Nursing the Primary Care Shortage Back to Health: How Expanding Nurse Practitioner Autonomy Can Safely and Economically Meet the Growing Demand for Basic Health Care

Article excerpt


     A. History and Background
     B. Educational Requirements
     C. Policy Arguments

     A. Opposition from the Medical Establishment
     B. Physician Involvement
     C. Prescriptive Authority
     D. Identification





The role of nurse practitioner (NP) has emerged as a profession capable of closing the gap between the declining number of primary care providers caused by the dearth of family practice physicians and the growing number of Americans in need of health care. Studies have shown that NPs are equally as competent as physicians when it comes to diagnosing and treating basic ailments. NPs cost less, spend more time with patients, and garner high satisfaction reviews from those patients.

Due to the popularity and efficiency of NPs, the medical establishment has viewed the profession as a threat to their livelihood. In the forty plus years since the first NP graduated, NPs have had to continually fight and lobby for the right to practice their profession, preferably independent of physicians. The result has been a state-by-state patchwork of laws and regulations governing NPs' scope of practice.

This article first discusses the history and educational requirements of the NP profession. It then discusses the policy reasons why NPs should, and do, play an important role in the country's health care delivery system. The core of the article deals with the legal issues surrounding the NP's scope of practice including the need for collaborative agreements with physicians, authority to prescribe drugs, and identification. Finally the article discusses how NPs fit into the health insurance scheme and their liability for malpractice.


A. History and Background

A nurse practitioner (NP) (1) is a registered nurse who has undertaken additional education in order to perform tasks more traditionally associated with the medical profession. (2) The American College of Nurse Practitioners provides the following definition: nurse practitioners are "registered professional nurses who are prepared, through advanced graduate education and clinical training, to provide a wide range of health care services, including the diagnosis and management of common, as well as complex, medical conditions...." (3) NPs distinguish themselves from physicians by emphasizing that, as nurses, they are patient focused--examining the patient's history and family--while physicians are disease focused. (4) While some NPs specialize in areas such as neonatal, geriatric, psychiatric, or acute care, the majority of NPs provide primary care. (5)

The role of NP began in the mid-1960s in response to a nationwide shortage of physicians. (6) The first NP program began as a master's degree at the University of Colorado School of Nursing in 1965. (7) Other NP educational programs began springing up throughout the country. (8) At the outset, most NPs practiced in traditional settings by associating with physician groups or hospitals. (9) However, in 1977, the Arizona State University School of Nursing began a federally funded nurse-managed health care center, (10) paving the way for NP independent practice.

By the 1990s, the number of NPs had skyrocketed (11) and between 1996 and 2001 the number doubled. (12) Between 1999 and 2009, the number doubled again. (13) As of 2009 there were 157,782 NPs in the United States. (14) As of 2007, there were 250 nurse-managed health care centers, mostly in medically underserved rural and urban communities. (15) However, the majority of NPs practice in settings supervised by physicians. (16)

B. Educational Requirements

In most states, the NP profession is regulated by the state Board of Nursing (BON). (17) However, in a minority of states, NPs are regulated by the BON and the Board of Medicine (BOM) or some other regulatory authority. …


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