Nurse practitioners have been valuable members of the healthcare ecosystem for decades. As providers with increasing practice autonomy, NPs fill significant healthcare delivery gaps.
With a growing shortage of primary care physicians, the need for NPs could not be more dire. When NPs approach patient care innovatively, everyone benefits from their creativity.
NP Innovation is Here
Coming from a background steeped in nursing’s more holistic view of patient care, nurse practitioners’ outlook can differ significantly from physicians’ perspectives.
“Nurse Practitioners do what nurses do best — educate and listen to their patients,” states Dr. Mykale Elbe, DNP, APRN, FNP-BC, Assistant Dean of Nursing and Associate Professor at the Catherine McAuley School of Nursing of Maryville University. “Patients report that nurse practitioners listen well and educate them more on their disease and treatment plan.”
She affirms that nurses are responding to the needs they perceive.
“Nurses are returning to obtain their NP degree to serve their communities due to the need for more providers. Most nurses write about the need for primary care or mental health services in admissions essays. With nurses being on the front lines and seeing the needs of their patients, they are being motivated to advance their education and make a difference.”
Claire Afua Ellerbrock, DNP, APRN, PMHNP-BC, is a psychiatric mental health nurse practitioner who supports other PMHNPs in managing their well-being. She sees the NP’s point of view as key to creating effective provider-patient collaboration.
“Nurse practitioners’ approach to the provider-patient relationship is unique, with its foundation rooted in compassion, collaboration, and trust,” states Dr. Ellerbrock. “As nurses first, NPs excel in building trust with patients, and this trust significantly enhances healthcare delivery.”
Dr. Ellerbrock elaborates on how NPs can provide quality care that matches or exceeds that of physicians. “A 2015 systematic review of ten randomized controlled trials found that NPs ‘demonstrated equal or better outcomes than physician groups for physiologic measures, patient satisfaction, and cost.’ Our ability to foster trust is the cornerstone of these positive outcomes.”
And in terms of innovation, Dr. Ellerbrock is enthused by what she sees.
“I’m witnessing exciting innovations in NP entrepreneurship. Nurse practitioners are identifying unmet needs and creatively addressing them, whether it’s through innovative delivery models or educational initiatives for NPs. For example, Justin Allen from The Elite NP has developed a business that assists other NPs in establishing their practices and ensuring high-quality patient care.”
Dr. Ellerbrock continues, “Additionally, my online course business, Stress Free Psych NP, is dedicated to empowering psychiatric and family practice NPs to diagnose and treat mental health patients with greater confidence. I firmly believe that entrepreneurship is the driving force behind advancing healthcare.”
Other NP innovators dot the country with their unique practice models.
Dr. Joanne Patterson, DNP, PMHNP-BC, CIMHP of Atlanta, has created the first-ever tiny house psychiatric clinic on wheels. She can deliver on-site mental health care for businesses, corporations, and schools and reach patients who might otherwise lack the ability to get a fixed office location. Dr. Patterson’s innovation extends to being licensed to treat patients virtually in Maryland, Nevada, Florida, and Washington, D.C., which increases the number of patients who can benefit from her holistic orientation and broadens the market for her business.
Josie Tate, MSN, CRNP, FNP-C, is a nurse practitioner who provides career guidance for other NPs. She feels that NPs are thinking innovatively and creating careers that work for them.
“NPs are leveraging their skills to become intrapreneurs and entrepreneurs within the healthcare industry,” shares Ms. Tate.
“Healthcare organizations benefit from NPs being highly experienced personally and professionally, “adds Ms. Tate. “We’ve created blended and flexible schedules and salary structures that challenge the norms. Whether having two PRN roles, taking locum tenens assignments, or 1099 contract positions, we provide optimal care while living our vision of a liberated life.”
