The Role of Nurse Practitioner in Primary Care

Nurses represent the largest group of the entire health care workforce in the United States. The number of registered nurses (RNs) have been steadily rising over the last decades to approximately 3 million (Naylor & Kurtzman, 2011). Moreover, the need to provide high-quality and cost-effective health care have stimulated the growth in the advanced-practice registered nurses (APRNs) workforce. Advanced-practice RNs are highly trained health care specialists that have been certified and licensed by professional nursing organizations to deliver quality care within their areas of expertise (Naylor & Kurtzman, 2011). APRNs account for 8 percent of all nurses in the United States and represent four separate roles: nurse anesthetics, nurse midwives, clinical nurse specialists, and nurse practitioners (NPs) (Naylor & Kurtzman, 2011). The aim of this paper is to explore the role of NPs in delivering primary care. It will also distinguish this role as clinical or non-clinical in accordance with the National Patient Safety Goals (NPSGs) and examine how it promotes patient safety.

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Literature Review

NPs are the main group of health care specialists providing health care services in the United States. The Joint Commission (2016) that issues NPSG recognizes the clinical role of NPs and their importance in meeting increasing demand for quality health care services. An article exploring the role of NPs in reinventing primary care suggests that almost 80 percent of APRNs deliver primary care in the following specialties: pediatrics, adult health, gerontology, and nurse midwifery (Naylor & Kurtzman, 2011). Almost 160, 000 nurse practitioners provide health care in the wide range of settings such as hospitals, schools, military facilities, and workplaces among others (Iglehart, 2013; Naylor & Kurtzman, 2011). The article analyses current literature and looks at the evidence of NP’s contribution to delivering high-quality health care across the United States. The structured literature search of PubMed and Medline databases analyzed 131 papers at the title and abstract levels and focused on twenty-six studies eighteen of which are descriptive, two are systematic reviews, and six are scholarly opinions on retail clinics and nurse-managed health centers (Naylor & Kurtzman, 2011).

The authors of the article suggest that NPs provide health care of a quality that is “equivalent to that of care provided by physicians” (Naylor & Kurtzman, 2011, p. 894). Their conclusion is substantiated by a report issued by the congressional Office of Technology Assessment (OTA). The findings of the study reveal that when comparing the quality of care provided by physicians and NPs, patients visiting NPs are generally more satisfied and have longer consultations (Naylor & Kurtzman, 2011). Moreover, there are no significant differences in health status or process of care. According to Naylor and Kurtzman (2011), NP-delivered primary care has a positive economic effect on the health care of the country. The authors argue that “substitution of visits to physicians by visits to nurse practitioners” (Naylor & Kurtzman, 2011, 895) will allow states to save from $4.2 to $8.4 billion by 2020.

An article written by Iglehart (2013) explores the risks and benefits associated with the expansion of the NP role. The author argues that a shortage of primary care physicians exacerbated by the expansion of coverage is the main reason for the substantial increase in numbers of primary care NPs (Iglehart, 2013). Even though nurse practitioners work in a wide range of settings, “more than half are employed in private physician practices (27.9%) and hospitals (24.1%)” (Iglehart, 2013, p. 1935). The role of NPs is supported by numerous studies that suggest that collaborative model of primary care delivery is safe and effective (Iglehart, 2013). However, the author notes that the American Medical Association (AMA) is skeptical about the independent practice by NPs (Iglehart, 2013). Iglehart (2013) argues that the opposition of medical authorities to the independent practice could become a significant impediment to delivering health care in an effective manner.

An article written by Donelan, DesRoches, Dittus, and Buerhaus (2013) explores perspectives of physicians and NPs on their role in primary care practice. The findings of the study reveal that NPs and physicians differ significantly with respect to sex, experience, income, a number of working hours, and patients. According to Donelan et al. (2013), 95.6% of NPs and 76.3% participating in the study believe that “nurse practitioners should be able to practice to the full extent of their education and training” (p. 1900). It means that event though these two groups of medical professionals “come from very different cultures of professional education, and are guided by different theoretical perspectives” (Donelan et al., 2013), they both support the expansion of the role of NPs. However, it should be mentioned that NPs and physicians disagree about the provision of equal pay and medical services.

Conclusion

This paper showed that NPs significantly contribute to the delivery of efficient, timely, and high-value primary care. The large body of literature supports their role and suggests that an increased supply of NPs could result in significant improvement of primary care quality and overall health care savings.

References

Donelan, K., DesRoches, C., Dittus, R., & Buerhaus, P. (2013). Perspectives of physicians and nurse practitioners on primary care practice. New England Journal of Medicine, 368(20), 1898-1906.

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Iglehart, J. (2013). Expanding the role of advanced nurse practitioners — risks and rewards. New England Journal of Medicine, 368(20), 1935-1941.

Naylor, M., & Kurtzman, E. (2011). The role of nurse practitioners in reinventing primary care. Health Affairs, 29(5), 893-899.

The Joint Commission. (2016). 2017 National patient safety goals. Web.

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