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Advanced Practice Registered Nurses

The Issue

A range of factors—including a rapidly aging population with multiple health needs; provisions in the Affordable Care Act that focus on the importance of close monitoring of those with chronic illnesses and the prevention of hospitalization; and the addition of 30 million newly insured people into the healthcare system—are driving a need for primary care providers (PCPs). The current gap in PCPs is 15,000; the number is expected to triple to 45,000 in the next seven years.

Many of the ongoing health needs of persons across the age spectrum, from birth to death, can be met by advanced practice registered nurses (APRNs). There are currently over 267,000 advanced practice registered nurses in the U.S. APRNs are registered nurses with graduate level education or certificate, extensive specialized knowledge and training, and certification following rigorous national testing. There are four APRN roles:

  • certified registered nurse anesthetist (CRNA)
  • certified nurse-midwife (CNM)
  • clinical nurse specialist (CNS)
  • certified nurse practitioner (CNP)

Unfortunately, many physicians and the groups representing them are opposed to an expanded role for APRNs and are working at the local, state and national levels to discredit their competency and to oppose their competition. Interestingly, research has shown that patient outcomes for those receiving care from APRNs are comparable to the outcomes of those who see physicians. Additionally, patients report that APRNs are better communicators and better educators than their physician counterparts.

As a strategy to mitigate questions about the role and preparation of APRNs, the National Council of State Boards of Nursing and the nursing community as a whole has come together and developed a Consensus Model for APRN Regulation to standardize licensure, accreditation, certification and education. The Consensus Model provides guidance for states to adopt uniformity in the regulation of APRN roles. The target date to complete that work is 2015. Today, many states have adopted portions of the Model elements but there still may be variation from state to state.

Evidence to support nurse practitioners: EVIDENCE TO SUPPORT NURSE PRACTITIONERS:

  • The Bipartisan Policy Center's Health Care Cost Containment Initiative recommends state reforms that strengthen the primary care workforce and make greater use of nonphysician practitioners (Daschle et al., 2013).
  • Recent analysis shows no variation in physician earnings between states that have expand­ed APRN scope-of-practice laws and states that do not (Pittman and Williams, 2012).
  • A literature review by the National Governors Association (NGA, 2012) found that APRN care is comparable to physician care on several key process and outcome measures. Also noted: APRNs provide improved access to care for the underserved.
  • Research comparing patient outcomes between care provided by physicians and APRNs gives no evidence of the need for physician oversight of APRNs (AARP Foundation, 2010).
  • A 19-year review of outcomes for women delivered by certified nurse midwives (CNMs) and physicians shows CNMs have a lower rate of Caesarean sections and complications that increase the cost of care (Newhouse et al., 2011).
  • Only 2 percent of APRNs have been named as a primary defendant in a malpractice case (AANP).
  • 97 percent of APRNs maintain national certification; 93 percent have graduate degrees (American Academy of Nurse Practitioners, 2011).
  • 88 percent of APRNs are prepared in primary care; 68 percent practice in at least one primary care site (American Academy of Nurse Practitioners,2011).
  • 87 percent of APRNs see patients covered by Medicare, and 84 percent see patients covered by Medicaid (American Academy of Nurse Practitioners,2011).

 

AFT ACTION:  Letter of Support to Kathleen Sebelius, Secretary, U.S. Department of Health and Human Services

RESOURCES: American Association of Nurse Practitioners (AANP), Advocacy Center.


References

American Academy of Nurse Practitioners. (2011). Nurse Practitioner Facts 2010-2011.

Daschle, T., Domenici, P., Frist, W. and Rivlin, A. (2013). "Prescription for Patient-Centered Care and Cost Containment." New England Journal of Medicine, 369(471-474).

Improving Access to Primary Care: The Growing Role of Advanced Practice Registered Nurses.   (2010). Washington, DC: AARP Foundation & Robert Wood Johnson Foundation's Center to Champion Nursing in America.

National Governors Association. (2012). The Role of Nurse Practitioners in Meeting Increasing Demand for Primary Care. Washington D.C.: Author.

Newhouse, R., et al. (2011). "Advanced Practice Nurse Outcomes 1990-2008: A Systematic Review." Nursing Economics, 29 (5), 230-250.

Pittman, P., and Williams, B. (2012). "Physician Wages in States with Expanded APRN Scope    of Practice." Nursing Research and Practice. 1-5.