Turning the Tide for a Bright Future
When it comes to the future, many NPs see a limitless horizon. Nurse practitioners can focus on adult gerontology (AGNP), the entire lifespan (FNP), mental health (PMHNP), pediatrics (PNP), midwifery (CNM), and other specialties, and certain roles can be pursued through educational pathways focused on either acute care or primary care. NPs can also earn post-master certificates in other disciplines.
Additionally, full practice authority is slowly growing despite resistance by medical groups who may feel threatened by NPs’ success and growing market share.
Ms. Tate states, “I envision the future for nurse practitioners as the powerhouse of healthcare, especially with an increased number of states gaining full practice authority. Primary care for underserved populations will be accessible thanks largely in part to nurse practitioners.”
Dr. Ellerbrock concurs. “I see the future of the NP role expanding to encompass full practice authority in all states, effectively bridging gaps in primary care and reaching underserved populations.”
She continues, “These gaps in care are not only persisting but also expanding, both in the United States and globally. By 2030, the demand for healthcare workers worldwide is projected to rise to 80 million, while the supply of healthcare workers is expected to reach only 65 million over the same period. Granting NPs the authority to practice to their fullest extent across the country positions us well to meet these growing needs.”
When it comes to embracing this rising tide, Ms. Tate adds, “Nurse practitioners need an empowering mindset to guide and direct their career paths. This mindset will build on their strengths and open opportunities throughout healthcare.”
Dr. Elbe is encouraged by how today’s NPs are being educated. “We’re ensuring that we’re preparing NP students around access to care, understanding social determinants of health, and the role NPs can play in improving outcomes, promoting health, and preventing disease cost-effectively.”
There’s no denying that nurse practitioners are reaping the rewards of decades of hard work, advocacy, and professional advancement. From entrepreneurship and a business mindset to innovative patient care models, NPs will continue to be an essential cornerstone of keeping the American healthcare system serving patients with increased access to care and the compassionate, skilled providers to treat them.
The American Association of Nurse Practitioners (AANP) welcomed Stephen A. Ferrara, DNP, FNP-BC, FAANP, FAAN, as the organization’s new president, taking the reigns from former AANP President April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN in late-June.
Ferrara is a busy man, wearing many hats.
He’s an actively practicing NP in New York and a member of the senior leadership team at Columbia University’s School of Nursing, serving as the associate dean of clinical affairs and assistant professor responsible for overseeing the NP primary care faculty practice located in New York City and teaches health policy in the DNP program.
Ferrara is passionate about health information technology and integrating evidence-based practice into daily nursing practice. His doctoral work examined the impact of group medical visits for patients with Type 2 diabetes and whether this intervention led to better health outcomes. He’s been honored with the AANP New York State Award for Clinical Excellence and inducted as a Fellow of AANP, as well as into the American Academy of Nursing and the New York Academy of Medicine.
Meet Stephen Ferrara, the president of the AANP.
Congratulations on becoming the new president of AANP. What do you look forward to most at the helm of one of nursing’s most influential organizations?
It’s just great to be leading the largest NP organization that represents over 355,000 nurse practitioners across the U.S. I’m excited to continue to have nurse practitioners partner, care, and grow so we can build the NP workforce for the future. We do that through speaking with our policymakers and modernizing state and federal laws that will allow our patients greater access to NPs.
Talk about your early years in nursing and what inspired you to become a nurse.
I’ll start with what inspired me to become a nurse. I knew early on I wanted to be in a profession that helped people. I was unsure what that profession would be, but I always gravitated towards the help professions. I credit my aunt, a nurse, who all the while was saying consider nursing, and I did it. It took me a while to come to that decision on my own. Once I understood the role of nurses and patient advocacy, the ability to share health information and care for people and promote health and wellness, that was my epiphany.
