Advanced nurse practitioners

ANSWER

This is a draft discussion post that answers the following queries:

Is it necessary for advanced nurse practitioners to recognize health issues in their clinical and community settings?

Indeed, in both clinical settings and local communities, advanced nurse practitioners (NPs) are essential in recognizing health issues. As primary care physicians, NPs are in a unique position to evaluate the health needs of the community and deal with urgent problems like access to preventive care, mental health, and managing chronic diseases. The American Association of Nurse Practitioners (2021) states that NPs are taught to prioritize illness prevention and health promotion, which necessitates a thorough comprehension of the unique health issues in their areas. For instance, NPs can carry out focused treatments in underprivileged communities by identifying common health inequalities, such as high diabetes rates or a lack of mental health services. This closes care gaps and enhances general health outcomes.

In accordance with the APRN Consensus Model (2008), NPs are guaranteed to practice to the fullest extent of their scope when community-specific health issues are identified. By concentrating on local problems, NPs help to lower systemic healthcare burdens including unmanaged chronic illnesses and hospital readmissions in addition to provide individualized care. Effectively tackling present and future healthcare issues requires this proactive strategy.

When healthcare issues are identified, how are APRNs viewed as change agents?

Because of their capacity to integrate clinical knowledge with advocacy and leadership, APRNs are naturally change agents. APRNs identify healthcare problems and implement evidence-based solutions that enhance patient care and encourage systemic change. An APRN working in a rural clinic, for instance, might notice that there aren’t enough easily available mental health treatments. The APRN could act as a change agent by promoting the use of telemedicine, educating employees about mental health screening resources, and working with legislators to obtain funding for these projects. These acts show how APRNs use clinical insights and strategic solutions to bring about change.

Their advanced training, which emphasizes quality improvement and incorporates leadership abilities, supports this function. More than 25% of primary care in rural areas is provided by NPs, who frequently spearhead efforts to close major care gaps, according to Barnes et al. (2018). The change-agent position is essential to their professional duties because of their ability to impact policy, inform communities, and use creative techniques.

Does Their Role Include This?

Yes, an essential component of the APRN function is acting as a change agent. All primary care practitioners, including APRNs, must practice at the highest level of their license in order to meet the growing needs of healthcare, according to the National Academies of Sciences, Engineering, and Medicine (2021). This entails actively recognizing systemic problems and putting long-term, patient-centered remedies into practice. APRNs carry out their professional and ethical obligation to promote better health outcomes and equitable care delivery by approaching healthcare issues holistically.

Citations

The American Nurse Practitioner Association, 2021. primary care nurse practitioners. taken from the website https://www.aanp.org
McHugh, M. D., Barnes, H., Richards, M. R., & Martsolf, G. (2018). Nurse practitioners are becoming more and more common in primary care physician clinics, both rural and nonrural. 908–914, Health Affairs, 37(6). 10.1377/hlthaff.2017.1158 https://doi.org
The National Council of State Boards of Nursing and the APRN Consensus Work Group Advisory Committee for APRNs. (2008). APRN regulation consensus model: education, certification, accreditation, and licensure. taken from the website https://ncsbn.org
National Academies of Medicine, Science, and Engineering. (2021). The 2020–2030 nursing future: laying out a plan to attain health equity. Press of the National Academies.
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QUESTION

From the website: [ read the article DQ Question at the bottom]

Nurse Practitioners in Primary Care

Millions of Americans choose a nurse practitioner (NP) as their primary care provider. NPs are advanced practice registered nurses (APRNs) who are prepared at the master’s or doctoral level to provide primary, acute, chronic and specialty care to patients of all ages and backgrounds. As clinicians who blend clinical expertise in diagnosing and treating health conditions with an emphasis on disease prevention and health management, NPs bring a comprehensive perspective and personal touch to health care. Utilizing NPs to the fullest extent of their education and clinical training — especially in primary care — is critical to meeting the nation’s health care needs and combating chronic disease and rising health care costs.

Primary Care and NP  Scope of Practice

NPs diagnose, treat and manage acute and chronic diseases, while emphasizing health promotion and disease prevention. NPs practice in every primary care setting, including but not limited to clinics, health care systems, health maintenance organizations, private physician offices, NP-owned practices, nursing homes, schools, colleges, public health departments, nurse managed clinics and homeless shelters.

 

NP practice includes, but is not limited to, assessing patients; ordering, performing, supervising and interpreting diagnostic and laboratory tests; making diagnoses; initiating and managing treatment, including prescribing medication and non-pharmacologic treatments; coordinating care; counseling; and educating patients, their families and their communities. NPs practice autonomously and, like other clinicians, coordinate with health care professionals to manage patients’ health needs. In all 50 states and the District of Columbia, NPs hold prescriptive authority, and they complete more than 1 billion patient visits annually.

