Nurse practitioners (NPs) are becoming increasingly integral to the U.S. healthcare system, assuming responsibilities such as diagnosing and prescribing medication and therapies—duties traditionally handled by doctors. However, some have raised concerns over the question of whether NPs are a safe and effective alternative to a physician’s care; this article includes those concerns as well as a descriptive response regarding nurse practitioner’s importance in the provision of healthcare.
A 2018 article in Health Affairs Forefront highlights concerns about the readiness of newly graduated NPs. And more recently, a March 2024 report by Medical Economics indicated that recent changes in NP educational requirements have raised alarms among experienced practitioners.
Historically, NP programs were both rigorous and competitive, often requiring years of bedside experience as a registered nurse before admission. However, recent shifts towards online learning and reduced entry requirements have prompted concern. Some programs now reportedly accept students without a nursing degree or prior nursing experience, with some claiming these individuals can be trained as NPs in as little as 12 months.
In July 2024, Bloomberg highlighted their concerns in an article titled “The Mis-Education of America’s Nurse Practitioners.” The article questioned the safety implications of relying heavily on NPs, given the potential decline in training quality.
The American Association of Nurse Practitioners (AANP) defended the nurse practitioner profession in a letter to the Bloomberg News. The letter emphasized the significant contributions NPs have had on patient care and the healthcare system.
According to the AANP, nurse practitioner programs are nationally accredited, incorporating rigorous training, and hands-on clinical rotations prior to certification. These national accreditation bodies are overseen by the U.S. Department of Education (DOE). After graduation and certification, NPs are subject to regulation according to the policies of the states in which they are licensed.
Depending on the state, a nurse practitioner may be in one of three types of practice environments. They may have full, reduced, or restricted authority as a practitioner.
- Full Practice: NPs are permitted to evaluate and diagnose health conditions, order and interpret diagnostic tests, and prescribe treatments, including medications and controlled substances.
- Reduced Practice: NPs are restricted in at least one element of practice, and the state may require the NP to practice in collaboration with another health care provider, such as a physician.
- Restricted Practice: NPs are restricted in at least one element of practice and must be supervised or managed by another health care provider.
During the Covid-19 pandemic, several states moved towards Full Practice Authority (FPA) and some of these emergency changes became permanent. The APRN Compact, which was adopted in 2020, allows Advanced Practice Registered Nurses (APRNs) to hold a multistate license and practice across states. These compact licenses allow APRNs, including nurse practitioners, much more flexibility.
During the pandemic, NPs provided essential services in underserved areas, despite limited personal protective equipment (PPE) and sometimes at the risk of their own lives. They have been instrumental in setting up mobile clinics, treating opioid use disorder, and maintaining care in rural areas despite the challenges.
An article published in the Journal of the American Association of Nurse Practitioners in 2021 states NPs achieved comparable performance to physicians in clinical safety and positive outcomes in specialty areas. Additionally, NPs met or surpassed physicians in patient education and satisfaction.
The Health Services Research Journal suggests nurse practitioners are on par with medical doctors in primary care settings and offer a more cost-effective alternative, underscoring the potential of NPs as a valuable solution for addressing disparities in access to care. Research has also shown that NPs achieve comparable or superior outcomes to physicians at similar costs for patients with a variety of co-morbidities or chronic diseases. This suggests that NPs are well-equipped to manage complex cases and should not be restricted to treating only less-complex patients.
The role of nurse practitioners becomes crucial considering the projected physician shortage, especially in rural areas. The Future of Nursing 2020-2030 report highlights the critical role of nurses in healthcare, especially in health equity. The report calls for the elimination of scope-of-practice restrictions to fully utilize nurses and APRNs. Eliminating these restrictions would increase the amount and types of care an NP can provide, which can increase access to care across the board.
Nurse practitioners are increasingly vital to the U.S. healthcare system, performing crucial roles in diagnosing and prescribing treatments traditionally reserved for physicians. Despite concerns about evolving educational standards and training quality, NPs have demonstrated their essential value, particularly during the COVID-19 pandemic, by providing high-quality care in underserved areas and adapting to changing needs.
As highlighted by recent reports and the AANP’s defense, NP programs maintain rigorous accreditation standards, ensuring that graduates are well-prepared to deliver effective care.
The ongoing expansion of Full Practice Authority and the implementation of the APRN Compact, allowing NPs to practice across states, represent significant advancements. These changes aim to enhance the flexibility and reach of NPs, ultimately improving patient access to care and supporting health equity. As the healthcare landscape continues to evolve, ensuring that NPs can practice to the full extent of their training will be crucial for addressing gaps in care and meeting the diverse needs of patients nationwide.
Despite concerns about the adequacy of their education and the implications for patient safety, NPs have consistently demonstrated their ability to deliver high-quality, cost-effective care across diverse settings.
As the role of nurse practitioners becomes increasingly pivotal in the U.S. healthcare system, the debate surrounding their training and practice standards continues to evolve.
Given these developments, it is more important than ever to ensure that NPs are effectively integrated into the healthcare system and that their practices are guided by clear, evidence-based standards. This is where an experienced legal nurse consultant can play a crucial role.
If you are handling a negligence case involving a nurse practitioner, partnering with a specialized legal nurse consultant can offer crucial insights into NP training, experience and practice standards. Our expertise ensures that your cases are supported by accurate and comprehensive nursing knowledge.
Integrity Legal Nurse Consulting provides professional merit screening and qualified NPs as expert witnesses. Contact us to obtain the expert analysis and testimony needed for a thorough evaluation and favorable case outcomes.