The increasing presence of nurse practitioners in healthcare in the United States has brought exciting change to the practice setting. In the early 1970s, there were few nurse practitioners in this country, and most were prepared with certificate programs. Today there are more than 70,000 in the United States. Their roles range from primary care in clinics to acute-care consultation in the hospital (Finocchio et al., 1995; National Organization of Nurse Practitioner Faculties, 1997; McGrath, 199o; Office of Technology Assessment, 1986). Nurse practitioners have been in increasing demand since the advent of managed healthcare: Numerous studies document their efficacy, and nurse practitioners frequently command lower salaries than physicians who might perform the same role (Safriet, 1992). It is still not clear what the demand for nurse practitioners will be in the coming years, given the competition for managed care patients and the impossibility of knowing what changes the new administration in Washington will bring. However, the burgeoning number of older adults in this country suggests geriatric nurse practitioners (GNPS) will be vital to the future of healthcare for older adults.
Professional nursing, like any other profession, is driven by the cycle of supply and demand. Currently, there is a shortage of nurses at all degree levels, and nurse practitioners are in steady demand. This demand varies geographically, affected by local circumstances, but current projections indicate a growing demand for GNPs (Mundinger and Kane, 2000; Buppert, 1999; Sakr et al., 1999; Dahle et al., 1998).
The efficacy of nurse practitioners has been examined in a variety of conditions over the past twenty years. Additional studies have been conducted in the past five years to examine the role of nurse practitioners in light of recent health system reengineering efforts. Nurse-practitioner research consistently documents that nurse practitioners can deliver care at a "comparable quality and at a lower cost than physicians" (Safriet, 1992). As the number of nurse practitioners continues to increase, so too do the data that allow us to look at their role- and at the opportunities that changing circumstances offer nurse practitioners.
THE CHANGING ROLES OF GNPs
Elders receive 70 percent of the available healthcare services in the United States and occupy half of the available adult hospital beds.
At least 80 percent ofAmerican elders are diagnosed with one or more chronic diseases that impair function and require follow-up. In addition, the need for nursing home care continues to grow (Womack, 1997). By 2020, more than 20 percent of the U.S. population will be age 65 or older, and those ages 85 and older will constitute the fastest growing age group (Heller, Oros, and Durney-Crowley, 2000). The impact on the demand for nurse practitioner labor is direct. GNPs are especially prepared to meet the demands of the aging U.S. population because their background prepares them to treat physical symptoms and to evaluate psychosocial, spiritual, and environmental needs. Because GNPs are more available to long-term care facilities than are physicians, as a result of supply and cost, GNPs are now a crucial component of effective long-term care. In long-term care facilities it is important that GNPs are able to work autonomously as well as in the context of the team (Pierson, 1997).
Unfortunately the current nursing shortage will have a negative impact on patient care, particularly in acute and long-term care, and will come at a cost to the healthcare industry. The shortage exists as a result of such factors as the aging and incipient retirement of the baby boom generation; increasing career options for women; and the persistent perception of nursing as a trade rather than a profession, which has slowed entrance into the field.
Nevertheless, the nursing shortage means that nurses are seeing increases in salary and job flexibility. …