Evolution of the Family Nurse Practitioner Role in Health Care

¶ … Nurse Practitioner has evolved throughout the decades. It is one that continues to change as health care further develops into a continuum of patient care and continuous educational access. The Family Nurse Practitioner (FNP) has become synonymous with that of a primary care physician. In all 50 states, including the District of Columbia, and around the globe, FNPs are being used to fill the growing gap that medical doctors are leaving behind. FNPs are able to assess, diagnose, and treat acute and chronic illnesses, conduct routine patient check-ups and annual physical examinations, provide counseling, prescribe and order medications and labs, and manage a patient's overall care (AANP, 2015). Numerous states allow FNPs to practice autonomously, while others require supervision or collaboration with a medical physician in order to legally practice for a specific amount of time.

There are clinical and non-clinical ways in which the Family Nurse Practitioner role comes into play. The traditional, or more well-known role is the clinical one. Just as aforementioned, the clinical nurse practitioner has personal hands-on experience with patients. They treat and assess patients and act as the primary care provider, much as a medical physician does. A nurse practitioner falls into a non-clinical category when they go into fields where direct patient care isn't necessarily their primary job. This includes the roles of consulting for pharmaceutical companies, insurance companies, or medical and manufacturing equipment. They provide these companies with information that has the patients' best interest in mind, from a nursing and medical perspective. Managerial and staffing services provided by Nurse Practitioners can also fall into a non-clinical role, as there is no direct contact with patients. Although they do in turn affect patient care, it is in a more indirect fashion. According to the National Patient Safety Goals (NSPG) established by the Joint Commission, both of these varying roles provide for patient safety. Clinical NPs have to follow and abide by rules that assure the safety and well-being of their patients (jointcommision.org, 2015). They are to provide ethical care in a fashion that promotes health and the maintenance of it in a way where minimal harm is done. Non-clinical NPs promote the safety of patients by consulting and advocating for products and services that will enhance the well-being of individuals. Although separate in the roles in which they contribute to nursing and healthcare as a whole, they are very important aspects.

According to Naylor and Kurtzman (2010) the role of the nurse practitioner is reinventing primary care. As the number of physicians entering primary care medicine residency has been declining in recent time, the number of nurse practitioners has been increasing, creating a new realm and perspective on primary health care. As the article states, "Between 1995 and 2006, primary care residency programs declined by 3%, while primary care training programs for nurse practitioners grew 61%" (Naylor and Kurtzman, 2010). The research conducted by these two authors aimed at providing a better understanding of the overall role that the Family Nurse Practitioner plays in health care as medical doctors specializing in this field has been declining, while NPs have been on the increase. Two main topics were analyzed. The first one was patient satisfaction and quality care provided by the NP. In numerous studies, it was concluded that NPs provided equal or better care than MDs. They had better results in "follow-ups, consultation time… and the provision of screening, assessment, and counseling" (Naylor and Kurtzman, 2010). Secondly, economically, NPs were doing much better than their MD counterparts. Because of reimbursement rates by the government and insurance companies, the same health care can be provided by NPs for a fraction of the cost. For the period of 2010-2020 it has been projected that there can be "cumlutaive statewide savings of $4.2-$8.4 billion" (Naylor and Kurtzman, 2010). However the downside of the NP role is in its novelty. Although NPs have been around for decades, it is recently that their importance and contribution has grown and state laws are still attempting to catch up to what they can or cannot legally do (Naylor and Kurtzman, 2010). Another negative that the authors point out is that although economically NPs are a better solution, NPs are still only getting paid a fraction of what MDs get paid for providing the same services. Professional tensions between NPs and MDs is also a concern as they NPs seek more independence in their practice while MDs question their aptitude to do so.

Much like Naylor and Kurtzman (2010), Savrin (2009) also attempts to define the role of the Nurse Practitioner and makes a comparison to Erikson's stages of development. In it's infancy stage, the NP role was about learning. Not only learning for the nursing community, but for the community in general. Knowing exactly what the NP role entailed was something that society in general had to come to terms with. The second stage which the author referred to as toddlerhood was in the NPs' role's need to establish its independence and become autonomous from that of an MD (Savrin, 2009). Around the globe NPs have differing degrees of ability to practice on their own or at all. In the U.S. individual states are still attempting to find this balance between what can or cannot be done by NPs. The preschool stage is compared to the role's ability to expand its horizons and establish its initiative. As decades have passed since the role of the NP was first introduced, it has grown to become its own field and has grown in recognition. The author refers to the school age stage as that of consolidation and industry (Savrin, 2009). Universities everywhere are now offering this role as a sole concentration. Curriculums have been developed in order to fully establish the NP. The NPs role of rebellion and identity is referred to by the author as the adolescence stage (Savrin, 2009). As the role itself has become more independent and synonymous with superior health care, NPs are demanding more respect, recognition, and better economic reimbursement for their services (Savrin, 2009). Reaching out is the adulthood stage (Savrin, 2009). A role that was once contained to solely the U.S. And more developed countries, has now grown to become a global, well-respected speciality. However, the author questions that final role, the role of integrity, or older adult (Savrin, 2009). Although NPs are beginning to be very well-respected, the author questions whether it has fully achieved its goal.