Nurse Practitioners: Qualified Health Care Providers Americans Need

By Diana J. Mason, PhD, RN, FAAN and Julie Sochalski, PhD, RN, FAAN

We are both nurses and we know what good health care looks like. As patients and health care consumers, we seek out practitioners who focus on our whole health and not just disease. For many years we’ve been receiving that kind of care from excellent Nurse Practitioners (NPs) who are in practice with excellent physicians. As health care professionals, we also know that AARP, the national consumer organization representing the interests of Americans aged 50 and up, recognizes the value and contributions of NPs to assuring access to quality health care for the nation’s seniors. Unfortunately, millions of Americans still do not have access to these wonderful health care providers.

NPs are registered nurses with advanced education (master’s degree or higher) and clinical experience who offer a broad range of essential health care services. They diagnose common health conditions, manage chronic illnesses, prescribe medications and, importantly, they help patients promote their own health. In some areas, especially urban and rural communities, NPs are the exclusive providers of primary care, and research shows that their patients’ outcomes and satisfaction are excellent. Over the years, however, barriers to NPs providing these primary care services have arisen for several reasons.

First, states have a variety of regulatory and legal barriers to using them. Some states require that NPs practice under the supervision of physicians, even though it has not been shown to be necessary to ensure good clinical outcomes.

Second, even in states that permit NPs to practice without physician supervision, insurers may refuse to “credential” them, that is, NPs are not listed as approved providers. Instead, these same insurers will credential a physician who is in practice with an NP, pay the physician for the patients seen by the NP, and track the NP’s work and patient outcomes as if the physician had provided the services.

Medicare has also restricted NP practice by limiting their ability to order a variety of services, such as home care. This is particularly ironic since most of home care is nursing care, and an NP is ideally suited to knowing when and why to order such services.

Some of these restrictions rise out of concerns about the quality of NP care, but research has dismissed these concerns. NPs have also been seen as a source of competition to physicians, who sometimes support these regulatory barriers. Given the shortage of primary care providers, however, this is a counter-productive position.

Beyond these restrictions, there is the nationwide problem of inadequate funding for nurse education, a growing shortage of nursing faculty and a resulting bottleneck in the production of sufficient numbers of NPs. One of the major priorities of health care reform in the long run is to shift the focus from acute care to primary care and chronic care management. But every year, fewer medical students are choosing primary care and—as Massachusetts found out after extending health coverage to most of the state’s residents—we cannot meet the expected demand for primary care if we don’t remove the barriers to full utilization of NPs.

Some of the current health reform bills do include NPs in their definition of “providers” and prohibit insurers from refusing to credential them and other health care professionals solely on the basis of their title. These are important steps forward, but much more needs to be done to ensure that health care consumers throughout the country have access to the same excellent care we have.

Diana J. Mason, PhD, RN, FAAN, is the Rudin Professor and Director at the Center for Health, Media, and Policy, Hunter-Bellevue School of Nursing, Hunter College, City University of New York

Julie Sochalski, PhD, RN, FAAN, is an Associate Professor at the University of Pennsylvania School of Nursing and the AARP/American Academy of Nursing (AAN) Fellow in the Center to Champion Nursing in America at AARP