Born out of the physician shortage of the 1960s, the nurse practitioner role seems to have come full circle with the recommendations of the Institute of Medicine and Robert Wood Johnson Foundation’s 2010 report on the future of nursing. The report states, “the health care system needs to tap into the capabilities of advanced practice nurses to meet the increased demand for primary care.”
But there’s a major difference this time. The report also recommends that advanced practice nurses take a larger and more independent role in leading change and advancing health care.
By continuously expanding their roles, proving their competency and pushing the barriers of acceptance and authority for more than 45 years, nurse practitioners have not only earned a place at the leadership table, they have found more ways to practice.
“I see the difference in how fast our nurse practitioner graduates are finding positions,” said Grace Newsome, Ed.D., APRN, BC, FNP, professor and graduate program coordinator of the nursing department at North Georgia College & State University in Dahlonega. “Ten or 15 years ago, we placed them one by one. They had to inch into a position.
“Now, there’s a greater acceptance by physicians and the patient community. I’m seeing them take on different roles and go where they want to go.”
North Georgia College & State University has just started developing a doctor of nursing practice (DNP) program, the level of training advocated by the American Association of Colleges of Nursing. As a result of evidence-based practice and other factors, nurses have seen the curriculum of master’s-level programs increase in length and complexity.
“There’s always more to learn,” said Marcia Holstad, DSN, RN, FNP-BC, FAANP, associate professor of nursing at the Nell Hodgson Woodruff School of Nursing at Emory University.
Holstad finished a certificate program in 1976 and earned her master’s degree from Emory a year later to become a nurse practitioner.
“The role was so new,” Holstad said. “There were only a few of us in the state, but I always liked primary care and I liked the idea of independent practice. That’s what attracted me to the role.”
She’s worked in public health, in a woman’s prison and at various clinics. Since 1990, she has cared for and researched women with HIV. She practices at Grady Health System’s Infectious Disease Clinic.
“Becoming a nurse practitioner was the best decision of my career, and one of the top five best decisions of my life,” Holstad said. “It’s taken us a long time to become established as providers, but we can now be reimbursed by Medicare, Medicaid and private insurers, and we finally got prescriptive privileges in Georgia [in 2007]. The role is established now and it’s not going away.”
Holstad still finds Georgia regulations of NP practice too cumbersome, but she believes that nurse practitioners are in a front line position due to the changes brought about by health care reform. She’s hopeful that more barriers to practice will be removed.
“By 2014, there will be 30 to 32 million more people eligible for health insurance, and there’s a shortage of family practice physicians,” she said.
The opportunities for NPs are vast. “There are definitely more paths and lots more choices for nurse practitioners today,” Holstad said.
Emory offers master’s degrees to prepare nurse practitioners in acute, adult, emergency, family, geriatric, pediatric and women’s health care, as well as nurse midwifery.
According to the American Association of Colleges of Nursing, about two-thirds of the more than 140,000 nurse practitioners in the United States practice in adult or family care.
Ellen Olson, however, is one of a growing number of nurse practitioners who are partnering with physicians in specialized practice.
Olson, RN, MS, CPNP, is a nurse practitioner with the Aflac Cancer Center and Blood Disorders Service of Children’s Healthcare of Atlanta.
“I carry a full patient caseload, rotating between inpatient and outpatient services, and work with a multidisciplinary team that includes physicians, social workers, psychiatrists, pharmacists and others,” Olson said. “I love the interaction with patients and families, but as a nurse practitioner, I’m not at the bedside giving physical care. I’m managing patients care, assessing their health and treatment plans, modifying orders and medications based on their clinical status, and educating families.”
Olson believes she is working to the full scope of her practice and thinks that her colleagues and patients appreciate what she does.
“Nurse practitioners are increasing in numbers and influence, and the families I work with understand the role,” Olson said. “But as a nurse, the best part is always seeing the patients do well.”
Specializing in oncology and bone marrow transplants, Olson belongs to national and international professional organizations and is constantly adding to her knowledge. She doesn’t expect to practice independently in this specialty.
“Over the years, the nurse practitioner role has expanded beyond primary and chronic care,” she said. “Many advanced practice nurses now work in the specialties of psychology, pulmonary, [neurology] and cardiac care, to name a few.”
Katherine Abraham, MSN, FNP-C, GNP-BC, specializes in gerontology.
“The population is aging and we all know that we’re going to see more geriatric patients in the future,” said Abraham, practitioner and clinical advisor with Evercare, a health care coordination provider for people with chronic or advanced illness, particularly the elderly. “It’s a unique specialty because this population has different needs. Working with them is not only rewarding, but fun.
“Nurse practitioners are trained to see the whole patient and take a holistic approach to their care. That’s what drew me to the role.”
An aging population means there’s a growing need for nurse practitioners with gerontology training in home health and long-term care facilities. More nurses are answering that call. The Georgia Gerontological Advanced Practice Nurses Association has grown from 50 to 83 members in the last four years, said Abraham, a former president of the organization.
As director of University Health Services at Clayton State University, Julia Spinolo, DNP, APRN-BC, LNC, measures growth by the number of patients she serves. Since she became director in 2008, she has transformed the university clinic from a “nurse-in-a-box” operation to a primary care practice.
“Dr. Deborah Honeycutt [the clinic’s medical director] and I used to see 10 patients a week; now we see 30 a day,” Spinolo said.
The university clinic provides students, faculty and staff with primary health care.
“We do everything but X-rays and birthing babies, and because this university has such a diverse population, we see everything from hypertension to eating disorders to STDs,” Spinolo said.
Spinolo credits her DNP degree with giving her a better understanding of evidence-based practice and the financial and management skills required to lead a growing practice.
“Nurse practitioners are going to be utilized more in primary care and have more autonomy in the future,” she predicted, “because they are less expensive and they practice by seeing the whole patient, not just a disease to cure. The caring is more prevalent.”