Once that all came together, I said okay, this is what I want to do. So, I credit my aunt for putting me on the path to my career as a nurse practitioner. I knew I wanted to work as a nurse practitioner early on. I worked on a med-surg floor, which was a heavy orthopedic floor. And I give kudos to my colleagues who are on units in hospitals. But I knew that helped solidify that I did not want to be in that environment. I wanted to see patients on an ambulatory basis. And that’s where nurse practitioners became the natural fit for me. I’ve worked in some prior healthcare settings. I was associate director of student health services at Fordham University and loved working with college students. I also worked in retail health for a bit with MinuteClinic. Before joining the Columbia School of Nursing, I worked in occupational health. So, I was always connected to primary care. That’s where I wanted to be. That’s where I thought I could influence my patients and partner with them to reach our shared goals.
I’ve been incredibly fortunate to have these roles and fulfill what I wanted to do. Other than my presidency of AANP, I am the Associate Dean of Clinical Affairs at Columbia University School of Nursing. I oversee our primary care nurse practitioner practice as my everyday work, so I still do similar types of work, but more on a system scale than an individual patient basis. And I feel like I’m still contributing to the healthcare system through that NP lens.
When you were the executive director of the Nurse Practitioner Association of New York State (NPA), you were frustrated by “arbitrary limitations” in your practicer and successfully advocated for full practice authority (FPA). Can you talk about that?
I enjoyed my time at the Nurse Practitioner Association of New York State as a member of that organization and then ultimately as executive director. I was frustrated by things such as not being able to sign most medical orders of life-sustaining treatment forms or not being able to sign, believe it or not, a barber who needs a physical to be cleared to get their barber license in New York State. As a nurse practitioner, the law at the time prohibited NPs from signing this form. I’ve been performing physicals for hundreds of patients across the spectrum, and organizations accept my signature, except for this barber form. Some of those examples drove me to get involved at the policy level. And I thought that all we need to do is change these laws, and then you could do it, but it’s not an easy task. It’s certainly empowering to feel part of it, and my frustrations were not just mine. Once you speak to colleagues, they have the same frustrations. So, working with people who want the same things, ultimately taking care of the patients in front of us without those barriers, was very empowering.
In those ten years, nurse practitioners can now sign most forms in New York State, and we can sign the barber physicals. In April of 2022, New York Governor Kathy Hochul signed legislation that nurse practitioners with more than 3600 hours of clinical experience have full practice authority and are no longer mandated to have any contract with physicians to practice. So, what this means is increased access for patients. It means a more equitable healthcare system. We are improving those dynamics around us. I advocate for everyone to get involved in health policy because it affects us all personally or professionally. So, NPs have a crucial role in advocating. Nurses are the most trusted profession in the Gallup poll every year. And we need to continue using our voices outside patient rooms with our policymakers and lawmakers. So they need to hear the stories of the challenges we face that impact patients in their constituents and districts and then work together to solve them. I want to leave this profession better than when I found it. And it requires not just nurses and nurse practitioners to talk about these things, but collectively, we need to use our voices to escalate these issues. And we know as nurses, we’re leaders, we have no problem advocating for our patients. I would love to see us continue that advocacy beyond and to our lawmakers and policymakers.
You’ve worked with several national organizations. Can you talk about who they are, what motivated you to join them, and how nurses can become more involved?
I’ll use AANP as the first national organization. People need to join their membership organizations. They don’t necessarily consider joining an organization because information is out there, but our national organizations advocate for the profession. And they are looking out for us in ways we cannot do alone. So, join your national organization and your state organization. Sometimes, they’re not the same organization. And that’s somewhat confusing. So you have to be a member first and foremost. I recognize, and I’ve been through the ups and downs of a career, and sometimes you want to reach out to your organization and say, “I’m a volunteer, and I want to help you. I want to lend my talent.” And sometimes you are so busy with your work and personal life that you can’t possibly volunteer any more time, and that’s okay. But we want you to be a member. We want you to lend your time and talent and be part of the membership. That’s how we can band together and use our collective voices. Hopefully, that’s a loud voice with more people supporting the cause.
