How Nurse Practitioners Are Filling Gaps in Primary Care

Nurse practitioners (NPs) provide comprehensive healthcare services, from assessing and examining patients to ordering diagnostic tests, diagnosing illnesses, and treating or managing diseases. Additionally, nurse practitioners work with patients to promote wellness and prevent health problems with health education and preventive care.

According to data from the American Association of Nurse Practitioners (AANP), nearly 90% of the 355,000 licensed nurse practitioners in the United States are trained in primary care, and 70% of active nurse practitioners work delivering primary care.

Although nurse practitioners receive fewer years of schooling and clinical-training hours than physicians, they still play a pivotal, patient-facing role. An expanding share of primary-care services is delivered by NPs across a variety of settings, and a recent systematic review of 15 studies on NP-delivered primary care for adults with multiple chronic conditions found comparable quality of care, reduced emergency-department use and fewer hospitalizations compared with care models without NP involvement. This evidence underscores the benefits of nurse practitioners in primary care.

The Evolving Role of Nurse Practitioners in Primary Care

Compared to other professions, the role of the nurse practitioner is relatively new. As a result, the profession, associated training programs, and regulations around the United States continue to evolve to fill in gaps within the ever-changing healthcare industry while meeting the needs of patients.

Historical Overview and Recent Developments

Dr. Loretta Ford and Dr. Henry Silver developed the first nurse practitioner program in 1965. Throughout the second half of the decade, additional programs emerged in the U.S. — and by the early 1970s, almost seventy nurse practitioner training programs had been established. At this time, nurse practitioner organizations and education associations began forming, and 15,000 nurse practitioners were practicing in the United States by the end of the ’70s.

By the late 1990s, the number of nurse practitioners in the U.S. increased to almost 70,000. The profession began to experience rapid growth, and about 20 years later, the number of nurse practitioners had nearly quadrupled. There are now more than 355,000 active nurse practitioners in the U.S.

Comparing the Scope of Practice Across States

Nurse practitioners advocate for their ability to provide increased access to care by forming their own independent practices. In turn, the role, scope, and autonomy of nurse practitioners have expanded throughout the decades but still vary by state.

Idaho became the first state to recognize nurse practitioners and grant them independent practice in 1971. Beginning in the early 1990s, other states started adopting full practice authority; Alaska, Iowa, Montana, New Mexico, and Oregon were among the earliest to follow Idaho’s lead. By the mid-1990s, Medicare also approved reimbursement for NP-provided services.

Twenty-seven states currently allow full practice authority for nurse practitioners. Nurse practitioner authority in other states is classified as reduced practice or restricted practice — meaning that the nurse practitioners’ abilities are reduced, they are subject to collaborative agreements with licensed physicians, and they might be subject to career-long supervision.

Understanding the Education and Certification of Nurse Practitioners

The specific educational and certification requirements for nurse practitioners vary somewhat from state to state, so it is important to research the rules pertaining to the state where you intend to practice.

Required Educational Pathways

While the licensing requirements vary among states, generally, nurse practitioners are professionals who are already working as nurses; this means they have already obtained a Bachelor of Science in Nursing (BSN), received a registered nursing (RN) license, and are currently working as RNs.

To become a nurse practitioner, a registered nurse must complete graduate-level education. Most candidates earn either an MSN program designed for NP preparation, add a post-graduate NP certificate to a generalist MSN, or complete a DNP program that includes an NP concentration. After finishing the required coursework and clinical hours, nurse practitioners obtain population-specific national certification through one of several recognized certifying bodies, such as the American Nurses Credentialing Center or the American Academy of Nurse Practitioners Certification Board. In every state, nurse practitioners are licensed as advanced practice registered nurses, the regulatory category that also includes clinical nurse specialists, certified nurse-midwives, and certified registered nurse anesthetists.

Specializations and Continuing Education

In addition to completing the foundational education required to become an NP, aspiring nurse practitioners must choose a population-specific focus and meet national certification requirements that correspond to that specialization. These nurse practitioner specializations focus on distinct patient groups and ensure that the student’s clinical training, academic study, courses, and experience prepare them to meet the unique needs of the patients they are likely to encounter in practice.

