, Engineering, and Medicine published a nursing home report in 2022 with key findings supporting the use of APRNs in nursing homes. The report found improved outcomes in the following areas:
- Improved management of chronic illnesses
- Improved functional and health status
- Improved quality of life
- Reduced or equivalent mortality and hospital admissions
- Improved self-care
- Reduced emergency department use and transfers
- Lower costs
- Increased time spent with residents
- Increased resident, family, and staff satisfaction
Patient preference
An important argument in favor of NPs is that they can provide care where physicians are unavailable. However, this argument does not imply that NPs are a second choice.
Many patients choose NPs as their primary care providers. Some patients choose to see NPs because of past communication issues with physicians. Others simply prefer NPs to physicians.
Moving past the NP controversy to find solutions
Nurse practitioners are here to stay.
The growing NP trend is so strong there is no question regarding the need for nurse practitioners or their importance in the healthcare industry overall.
However, concerns regarding a perceived miseducation of nurse practitioners could help identify areas for improvement.
A potential solution could be to renew funding for NP preceptorship programs. Previous programs were considered successful but were not renewed due to high costs. However, this type of funding may be precisely what is needed to address concerns regarding the clinical knowledge and skills of new nurse practitioners.
Would you like to learn about other issues impacting healthcare delivery? Learn the causes, impacts, and statistics of the nurse staffing shortage.
Sources:
- The National Association Of Medical Doctors: The Miseducation Of America’s Nurse Practitioners
- American Association of Nurse Practitioners: AANP Responds to Recent Article in Bloomberg News
- American Association of Nurse Practitioners: Issues at a Glance: Full Practice Authority
- U.S. Bureau of Labor Statistics: Occupational Outlook Handbook (Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners)
- U.S. Bureau of Labor Statistics: Occupational Outlook Handbook (Physicians and Surgeons)