The other organization I’ve been involved with for two years is Jonas Nursing and Veterans Healthcare. I led that organization as executive director, and that was a fantastic opportunity to support nurses returning to school for their doctoral education in the form of scholarships. So, it was empowering to hear the stories of the applicants and what they wanted to do with their advanced education and plans. In every instance, it was about bringing increased access to care to their communities or studying underserved communities historically passed over. It was inspiring to me. It gives me hope for the profession’s future, knowing that such passionate people are in the pipeline and looking to finish their education to do the work they feel most impactful for their patients and their communities. So it’s been great.
You’ve worked in several nursing leadership positions. What advice do you have for nurses seeking leadership positions?
First, you need some experience. People should volunteer, whether volunteering their time or being a mentee, reaching out to individuals who might be out there who could help them. I support and endorse the idea of a mentor-and-mentee relationship. Finding the right mentor takes time. Sometimes, that mentor may not be available to you based on what’s going on in their lives. So there needs to be a plan, and you need to have a few people on your list that you identify that you can say, hey, I’m going reach out to them to see if they’ll give me some words of advice. I think that’s quite powerful.
The other thing to say to people is that once you have some experience, go ahead and apply for the job. You may not get that role, but going through the steps of submitting an application for interviews is always good. And it allows you to interview that organization as much as they’re interviewing you. That’s a key. As people mature in their careers and roles, I remember being in love with a job before it was offered. I’m like, “Oh, this would be the perfect job for me.” And then you go on the interviews, speak with people, and do your diligence. You’ve concluded that maybe that role is not the best for me. And I think that takes just having some experience, speaking with people, and making the best decision for yourself. Sometimes, we forget about that when we go on job interviews. We see a job description on paper, and it looks perfect. But the reality is no job is perfect. You have to look at the full pros and cons of any situation. Certainly, there are lots of opportunities for people to get involved. Nurses make great leaders, and I encourage people to seek those leadership positions.
Speaking of leadership, what was your motivation to run for president of the AANP?
I wanted to give back to my profession. I wanted to support the profession in ways I felt supported in the 20-plus years I’ve been a nurse practitioner. So I like working with people. I like making changes at the system level. And being the AANP President would allow me to continue doing those things at a national level. And so far, I am just still a few months into this. I officially became president at the end of June, but it’s been fun. It’s been so rewarding to me. Hearing and speaking with our members invigorates me and gives me the passion to continue creating positive change.
You are particularly interested in health information technology and integrating evidence-based practice into daily practice. How do you plan to make that a focus of nursing?
From a healthcare technology perspective, I think there’s a huge potential to allow us to care for patients better. The example I like to use is the electronic health record, which is sometimes challenging because it’s very structured and takes more time. But what we have accessible to us that we didn’t have before is just reams and reams of data. And it’s a lot of data points, and no human can look at all these data points and make sense out of them. And this is where I see the potential of artificial intelligence to look at information and summarize it. We have wearable technology like the Fitbit and Apple watches and things like that. We can get EKG readings every hour that can go to anyone. But that information isn’t helpful if it’s just recorded as a point in time. And that’s where technology can help us make better sense of the information and determine if this information that we’re getting is good and if it’s actionable. And that’s where a clinician’s expertise comes in to say yes; this is good information that I can make an educated decision for my patients. So that’s critically important.
My doctoral work focused on evidence-based practice to critically appraise data and ensure we’re doing things in healthcare because they are based on evidence and not just how we always did that. It’s vital for credibility; it’s essential to new treatments, and as we learn more about disease processes, it’s critical to keep incorporating these aspects into our daily practice. And then there’s the research piece. There are so many opportunities for research for nurse practitioners. At Columbia University, we’re working with our researchers on nurse practitioner and patient outcomes, but not just that. We’re also looking at nurse practitioner-led interventions and different studies aimed at taking better care of patients.
What is your vision for AANP under your tenure?
