Increasing the Acceptance of the NP Role
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“As nurse practitioners have become increasingly available, the public has begun to understand our role better. We have become more accepted.”Christopher Blackwell, PhD, Director of the Associate Professor, University of Central Florida
According to the Bureau of Labor Statistics, over 300,000 nurse practitioners were providing care across the US in 2022. Of those, 88 percent are certified in primary care. On average, a nurse practitioner will see at least three patients per hour, providing critical health care services to thousands of patients a year.
“We are in this for our patients,” shares Dr. Christopher Blackwell, director of the adult-gerontology acute care nurse practitioner program and associate professor at the University of Central Florida. “The focus of a nurse practitioner is on getting you better, forming an alliance with you, and working as your partner in healthcare. That is a unique perspective that can often get lost by other care providers because there is such a high demand for productivity.”
The nurse practitioner role was first established in 1965 in Colorado to address the shortage of primary care providers. Since then, this advanced nursing role has expanded nationwide, encompassing not just primary care but specializations such as midwifery and anesthesia. As the scope and number of nurse practitioners have grown, so has the public’s awareness of these skilled healthcare providers.
While there has been some hesitancy in the past from physicians and parents alike, overall, there has been an increased acceptance of the role of nurse practitioners. A poll conducted in 2022 found that 82 percent of respondents support allowing nurse practitioners to practice to the full extent of their education and training, including through telehealth.
Read more about the increased acceptance of this role, the differences between nurse practitioners and other healthcare providers, and the future of this field from Dr. Blackwell below.
Meet the Expert: Christopher Blackwell, PhD, APRN, ANP-BC, AGACNP-BC, CNE, FAANP, FAAN
Dr. Christopher Blackwell is the director of the adult-gerontology acute care nurse practitioner program and associate professor at the University of Central Florida. In addition to being in academia, he has been an active nurse practitioner for more than 20 years, currently providing care in pulmonary critical care.
He has a dedicated interest in LGBTQ health. He has spent extensive time studying high-risk sexual decision-making in gay and bisexual men who meet online, HPV vaccination knowledge in gay and bisexual men, and levels of homophobia and attitudes among professional nurses regarding discrimination against LGBTQ nurses in the workplace. He is also the associate editor of the Journal for Nurse Practitioners.
The Role of a Nurse Practitioner
Nurse practitioners are skilled healthcare practitioners, explains Dr. Blackwell: “They are all registered nurses who have completed graduate-level education. They’re much different than an RN thought because they are responsible, in some cases autonomously responsible, for prescribing medications, deriving diagnoses similar to what a physician would do in terms of diagnosing patients with various conditions, ordering lab work, and ordering diagnostic testing.”
While they can perform many of the same duties as a physician, they are not medical doctors: “We’re very different from physicians, primarily because we use the nursing model. When we use our clinical judgment and advanced clinical reasoning to manage patients, we do so through the lens of a nurse. It’s much more of a holistic approach that is person-oriented and has a focus on wellness rather than disease,” he says.
The level of autonomy of practice for nurse practitioners varies by state. In some states, they must be under physician supervision, while in others, they can be completely autonomous. Likewise, the types of diagnoses they can give and the medications they can prescribe may also be limited by the state nursing board.
Increase Acceptance of Nurse Practitioners
Dr. Blackwell has been a nurse practitioner for more than 20 years, and in that time, he has seen public perception shift: “As nurse practitioners have become increasingly available, the public has begun to understand our role better. We have become more accepted. Part of that is this role is not really that new anymore and has been around long enough to where most people have experience with nurse practitioners,” he says.
As more and more patients encounter nurse practitioners as their healthcare providers, they have positive experiences to draw on and form opinions. “If you look at the research on patient satisfaction with health care providers, you’ll see that the vast majority of them are happier with care from a nurse practitioner than a physician…I have patients that request me because they don’t want to see the physician,” says Dr. Blackwell.
Opposition to the Expansion of Nurse Practitioners’ Scope of Practice
Despite the general public’s increased acceptance of nurse practitioners, there has been some pushback to expanding the scope of practice or autonomy: “Much of the opposition is from political forces,” says Dr. Balckwell. “Whenever there are boundary or territorial threats, there will be some pushback. We have seen it from the American Medical Association and in my state with the Florida Medical Association. Physicians are starting to realize that NPs provide phenomenal care and have clinical outcomes that are at least equal to physician outcomes, which can create fear.”
In May of 2023, the AMA posted about their advocacy victory in limiting the scope of practice expansion for nurse practitioners. They believe patients deserve physician-led healthcare, as physicians are the most highly trained medical providers. The AMA and state medical associations successfully defeated bills in Georgia, Mississippi, South Dakota, and Indiana, as well as at the federal level.
Areas Where Nurse Practitioners Are Critical
Nurse practitioners are not just optional health care providers. To some populations, they are the only option: “In rural settings, where there is less access to physician services, nurse practitioners are critical. Specifically when it comes to anesthesia. CRNAs are more willing and likely to provide services in rural areas than anesthesiologists,” shares Dr. Blackwell.
Nurse practitioners tend to more readily embrace technology to provide care. “In many states, nurse practitioners can even have an autonomous practice where they can open their own practice to reach out to underserved populations. Nurse practitioners are ahead of the curve compared to physicians. At UCF, we’ve integrated telehealth concepts into almost all of our nurse practitioner management courses so they can hit the ground running providing remote care,” explains Dr. Blackwell.
Lastly, there are some populations where nurse practitioners provide most of the care. “In Florida, a law was recently passed and subsequently blocked, banning gender-affirming care for transgender minors and limiting it for adults. When that happened, I learned that nurse practitioners had provided the majority of transgender care in the state of Florida. They are a high-risk vulnerable population impacted by the exceptional care nurse practitioners can provide,” says Dr. Blackwell.
Future of The Nurse Practitioner Role
The future of the nurse practitioner is bright, according to Dr. Blackwell: “I think two things are going to happen. First, I think the public’s acceptance of nurse practitioners will grow exponentially. The other thing is, I think you will see this role increase. You’re going to see more nurse practitioners working in the healthcare setting with an expanded scope of practice,” he says.
“The reason is twofold. One is the cost. Nurse practitioners are cheaper. Second, we are demonstrating equivalent outcomes, or in some studies even marginally better, than physicians. With these two things, the consequence is that healthcare organizations will realize that nurse practitioners bring a significant value to practices.”