Nurse practitioners (NPs) provide care in doctors’ offices and hospitals throughout the US. You might have an NP whom you see on a regular basis, or you might see an NP when your doctor’s schedule is booked solid. Can you trust a nurse practitioner to provide high quality care? Do they know what they are doing? Yes! No need to worry! Nurse practitioners are qualified and capable.
What exactly is a nurse practitioner?
NPs are well trained professionals who provide care in a variety of settings, including primary, acute, and specialty clinics, as well as in hospitals.
Their emphasis is on the health and well-being of the whole person – focusing on health promotion, disease prevention, as well as health education and counseling.
NPs have provided care to patients of all ages and walks of life for almost 50 years. Millions of patients see nurse practitioners for their care, and that number is likely to grow.
What kind of training does a nurse practitioner have?
Nurse practitioners receive extensive formal educations as well as clinical training. All NPs must complete a master’s or doctoral degree. In addition to a formal education, NPs must receive advanced clinical training and national certification.
Moreover, NPs must undergo clinical outcome evaluations and periodic peer review and must adhere to a code for ethical practices. With all of this training, you should feel comfortable enough to trust a nurse practitioner!
Can a nurse practitioner work independently?
The answer to that depends on the state in which you receive your care because there are state laws and regulations that restrict the scope of practice for NPs.
Because state laws differ significantly, there is a large variation in the care that NPs can provide. According to the American Association of Nurse Practitioners (AANP), there are 3 levels of practice allowed:
Full Practice
22 states allow all nurse practitioners to evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage treatments—including prescribing medications and controlled substances—under the exclusive licensure authority of the state board of nursing.
Reduced Practice
16 states reduce the ability of nurse practitioners by requiring a career-long regulated collaborative agreement with another health provider. NPs in these states have limits on the scope or setting for one or more elements of NP practice.
Restricted Practice
12 states restrict the ability of a nurse practitioner by requiring NPs to practice under the supervision of a doctor or other healthcare provider.
Wondering what the laws are in your state?
You can find out what limits NPs in your state face on the interactive map on the AANP website.
What kinds of healthcare settings do NPs work in?
NPs work in virtually every type of healthcare setting – hospital surgical departments, mental health facilities, urgent care centers, freestanding primary care offices, and everything in between.
Primary care practices really benefit from nurse practitioners!
Primary care is the foundation of the US healthcare system, providing treatment for common conditions and illnesses, as well as for accidents. Additionally, primary care provides preventive services and ongoing care for patients with chronic disease.
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n the US, primary care is a patient’s entry point into the healthcare system. For patients, having a primary care doctor improves the quality of their healthcare, and improves outcomes, care coordination and the patient experience. Moreover, collectively primary care contains costs, reduces unnecessary utilization, and promotes the efficient use of healthcare resources.
NPs have a significant, positive impact in primary care medicine for patients and primary care doctors alike. How? Read on…
Primary health care doctors’ numbers are dwindling. And we should all be worried.
In the US, there is a shortage of primary care doctors, which is expected to worsen in coming years. A recent report by UnitedHealth group outlines the worrisome shortage:
- The supply of primary care doctors is, and will continue to be, insufficient to meet the demand of the population
- A primary care doctor with 2,000 patients would need to work an estimated 17.4 hours each day to provide recommended preventive, chronic, and acute care. It’s worth noting here that many primary care doctors have more than 2,000 patients.
The problem will likely worsen:
- Demand for primary care will increase significantly in the future as the US healthcare system serves a larger, older, and less healthy population.
- The shortage of primary care doctors may reach 49,000 in 2030, compared to 18,000 in 2018.
- In 2017, only one in six medical school graduates chose a primary care residency program.
Not all patients have reasonable access to primary care practices.
Everyone needs a primary care doctor to help them manage their health and healthcare. Unfortunately, that is almost impossible for many people in the US.
A shortage of primary care doctors impacts both the insured and uninsured. Moreover, the shortage impacts those living in rural, suburban and urban areas. As a result, healthcare for many is lacking.
The UnitedHealth report describes the problems:
- 13% of US residents (44 million) live in a county with a shortage of primary care doctors (<1 primary care doctor/2,000 people).