It will be working with our stakeholders and lawmakers at the federal and state levels. We want to remove barriers to practice that impede nurse practitioners from delivering healthcare to our patients. There are many outdated laws or policies, particularly Medicare and Medicaid. Medicaid is also legislated at the federal level, and there’s an opportunity there for us to make historic changes within those programs that will increase access to care. One of the items in the current bill in Congress, both in the House and in the Senate, is the ICAN Act, which aims to improve care and access to nurse practitioners. This bill will make many improvements and modernizations to laws, including a nurse practitioner’s ability to prescribe diabetic shoes for patients with Medicare insurance for cardiac rehab, inpatient cardiac rehab, and medical nutrition therapy. There’s a whole host of priorities that are included in this legislation. I was looking this up, and we only have 14 co-sponsors in the House right now for the ICAN legislation out of a possible 435 districts. On the Senate side, there is just one Senate co-sponsor. So, we have a lot of work to bring awareness to this bill and not have it lost in our society’s political discourse today. This means patients are prohibited from getting the care and access they need. The other thing we need to do is on the state level. We have 27 states that are full practice authority. We need to work with those 23 states that are not full practice authority. And we know that full practice authority leads to better outcomes. Most of the healthiest states in the nation are full practice authority states for nurse practitioners.
And conversely, the ones that are not healthy restrict NP practice. So there’s a lot of work to do. And it’s no one person’s responsibility to do all that work. But it’s truly working together and getting our lawmakers to listen to some of these challenges and hear the stories that everybody’s encountering on a daily basis.
You have a lot on your plate. What do you enjoy doing when you’re not working hard to elevate the role of NPs?
I put my family first and foremost. I enjoy being a father to my three children and a husband to my wife. My kids are involved in various sports and activities, so you’ll find me at the soccer or the football fields. I listen to music and exercise and try to have some sense of balance in my life. I also love things like sports and cars. I try to find a good mix of balancing everything, but sometimes it’s easier said than done.
Nurse practitioners (NPs) have a great deal of responsibility regarding patient care, and as the healthcare landscape evolves, so do the daily risks NPs face. Despite compassionate work and service to the community, one lawsuit can affect your professional reputation. Nurse practitioner malpractice data can be used to inform and address areas of clinical improvement as well as help to improve the quality of care and patient safety.
Nurses Service Organization (NSO) and CNA have published the new edition of the Nurse Practitioner Professional Liability Exposure Claim Report analyzing 232 closed professional liability claims against NPs, student NPs, and NPs covered through a CNA-insured healthcare business over five years (2017-2021). By equipping NPs with data, resources, and case study examples, our goal is to help them recognize their exposures, reduce their risks, and improve patient outcomes.
Nurse Practitioner Professional Liability Exposure Claim Report, Fifth Edition
Here are the key takeaways.
NP Professional Liability 5-Year Closed Claim Analysis Patterns and Trends
Malpractice claim costs are on the rise.
The average total incurred amount of a nurse practitioner malpractice claim has increased to $332,137 – a jump of more than 10.5% since 2017. In addition, there has been a continued shift towards larger claim settlements. For example, claims resolved for greater than $500,000 represented 21.5% of all claims in the 2022 dataset, compared to 13% in the 2012 dataset.
The most common allegation against NPs is related to diagnosis.
Diagnosis-related allegations represented 37.1% of all allegations against nurse practitioners and continue to be the leading allegation through 2012, 2017, and 2022 datasets. Contributing factors for these diagnosis-related claims included the failure of an NP to order a diagnostic/lab test to establish a diagnosis, failure to obtain a complete history and physical of the patient, and failure to refer a patient to higher level care.
Cancer and infection are the two most common diagnosis-related injuries, representing more than half of the claims. In many diagnosis-related closed claims, a lack of sound documentation supporting the decision-making process of the treating NP or other staff members under the NP’s supervision hindered the case’s legal defense.