NP Preparation and Growth of the NP Role

More than 88% of the 355,000 licensed NPs in the U.S. are educated and prepared in primary care, and more than 70% of those NPs who are clinically practicing deliver primary care, according to information from the American Association of Nurse Practitioners® (AANP) National NP Database (2021) and the  2020 AANP National NP Sample Survey .

 

NPs graduate from nationally accredited advanced degree programs that include didactic courses and clinical rotations. These programs are held accountable by the Commission on Collegiate Nursing Education (CCNE) and the Accreditation Commission for Education in Nursing (ACEN) to ensure core content and national education standards are maintained. Both CCNE and ACEN are recognized and accountable to the U.S. Department of Education for maintaining accreditation standards.

 

NPs are board certified and pass a standardized national certification exam. These exams are rigorous, psychometrically sound, legally defensible and competency-based. They test for knowledge and expertise in patient care. NP certification exams are accredited by the Accreditation Board of Specialty Nursing Certification (ABSNC) and the National Commission of Certifying Agencies (NCCA).

 

The NP role is consistent with the APRN Consensus Model, practicing in the population foci of family, pediatrics, women’s health, adult-geriatrics, neonatal and psychiatric mental health. The scope of practice is not setting specific, but rather, is based on the needs of the patient (APRN Consensus Model, 2008). Table 1 highlights the percentage of new NP graduates by examination for each primary care certification population.

Table 1 — Distribution of New NP Graduations* by Certification Exam, 2019-2020

	Percentage of All NP Graduations
Family	65.3%
Adult Gerontology Primary Care	8.4%
Psych Mental Health **	8.4%
Pediatric Primary Care	3.3%
Women’s Health	1.7%
Non-Primary Care Certifications (e.g., Adult Acute Care, Neonatal and Pediatric Acute Care	12.9%

*Includes master’s, post-master’s, post-master’s DNP NP and BSN-DNP NP program graduate data.

**Psychiatric-mental health NPs are educated, licensed and certified as primary care providers with a population focus of psychiatric-mental health. As the number of patients seeking mental health care in primary care settings continues to grow, there is an increasing need to manage these conditions in primary care settings (Moise et al., 2021; Poghosyan et al., 2019).

NPs are one of the most rapidly growing provider groups within the primary care workforce. Recent estimates from the Bureau of Labor Statistics indicate the job outlook for NPs is expected to grow by 28% between 2018 and 2028, compared to overall job growth of just 5% for all occupations (Chi, 2020). Additionally, an increasing number of Medicare beneficiaries are seeing NPs for their primary care needs (Medicare Payment Advisory Commission, 2022). Within rural and underserved communities, NPs are providing a larger share of primary care to patients. NPs make up more than 25% of rural providers, and it is estimated that nearly 1 in 3 primary care providers nationwide will be an NP by the middle of the decade (Barnes et al., 2018).

 

The number of NP graduates is also rising to meet evolving health care needs within the U.S. In fact, data from the American Association of Colleges of Nursing indicates NP program graduations leading to certification in an area of primary care have increased consistently in recent years (see Table 2).

Table 2 — Growth in Primary Care NP Graduations* and Percentage Increase by Year, 2015-16 to 2019-20

Year	Primary Care NP Graduations	% Change From Previous Year
2015-2016	22,734	14.2%
2016-2017	25,721	13.1%
2017-2018	28,063	9.1%
2018-2019	30,161	7.5%
2019-2020	32,129	6.5%

*Includes master’s, post-master’s, post-master’s DNP NP and BSN-DNP program graduate data.

Summary

For more than 50 years, NPs have provided patient-centered health care to a broad range of populations — with positive patient outcomes and cost savings observed. A brief review of studies examining NP outcomes is available in the  Quality of Care Bibliography  and  NP Cost-Effectiveness  position papers. Currently, our nation is facing new and emerging health challenges. As noted by the National Academies of Sciences, Engineering, and Medicine (2021), there is a critical need for all primary care providers to function at the fullest extent of their scope of practice. By establishing a strong health care system with a robust primary care workforce, the U.S. can better address its aging population, rising health care costs and the growing burden of chronic disease. NPs are key to building this solid foundation and bring added strength to the health care workforce. Maximizing this available potential is pivotal to addressing the current and emerging challenges.

 

With this knowledge, do you believe Advanced Nurse Practitioners need to identify health problems that affect your community and/or your clinical setting? Why or why not?

How are APRNs considered CHANGE AGENTS when a healthcare issue is identified? Do you believe this is part of their role? Why or why not?

 

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