Let nurse practitioners do more

Could be prescription for primary care shortage

AS A NURSE PRACTITIONER with over 27 years of experience, I understand what it means to provide high quality health care. I have counseled young mothers to track their babies’ milestones, ordered diagnostic tests to confirm the presence of chronic disease, prescribed medications to treat conditions from arrhythmias to pneumonia, identified mental health challenges, and coached hundreds of patients toward prevention and wellness.

In practice settings across Massachusetts, the demand for primary care has skyrocketed. As of January 2016, there are 72 so-called health professional shortage areas in Massachusetts and 6,100 across the United States – a number that has grown by nearly 300 communities in just 18 months, according to the Department of Health and Human Service’s Health Resources and Services Administration.

There is a way to fix the primary care crisis, and nurse practitioners know the prescription. Nurse practitioners have been at the forefront of providing primary health care to patients for over half a century. With more than six years of academic and clinical preparation, we assess patients, order and interpret diagnostic tests, make diagnoses, and initiate and manage treatment plans – including prescribing medications. We are the health care providers of choice for millions of patients, and manage 990 million patient visits per year.

More than 40 percent of states have adopted full practice authority licensure and practice laws, enabling nurse practitioners to deliver care without physician supervision. These states recognize that full practice authority improves access, especially in underserved urban and rural areas, streamlines care, decreases costs, and protects patient choice. In the last five years alone, seven states have enacted full practice laws, and this year states, including Massachusetts, Pennsylvania, and North Carolina, are among those considering such legislation. Organizations including the Institute of Medicine, Bipartisan Policy Center, National Governors Association, Federal Trade Commission, and AARP acknowledge that health care providers working at the top of their education and clinical preparation can improve health care delivery.

Despite the trend toward full practice authority for nurse practitioners, states like Massachusetts lag behind. Physician organizations continue to oppose patients receiving full and direct access to nurse practitioners, despite the fact that every major study on nurse practitioner care—more than 100—has shown that patient health outcomes are as good or better than other providers. The impact on patient care is undeniable: of the 10 states with the greatest number of health provider shortage areas, nine are located in reduced practice or restricted practice authority states. Massachusetts ranks 40th on the list of shortage areas.

Access to high quality primary care is key to improving patient outcomes. Research published by the University of Missouri in 2014 found that full practice states have lower hospitalization rates and improved health outcomes for Medicare and Medicaid patients. And, the United Health Foundation’s 2015 ranking of healthiest states in America included eight full practice states among the top 10.

If Massachusetts adopts full practice, nurse practitioners will come. In the five years since Arizona enacted full practice, the number of nurse practitioners in Arizona increased by 52 percent. Significantly, the number of nurse practitioners in rural counties increased by 73 percent and 48 percent in urban counties. Meanwhile, neighboring Nevada has seen more than a 20 percent increase in its nurse practitioners since recently changing its law in 2013.

Meet the Author

Nancy C. O'Rourke

Regon 1 Director, American Association of Nurse Practitioners
A majority of patients want greater access to nurse practitioner services and nurse practitioners have the skills and training to meet Massachusetts’ and our nation’s growing health care needs. Removing scope-of-practice barriers will ensure patients access to timely, high-quality, patient-centered, primary health care. Nurse practitioners are the right prescription to addressing the state’s and America’s primary care crisis.

Nancy C. O’Rourke is the Region 1 Director for the American Association of Nurse Practitioners. She has been a practicing Nurse Practitioner in acute care for more than 27 years. For more information, visit www.aanp.org.