Common missing or incomplete documentation noted in the dataset included:
Lack of a complete patient and family history.
Incomplete physical assessment.
Failure to list current medications and/or complaints.
Failure to document patient noncompliance with appointments, ordered diagnostic tests and/or prescribed medications.
Absence of notification of diagnostic test results and recommendations for further treatment or testing.
Nurse Practitioner’s Failure and Outcome
An example of an NP’s failure to order diagnostic/laboratory testing includes:
A 51-year-old diabetic male patient presented to the NP’s office following an emergency department (ED) visit due to a wound on his right foot that appeared to be infected. The NP photographed the wound, documented that it was 0.5 cm in diameter, and confirmed that the patient was still taking the antibiotics as prescribed to him by the ED provider.
Although he was instructed to return in a week for a recheck, he presented two weeks later. The NP documented the wound as 2 cm in diameter with granulation tissue and purulent drainage, and the forefoot was reddened, warm, and swollen. The NP opined that he might need to perform a procedure to evacuate the infected area, but for unknown reasons, the procedure was not performed. Instead, the patient was given a prescription for a different antibiotic, and his wound was cleaned and redressed. One week later, the patient returned, reporting vomiting and feeling weak. His eyes were jaundiced, and his right toe and right leg were more swollen than the prior week. The NP ordered Ceftriaxone 1 gram intramuscularly in the office and then every 24 hours for the next three days via home health. Also ordered were daily dressing changes to the affected foot, vital signs, and bi-weekly (twice-a-week) blood work for the next two weeks.
When home health arrived for the initial visit at the patient’s home, he appeared diaphoretic and pale. His vital signs were indicative of sepsis (high fever, elevated heart, respiratory rate, and low blood pressure). The patient was transferred to the ED and diagnosed with sepsis. He eventually underwent a below-the-knee amputation of his right leg.
Defense experts could not defend the claim, as they indicated that the patient should have been sent to the ED during his last visit with the NP or referred to an infectious specialist or wound care provider after his second visit. The NP testified he had encouraged the patient to go to the ED for treatment on the second and third visits but that the patient refused. There was no documentation in the patient’s healthcare information record to corroborate this testimony. The claim was resolved with a total incurred of greater than $950,000.
Nurse Practitioners: Analysis of License Protection Paid Claims
State Board of Nursing (SBON) investigations are serious matters and a significant investment of time and effort by the NP until they are resolved. Therefore, legal representation in these matters is highly recommended. A complaint against an NP’s license to an SBON differs from a professional liability claim in that it may or may not involve allegations of patient care and treatment provided by an NP. The disciplinary matters in this section represent the cost of providing legal representation to an NP in defending such actions rather than indemnity or settlement payments to a plaintiff.
The cost to defend license matters is increasing. For example, the average cost of defending complaints against nurse practitioners to an SBON is $7,155, a 19.5% increase compared to the 2017 report and a 61.1% increase compared to the 2012 report.
Key findings in the 2022 dataset related to licensing board complaints are:
Professional conduct, medication prescribing, and scope of practice complaints account for more than half of all license protection closed matters (58.4%).
License board complaints related to the professional conduct category were largely driven by matters categorized as professional misconduct defined by the state, such as unprofessional conduct with patients or coworkers, termination from employment due to unspecified performance issues, and professional boundary issues with patients.
Approximately 43% of license board protection matters led to some board action against an NP’s license. Common SBON actions included probation (12%), public reprimand (11.2%), consent order or stipulation (6.4%), and a fine (3.6%). The more severe SBON decisions – such as the surrender of license (2%), revocation (2.4%), and suspension (2.8%) – are less common but can effectively end an NP’s career.
Risk Control Recommendations for Nurse Practitioners
The following risk control recommendations can serve as a starting point for nurse practitioners seeking to evaluate and enhance their patient safety and risk management practices:
Practice within the requirements of your state nurse practice act, in compliance with organizational policies and procedures, and within the national standard of care.