- Rural residents are almost 5x more likely to live in a county with a primary care doctor shortage, compared to those living in urban and suburban areas (38 percent vs. 8 percent).
- Even though the percentages vary greatly, the density of populations in rural vs urban and suburban areas means that almost the same absolute number of urban and suburban residents (21 million) and rural residents (23 million) live in a county with a primary care doctor shortage.
Nurse practitioners to the rescue!
Good news for patients – 78% of NPs (over >193,000) work in primary care practices. NPs help practices increase their capacity and thereby increase access to care. Some interesting statistics regarding nurse practitioners from the UnitedHealth report:
- By 2025, the number of NPs practicing in primary care is expected to increase 47%.
- NPs are more likely than primary care doctors to practice in underserved communities, including rural areas. They’re also more likely to accept new patients.
- The quality of primary care delivered by NPs is comparable to care provided by doctors.
Nurse practitioners improve care in hospitals.
According to a new 2021 study, hospitals that have more inpatient NPs have lower surgical mortality, higher patient satisfaction, and lower costs of care. For instance, hospitals with more NPs had 21% fewer deaths after common surgical procedures, as well as 5% reduction in costs for Medicare patients.
Additionally, researchers found significantly higher patient satisfaction in hospitals using more NPs, as well as higher ratings for quality of care and patient safety. And, unsurprisingly, having a great number of NPs led to improvements among RN (registered nurses) staff, including improved job satisfaction and lower burnout.
Everyone would benefit if states removed their restrictions.
Because there is a shortage of primary care doctors we would all benefit from the easing of restrictions on NPs.
The UnitedHealth report recommends that states remove their restrictive laws and allow NPs to practice to the full extent of their graduate education, clinical training and national certification.
As a result of this change, there would be a significant increase in patients’ accessibility to primary care:
- The number of people living in counties with insufficient primary care access would decrease from 44 million to 13 million, a 70% reduction.
- The number of rural residents living in a county with a primary care shortage would decline from 23 million to 8 million, a 65 percent reduction.
Final thoughts.
Can you can trust a nurse practitioner to provide quality care? Of course. But, like any other medical professional, there is a range of ability, experience, and personality among nurse practitioners. When seeing a nurse practitioner, follow my recommendations outlined for all medical appointments in these blog posts:
- Understanding Medical Information Is Harder Than Most Realize.
- 10 Tips for a Better Medical Appointment.
- How Can You Get the Best Healthcare? Actively Participate!
- 10 Tips to Communicate Better with Doctors.
- 6 Tips to Better Manage Your Care.
- Communication Gap Among Doctors.
NOTE: I updated this post on 9-25-21.
You should not trust nurse practitioners. There is no standardization in their training. They train in nursing for 1-2 years after a college degree, while physicians go to 4 years of medical school after college and then must complete a 3-7 year residency in their specialty. There are multiple standardized national exams a physician must pass in order to safely care for patients. Nurse practitioners do not have an equivalent, especially those who someone practice in a specialty. Nurse practitioners do not do residency. It would be irresponsible for someone with a medical degree to treat patients unsupervised right out of medical school. It is absurdly dangerous for nurse practitioners to be able to do so after only finishing NP school (which is not as long or challenging as medical school). I have seen incredibly dangerous mistakes made by NPs as the norm. Of course there are some good NPs out there if they have been practicing a very long time and have been willing to learn and are aware of their limits, but the lack of standardization in training means that there is no quality control. They literally kill people. Please seek a physician for medical care aside from very simple primary care complaints – the kind of thing you would trust an urgent care with – runny nose, cough, wrist sprain. Even so I have seen many/most inappropriately prescribe antibiotics for viral infections. If more complex than simple complaints, it is beyond the scope of their training unless they have the humility to know their limits, learn, and have many years in the same field under their belt.
It seems like you have had some very bad experiences with NPs – I am sorry to hear that! Personally, my family and I have had many positive experiences. NPs need 2 years of college after receiving a 4-year BSN degree. Of course, they are not as well trained as doctors, but in many cases (but not all) they work in conjunction with doctors who can provide guidance and advice as needed. And it is important for NPs to understand their limits.
