Annette Mulkay, College of Nursing
My research project entitled Nurse Practitioners’ Present and Future Viability has four research questions:
• What is the role of nurse practitioners today?
• How do nurse practitioners perceive their role in health care reform?
• What do nurse practitioners perceive as barriers to acceptance in the current health care delivery system?
• What policy changes do nurse practitioners view as necessary to enable them to meet their potential for practice in the future?
The purpose of this study was intended to investigate the current and future viability of nurse practitioners in light of the current movement for health care reform. The design used was a descriptive exploratory study using a semi-structured interview tool. The structure of the few pre-prepared questions provided direction for the interviews. This design was selected to explore the views of currently practicing nurse practitioners and discover what meanings are attached to each nurse practitioner’s view. Because of the qualitative nature of this design, intuition and insight must play important roles in these processes. In qualitative research, number of subjects, usually called informants, is low compared with traditional quantitative designs. Goals are to obtain valid, dense, subjective data from a few informants, as opposed to more objective data from many subjects. Qualitative data is important when the purpose is to describe, rather than predict.
The informants were four family nurse practitioners with a master’s degree, certified and practicing in Utah in ambulatory care settings. Two practice in the public sector (services provided by the State), and two practice in private settings (services in a physician’s or family nurse practitioner’s private office). Further interviews will be conducted in Indiana, with the goal of 10 to 20 subjects. Enclosed is a draft of preliminary themes among the findings. Direct quotations are offered.
This project was exciting to me because I was able to explore questions I have been considering throughout my entire undergraduate nursing experience. I had been searching for answers from my professors and from current research, and now was able to make discoveries from my own research. In addition to the information discovered, I was able to see many of these nurse practitioners in their workplace and observe interactions with clientele, facilities, etc. in a way I would not have been able had I not made a specific visit.
Lastly, I have developed a small network of nurse practitioners in the state of Utah. This has been helpful in terms of advice with regard to planning toward an advanced degree. Unfortunately, I am leaving the state of Utah and will be practicing in the state of Indiana. The most valuable option for me would be to network there at this time.
I learned that the role of NPs is expected to be the biggest role for nurses in the future. Most of the nurses feel that their role is already autonomous now, but it has the potential for having even more autonomy in the future. One disturbing realization is that with the potentially increased supply of NPs, there is always the risk that their educational level and delivery of health care may be substandard.
Even more alarming is the potential for their role to be exploited by decreased salaries and being forced by the dollar to provide more for less. However disconcerting, this potential information is valuable for me to see the big picture and foresee complications before they arise. Despite these disturbing aspects, this role is still the most viable role for any RN in the future.
I was also made aware of the gender issues at hand. Nursing has always been a predominantly female profession which has predisposed itself to cross-gender hardships. Fortunately, for some NPs they are learning/ implementing strategies that will aid them in not only health care delivery but in the “business” of present-day health care. This awareness, along with valuable suggestions, will aid me in my approach to tackling these intraprofessional and interprofessional relationships as they come along.
My project offers a beginning descriptive examination of the role of nurse practitioners. There is a need for continued research on the role and practice of such an important member of the health care team. Thank you for the opportunity to participate in this project.
Findings
Today’s role
“Pimary health care. Not a specialist” “Doing episodic care…”filling in the gaps”. Nurse practitioners in the public sector did not practice chronic care.
The scope of practice/ clientele all differed. One worked in pediatrics, one worked mostly with adults, and the public health nurse practitioners (NPs) worked with the young families.
All felt they were “extremely autonomous” in their roles.
Prescriptive practice differed for each of them. Three NPs did not have a Drug Enforcement Agency (DEA) number, necessary to prescribe medications. For various reason they did not want to prescribe controlled substances. One NP does have a DEA number and feels comfortable prescribing controlled substances.
All the NPs took upon the roles of educator and clinician within their practice. Two NPs have taken on both administrator and legislator roles.
Role in Health Care Reform
“An increased focus on primary care… there could be less funds available… NPS will be greater utilized… NPs will be more accountable to politics… there will be an increase in preventive services… we will begin to take on the responsibility of chronic health problems”
“The changes will be detrimental for the consumer… there will be increased wealth for others… there will decreased competition… Because of the decrease in RN positions, many colleges are choosing to cut out their undergraduate RN programs and put in nurse practitioner programs instead. This would mean a flood of nurse practitioners into the health care system. As a result, the role of nurse practitioners would be greater utilized. However, there is also a greater risk for exploitation”
“Greater autonomy… increased reimbursement from the government… increased demands on NPs… more physicians using NPs in their clinics…. increased need for NPs to go into business for themselves and ‘hang own shingle out'”
Barriers to practice
“Laws prevent increased autonomy… lack of insurance reimbursement… decreased funds for educating NPs… Doctors and administrators opinions of NPs are sometimes less than favorable… Some gender issues are that if a man is aggressive in the workplace it is perceived as assertive, but if a woman is assertive is can be perceived as aggressive. There are also discrepancies between when a man vs. a woman are negotiating salaries. NPs need to be taught to deal with politics. NPs are not listed in the yellow pages. There needs to be a networking system in each district. NPs ought to have their name and title on their door for increased recognition.”
“Decrease resources for both the patient and the NP … decreased supplies because drug representatives don’t come to the public health department … many clients don’t have insurance”
“It is easier for males …. Nursing is and always has been a gender issue … there needs to be an bigger push toward woman’s health. The American Medical Association has been a big ‘con’ in promoting NPs.”
“Lack of resources and access … there are often political battles with pharmacists over prescription privileges … many times there is a decreased response to an NP ordering a diagnostic test rather than if a doctor would have ordered it. Independent practice is an issue.”
Necessary policy changes to improve NP practice
“Reimbursement is an issue. Senator Orrin Hatch was considering eliminating funds for RNs’ advanced education. Nurses need to speak out concerning this issue. Also more NPs need hospital privileges.”
“NPs need independent practice. Also there needs to be increased state funds to rural areas. “Nurses need to work together as a political group for prescription privileges and hospital admitting privileges in rural areas.”
“Independent practice … we need to get away from the pre-written protocols. This can often stifle us or get us into legal trouble.”