Maintain basic clinical and specialty competencies by proactively obtaining the professional information, education, and training needed to remain current regarding nursing techniques, clinical practice, medications, biologics, and equipment.
Document your patient care assessments, observations, communications, and actions in an objective, timely, accurate, complete, and appropriate manner.
Consider these questions when pursuing a specific diagnosis:
Are factors present that do not align with the diagnosis?
Are there symptoms inconsistent with the current diagnosis?
Are the symptoms indicative of another diagnosis?
Are there elements that can’t be explained?
Is there a condition with similar symptoms to consider?
This analysis of NP professional liability and license protection closed claims reveals that, while there have been advances in clinical practice and patient safety, many claims continue to develop due to a failure to diagnose, treat, or take precautions regarding medication safety. Further, communication missteps, inadequate documentation, and unprofessional conduct made matters challenging to defend.
It is anticipated that the data, analysis, and risk control recommendations shared in the report will inspire nurse practitioners nationwide to examine their practices and focus their risk control efforts on the areas of statistically demonstrated error and loss.
The Nurse Practitioner Professional Liability Exposure Claim Report: 5th Edition is the fifth claim report published by CNA and NSO addressing nurse practitioner liability since 2005 and represents NSO and CNA’s ongoing commitment to educating the nursing community. The general analysis includes 232 anonymized closed claims involving a nurse practitioner, nurse practitioner receiving coverage through a CNA-insured healthcare business, or nurse practitioner student that resulted in paid indemnity greater than or equal to $10,000.
This information is provided for general informational purposes and does not provide individual guidance. This information is not a substitute for any workplace practices and is not establishing a standard of care.
The $125 million donation by Penn alumnus Leonard A. Lauder, Chairman Emeritus of The Estee Lauder Companies, to create this first-of-its-kind, tuition-free program is the largest gift ever to an American nursing school.
The gift comes at a time when the COVID-19 pandemic has magnified the nation’s acute shortage of primary care providers and persisting inequities in access to quality healthcare.
“This is the most timely and consequential gift not only for our university but for our country. It is unprecedented in its potential to address America’s most critical need of providing primary health care to all who currently lack it by investing in nurses,” says former Penn President Amy Gutmann. “Growing the number of nurse practitioners who are prepared and committed to working in underserved areas is the most practical and inspiring way to ensure a healthier country. I am grateful and honored that Leonard would make this gift to Penn Nursing, and thrilled to know that it will have an immediate impact that will last far into the future.”
University of Pennsylvania’s new tuition-free program to recruit, train and deploy nurse practitioners to underserved communities across the U.S.
Nurse practitioners are leaders on the front lines of care, a role never more important as Americans confront a primary healthcare shortage in their communities. With their advanced clinical training and graduate education, nurse practitioners have the knowledge and skill to supervise and manage critical aspects of care in decision-making, from patient diagnosis to ordering and interpreting tests, to prescribing medication. In addition, nurse practitioners deliver high-quality primary care to people of all ages, such as treating common illnesses, managing chronic conditions, and providing preventive care that helps patients stay healthy.
Nurse practitioners can also able to take on key leadership roles, from managing and operating walk-in or community clinics to leading interdisciplinary teams within health systems. The new program will better the lives of patients and communities most in need while providing a pathway for the many nurses interested in advanced education who may not otherwise have the
“Now more than ever, the country needs greater and more equitable access to quality primary care—and highly-skilled nurse practitioners are the key to making that happen,” says Leonard A. Lauder. “The program will ensure that more Americans receive the essential healthcare services that everyone deserves, and I’m so pleased to be working with Penn Nursing on this initiative. I look forward to welcoming our first class of future nurse practitioners this fall. I know their expertise will be matched only by their commitment to serving our communities.”
