John Distler, FNP-C, DPA, MBA, FAANP, dean of the MSN nurse practitioner track at Chamberlain College of Nursing, based in Downers Grove, Ill., shared his insights about what’s ahead for nurse practitioners:
Q. How are family nurse practitioners addressing the looming primary care shortage?
A. Nurse practitioners providing primary care is a big thing. Ive been a nurse practitioner for 25 years and have seen a changing face of medical care in the nation. This is one of the first times I remember a push toward primary care, which means disease prevention. It is a lot less expensive than secondary or tertiary care. There has always been a primary care physician shortage, especially in rural communities, and there has been a problem with patient access. Now, with the Affordable Care Act, FNPs are poised to fill in the gaps in rural areas and urban areas and most likely will become a large percentage of primary care providers in the U.S.
Q. How has the changing healthcare landscape expanded the roles of NPs?
A. The patient-centered medical home is a major focus of the changes taking place in the primary care initiative in which everyone is attempting to control costs, especially in the repetition of tests. The patient-centered medical home offers more of a multidisciplinary approach to caring for the patient. The same goes for the nurse-managed health centers, which offer more access to care. In the U.S., we have a great medical community, but access is a problem, not just rurally but in low-income and different socioeconomic groups. NPs are running patient-centered medical homes, and a lot of NPs are opening their own practices, depending on the state in which they live. In Maryland, I can practice independently and not have a collaborative agreement with a physician. Independent practice has been a big issue for nurse practitioners. Some members of the medical community are trying to put the brakes on NPs practicing in the primary care role. In the past, the American Medical Association opposed independent NP practice and interfered in certain states to block legislative efforts to allow NPs to work more autonomously. But NPs are working on it. The Institute of Medicines Future of Nursing report supports more autonomous practice for NPs, plus the healthcare landscape is changing to accept nurse practitioners in a primary care role.
Q. What advice would you give to NPs who want to practice independently in terms of mentors and resources they can use to help them in the early years of practice?
A. I suggest that new NP grads have at least two years of supervision and review patient treatment plans with another more experienced NP or physician before they plan to practice independently. NP programs prepare NPs to function at an entry-level position and therefore further training is required. Also, I NPs should become involved in their local, state and national NP organizations.
Q. What qualities do you think an NP needs to possess in order to provide safe and quality care to patients?
A. I advise NPs to know your limitations and know when to ask for help or clarification. Do not practice in an independent practice unless you have the skills and self-assurance that you are practicing in a safe manner. Keep up to date on current practices, read evidence-based journals and attend national NP conferences.
Q. What are the challenges that NPs face in practice today and how do you recommend they overcome them?
A. The challenges that we face are dependent upon the state in which we practice in terms of independence of our scope of practice. By becoming involved in NP organizations, you can stand up for your rights to practice as a licensed independent practitioner. The bottom line is to always do the right thing for your patients and their families.
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