You probably say "I'm going to the doctor" when heading to a health care visit, but it could well be "I'm going to the nurse practitioner" instead. When faced with the choice of primary care providers, you might like to know a bit more about this growing group of health professionals.
1. What they do. Nurse practitioners – who build on their registered nurse backgrounds with advanced education, certification and skills training – are licensed to practice independently. Like other RNs, they perform thorough assessments, but a nurse practitioner also has the ability to diagnose patients, prescribe their treatments and medications, and take charge of their overall care.
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2. Where you find them. You can run into a nurse practitioner in any number of health care settings. Maribeth Capuno practices in the cardiology department at the Salem Veterans Affairs Medical Center in Virginia, where she sees "the gamut of cardiac patients" with conditions such as heart arrhythmia, coronary artery disease and heart failure, including patients with stents after heart surgery. Capuno, who is president of the Virginia Council of Nurse Practitioners, also volunteers at the Bradley Free Clinic in Roanoke, Virginia, where she provides general health care.
While more than half of nurse practitioners work in family or adult practices, others specialize in gerontology, neonatology, oncology, pediatrics, psychiatric-mental health, women's health and acute care.
3. They have a preventive, holistic focus. Sandra Nettina is a family nurse practitioner at the Columbia Medical Practice in Maryland. In this large multi-specialty practice, patients can choose whether to see a nurse practitioner or physician as their primary care provider. Nettina says those who opt for the former may want a provider who will take more time to listen and discuss preventive health issues such as diet, smoking cessation and exercise.
Whatever the reason for their visit, Nettina says, she and the patient often also discuss a single lifestyle behavior, like soda consumption. “Then we’ll have a more comprehensive, educational visit where we’ll really do a half hour about some number of things they want to work on changing."
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4. They fill unmet needs. Nettina sometimes visits housebound patients with conditions like severe rheumatoid arthritis, older patients with chronic obstructive pulmonary disease and heart failure, or those whose obesity prevents them from traveling by car.
She says in some rural parts of the country, a nurse practitioner might be the only provider in town and miles beyond.
Geri Reeves, director of the family nurse practitioner specialty at Vanderbilt University School of Nursing, says, "because of the shortage of primary care providers in this country, you are much more likely to see a family nurse practitioner than you would have 10 years ago." And patients today are more familiar and comfortable with nurse practitioners, says Reeves, who practices at the Vanderbilt Walk-In Clinic Franklin in Tennessee.
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5. They're partners on the health care team. "Most of us have a very lovely collaborative relationship with physicians," Capuno says, "and if we get into a situation of something we’re unfamiliar with, we collaborate with other nurse practitioners and physician assistants as well as our collaborating physician."
In most cases, Nettina says, when she makes a referral, it’s because a diagnosis is complex, or because the patient requires a higher level of care from a specialist such as a pulmonologist or endocrinologist. She says the relationships in her office among physicians, nurse practitioners and the single physician assistant are “very collegial” with frequent sharing of information and cross-coverage of patients.
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6. Insurance usually covers their care. Most insurers don’t require that patients specify their primary care provider, Nettina says, although certain HMOs and managed care plans do. “Some of the insurances credential nurse practitioners just like physicians, and they can be listed as the primary care provider,” she says. “Some still don’t. In that case, patients need to pick a physician, even if they wanted to see a nurse practitioner most of the time. In most cases, they can pick either."
7. Their independence is evolving. Although the providers usually work together in harmony, political and turf issues exist between the nurse practitioner and other medical professions. At issue are collaborative agreements that nurse practitioners must sign with physicians, rather than run their own practices without physician oversight. However, some states allow more autonomy: In May, Minnesota passed full-practice authority for nurse practitioners, raising the total to 19 states plus the District of Columbia.
8. Their presence is growing. Nearly 190,000 nurse practitioners currently practice in the United States, according to the American Association of Nurse Practitioners. In 2010, that number was estimated at about 106,000, according to the Agency for Healthcare Research Quality. The Bureau of Labor Statistics estimates there will be about 37,100 new job openings in the field by 2022.
9. What you should look for. If you decide you’d like to see a nurse practitioner, Reeves says to make sure he or she is nationally certified. Nettina says to check out hours and accessibility: Is the nurse practitioner willing to work with you to do a quick phone call at times instead of insisting on an office visit?
"Just as you would be if shopping for a physician, you want to look for someone you have a comfort level with," Capuno advises. "You want to talk to your friends, talk to other health care providers, people that have a good reputation.” In general, she says, “nurse practitioners have very high patient satisfaction scores, and we have very good outcomes with our quality of care as well.”