As you may have read in my post, a 2021 study found that hospitals with more inpatient NPs have lower surgical mortality, higher patient satisfaction, and lower costs of care. Additionally, NPs provide care in areas without an adequate number of doctors.
That being said, all medical professionals are capable of making mistakes, including mistakes with deadly consequences. As you may know, medical errors are the 3rd leading cause of death in the US (if you don’t consider COVID deaths), and these errors occur at the hands of a wide range of medical professionals – including doctors, nurses, NPs, pharmacists, etc. Whenever, and wherever, you receive medical care, it’s important to be engaged in the process and to speak up if something doesn’t seem right.
I have been a nurse for 30 years working in multiple specialties. I could write volumes about the horrible care provided by many physicians and NPs in addition to amazing care provided by physicians and NPs. Physicians argue about whether nurse practitioners should be allowed to practice independently. Let me be clear! Any provider who practices without consulting other providers is dangerous! So, let’s put this silly argument to rest . I will graduate from a nurse practitioner program next month and will care for patients to the extent of my knowledge and will consult others including MDs and other NPs as needed. With 30 years of healthcare experience I have to wonder if anyone should be allowed to enter medical school or NP school without extensive bedside healthcare experience. Maybe we should look at setting the bar higher for all types of training, requiring that young persons have real life experience before applying to med school much like many nurses who apply to NP school. The training is different but the life experiences of those applying is also different. I suspect most of the silly arguments against NPs is coming from the young and inexperienced physicians. Act like the mature scientists you are supposed to be!
I have been a huge fan of NP’S as PC since my early 20’s (I’ll be 50 this year). I have always found them to be extremely thorough, sensitive and caring. Too bad they get looked down upon or disregarded. Even in states where they have full control of your care, they still seem to have at least one MD associated with the office to review charts.
Having worked for a Specialist for 14 years, Primary care is not necessarily the place for certain diagnoses, but they see the overall picture to get you to the right specialist for diagnosis and then they can work with the specialist to maintain your overall care.
As far as fasting or not fasting for blood work, it’s usually a general, “yes or no” question during the check-in procedure and does not need to be made a point of again during the draw. On the other hand, if you didn’t fast when you were told to, they would make a big deal of that. You would have wasted your time, the busy staffs’ time and your gas going to the lab. If in doubt, you can always verify with the office, lab and sometimes Dr Google before you go.
I’m glad you have had many positive experiences with nurse practitioners, as have I. However, no medical professional is perfect and anyone can make a mistake. Therefore, be engaged in the process and speak up if something doesn’t seem right!
I saw my very first NP today to get pre-op medical clearance. I was very impressed with her attention to detail, knowledge and overall concerns for my medical care. She spent a lot of time with me, and her bedside manner was some of the best I have ever encountered with any doctor in my life. I am 73 years old. To the above commenter, “Don’t dismiss NPs based on one bad experience.”
Ray,
Thank you for sharing your experience! I have had many positive interactions with nurse practitioners. However, just like any other healthcare professional, some provide better care than others. Not matter who treats you, it’s always important to ask questions, take notes, and speak up if something doesn’t seem right.
Roberta
I had been under the NP treatment for 9 years and had a great experience. My NP was very professional and dutiful. Actually, I found her approach to treat and roll out the root cause was more accurate and wise than my previous medical experiences.
Rose,
I am glad you had a great experience with your nurse practitioner! I have also had many great experiences with various NPs over the years.
Take care,
Roberta
A Nurse Practitioner I had misinformed me regarding a blood test. On my online chart, she mentioned fasting prior to my blood test, even though that person made no mention of having to fast before getting my blood drawn. I Filed a complaint and further stated that I will NOT have any further dealings with her, or any other NP.
I am sorry that you had a very bad experience. Unfortunately, all medical professionals are people, and there is no person in the world who never makes a mistake. In fact, medical errors are the 3rd leading cause of death in the US. And they can happen at the hands of any type of medical provider – doctor, nurse practitioner, nurse, etc. It sounds like you were treated by an NP who made a serious mistake, so I understand not wanting to be treated by this particular NP. However, I think giving up on NPs in general could be a mistake. Read this blog post to learn more about medical errors: https://zaggocare.org/reduce-risk-medical-errors/.