Health policies change rapidly at the national, state, and community level and are especially critical during times of international health crises. Nurses are positioned on the front lines of both health care delivery and health policy development. In particular, advanced practice registered nurses (APRNs) have a unique perspective that allows them to offer meaningful input at many levels. Nurse practitioners play a significant role in shaping health policies, including:
Health care access
Health care equality
Health care legislation
Nursing scope of practice
Community-wide disease response
Nurses are an essential part of informing health policies, educating the public, and applying health policies in practice.
National Health Policy
Strong nurse leaders represent their communities and patients across the nation. Nurse practitioners who engage in health policy development at the national level may work with other health professionals to adopt or change guidelines put forth by the Centers for Disease Control and Prevention (CDC), Food & Drug Administration (FDA), Center for Medicaid and Medicare Services (CMS), and the U.S. Health Resources and Services Administration (HRSA). These policies guide decisions for the creation of public health guidelines that affect the entire nation. With their background in direct patient care, nurse practitioners offer a wealth of knowledge and clinical insight to help inform the development of new health policies and improve existing policies. Health care issues that are addressed at the national level include:
Access to care
Quality of care
Cost of care
Public health crises
National nursing organizations such as the American Academy of Nurse Practitioners (AANP) and the American Nurses Association (ANA) lobby extensively for policy change and advocacy for all nurses at the national level. As strong advocates for the entire profession, nurse practitioners demonstrate an understanding of the necessary details to create health policies that help, rather than hinder, nurses working in direct patient care. With this first-hand experience in patient care, nurse practitioners serve as invaluable advisors for educators, policy makers, and lobbyists. Nurses can help create legislation that affects both national and state-level laws regarding nursing practice, patient safety, and access to health care. Nurses are also able to review proposed health care legislation to help determine changes that promote best practices.
State Health Policy
Changes in global health policies impact health care delivery at the state level. For example, state-specific guidelines regarding telehealth practices were implemented to help maintain access to health care during COVID-19. This required rapid action by policy-makers—including nurses. As officers in state nursing organizations, nurse practitioners can directly influence policies that relate to both scope of practice and education standards. By understanding the training and education involved in the profession, policies that aim to allow nurses to use the full extent of their training are essential. Nurse practitioners can express with certainty which policies will affect nurses, other health care providers, and the general population.
Local Health Policy
Through direct observations in their own communities, nurse practitioners have a unique advantage in recommending guidelines for community-wide, school, and even environmental health issues. Nurse practitioners can also be involved in advisory boards for city and county planning regarding water conservation, hazardous waste disposal, and ongoing public safety concerns. Policies that affect the natural environment directly influence the health of residents, and nurses can play a key role in advocating for the public and keeping the community safe.
Facility Health Policy
Health policy also impacts the operation of hospitals, outpatient health centers, long-term care facilities, and schools in communities nationwide. Health policy nurses bring their expertise to understand the challenges and risks facing the public and health care workforce. Once the challenges are identified, nurses can offer meaningful solutions based on clinical insight from direct interaction with patients. Additionally, nurses can influence facility policies such as patient care standards, the use of electronic medical records, and guidelines regarding specific populations.
Research in Health Policy
Master’s degree or doctorate-prepared nurses play a crucial role in both qualitative and quantitative health research. This includes working directly with medical, pharmaceutical, and environmental agencies to identify and understand gaps in health care knowledge. This may include gaps in health care delivery, a lack of current guidelines for specific health concerns, or the ways that environmental toxins affect population health. Nurse-led research involves real-world problems that affect individuals in their own practices. Quality research results are critical to passing health care legislation, improving patient care, and advancing the nursing practice.
Nurse practitioners take direct clinical experience to the local, state, and national level to identify key challenges, inform decisions, and solve health care-related issues. In order to influence health policies and guide communities through times of crisis, it’s important for nurses to offer their unique skills in understanding and caring for patients. A strong presence of nurses in legislative review and health policy planning is critical to promote change and ongoing improvements in health care across communities.