The Evolving Role of the Family Nurse Practitioner

Introduction to the Family Nurse Practitioner Role

The Nurse Practitioner role has evolved throughout the decades and continues to change as healthcare 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 left behind by declining numbers of medical doctors entering primary care. 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 specified period of time.

Clinical and Non-Clinical Functions of FNPs

There are both clinical and non-clinical ways in which the Family Nurse Practitioner role comes into play. The traditional, and more well-known, role is the clinical one. As noted above, the clinical nurse practitioner has direct, 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 working in fields where direct patient care is not their primary responsibility. This includes consulting roles with pharmaceutical companies, insurance companies, or medical and manufacturing equipment firms. In these positions, NPs provide companies with information that has the patients' best interest in mind, from both 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 these roles affect patient care, they do so in a more indirect fashion.

According to the National Patient Safety Goals established by the Joint Commission, both of these varying roles contribute to patient safety. Clinical NPs must follow and abide by rules that assure the safety and well-being of their patients. They are expected to provide ethical care in a manner that promotes health and its maintenance while minimizing harm. Non-clinical NPs promote patient safety by consulting and advocating for products and services that enhance individual well-being. Although they contribute to nursing and healthcare in different ways, both roles are important aspects of the profession.

FNPs Reinventing Primary Care

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, the number of nurse practitioners has been increasing, creating a new perspective on primary healthcare. As the authors state, "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 healthcare as the number of primary care physicians declines and the number of NPs increases. Two main topics were analyzed. The first was patient satisfaction and quality of care provided by NPs. Across numerous studies, it was concluded that NPs provided equal or better care than physicians. They had better results in "follow-ups, consultation time… and the provision of screening, assessment, and counseling" (Naylor and Kurtzman, 2010).

Secondly, from an economic standpoint, NPs were performing much better than their physician counterparts. Because of reimbursement rates set by the government and insurance companies, the same healthcare can be provided by NPs at a fraction of the cost. For the period of 2010–2020, it was projected that there could be "cumulative statewide savings of $4.2–$8.4 billion" (Naylor and Kurtzman, 2010).

However, the downside of the NP role lies in its relative novelty. Although NPs have been around for decades, their importance and contributions have grown considerably in recent years, and state laws are still attempting to catch up with what NPs can or cannot legally do (Naylor and Kurtzman, 2010). Another concern the authors raise is that although NPs represent a more economically efficient solution, they are still paid a fraction of what physicians earn for providing the same services. Professional tensions between NPs and physicians are also a concern, as NPs seek greater independence in their practice while physicians question their aptitude to do so.

Conclusion

In all, the role of the Family Nurse Practitioner is one that continues to evolve. From clinical and non-clinical functions to questions of autonomy, economic value, and global recognition, FNPs occupy an increasingly vital place in modern healthcare, even as professional, legal, and educational frameworks work to keep pace with their expanding contributions.

References

Golden, A., & Blackwelder, R. (2013). Should nurse practitioners be able to treat patients without physician oversight? The Wall Street Journal.

Naylor, M., & Kurtzman, E. (2010). The role of nurse practitioners in reinventing primary care. Health Affairs, 29(5), 893–899.

Savrin, C. (2009). Growth and development of the nurse practitioner role around the globe. Journal of Pediatric Health Care, 23(5), 310–314.