In addition to these basic education and certification requirements, aspiring nurse practitioners may also select a focus or specialization upon entering a nurse practitioner program. These nurse practitioner specializations focus on different patient populations and ensure that the student’s clinical program, academic study, courses, and experience prepare them to meet the unique needs of the patients they may encounter in their practice. Upon completing their studies, candidates pursue national board certification that corresponds directly to their chosen specialization.

Examples of nurse practitioner specializations include:

• Adult Gerontology (primary or acute care)
• Family and Primary Care
• Neonatal
• Pediatric
• Psychiatric and Mental Health
• Women’s Health

When selecting a focus, aspiring NPs should consider their areas of interest, the types of patients with whom they wish to work, and the type of clinical setting or work environment in which they see themselves thriving.

Impact on Patient Access to Healthcare

While patients in rural areas have historically been underserved, a primary care provider availability challenge is currently impacting patients in both rural and urban areas, making standard healthcare difficult to access. The steady increase in nurse practitioners with full, restricted, and reduced practice authority, however, is helping to alleviate the strain by:

• Augmenting primary care physicians’ practices.
• Starting their own practices.
• Serving in locations that are designated as health professional access-limited areas.
• Helping to meet rural patients’ needs.

Strengthening the Primary Care Workforce to Support Community Needs

In 2024, 13,000 fewer primary care physicians were practicing in the United States than the number actually needed to adequately serve the country’s population, according to estimates from the Health Resources and Services Administration (HRSA). As the existing workforce continues to age into retirement and burn out from increased workloads — and as aspiring physicians choose primary care specializations less frequently — the gap will continue to widen. Projections from the Association of American Medical Colleges (AAMC) predict a gap of 86,000 physicians by 2036.

Despite the increasing need for primary care physicians, the number of nurse practitioners is growing rapidly to meet the need, thanks to the continued expansion of NP graduate programs, even though there is a shortage of nursing faculty, and a comparatively quicker track to licensure. A study from the Association of American Medical Colleges Research and Action Institute estimates the supply of nurse practitioners to rise by 66% between 2024 and 2034.

Expanding Access in Rural and Underserved Areas

While the entire nation is experiencing challenges in primary care availability, certain regions are more profoundly affected. These areas are known as health professional shortage areas (HPSAs), and more than 65 million Americans (20% of the population) live in these areas. HPSAs can occur anywhere, and they cover an enormous swath of the United States. However, rural areas are more likely to face challenges in accessibility, as they account for 66.33% of HPSAs, according to data from the Rural Health Information Hub. Current data shows that more than 13,000 primary care practitioners are needed to fill the HPSA healthcare gap.

The expanding workforce of nurse practitioners is uniquely poised to help meet the needs of Americans living in HPSAs. In fact, research from the National Institutes of Health shows that members of the expanding nurse practitioner workforce are more likely to practice in underserved HPSAs, and nearly 90% of these practitioners would be qualified for primary care settings.

Quality of Care Delivered by Nurse Practitioners

Although addressing primary care needs is vital to the health and well-being of millions of people, providing patients with high-quality care must still be a top priority. Numerous studies have compared the quality and outcomes of care provided by nurse practitioners and physicians — and this research has found that the quality, treatment outcomes, and patient satisfaction with their treatment experiences are comparable between the two groups of providers.

Patient Satisfaction Levels

A review of several studies, published in the International Journal of Nursing Studies Advances, found that patients of nurse practitioners reported either equal or greater levels of satisfaction compared to patients of physicians. The review revealed a positive impact of NPs on treatment outcomes, waiting times, chronic disease management, and cost, helping patients feel satisfied with their overall treatment experiences.

Outcomes Compared to Physician-Led Care

Another study reviewed the findings reported in several research papers that compared the quality of and effectiveness of care provided by nurse practitioners and physicians. The study found that both sets of patients received similar care in terms of quality, safety, and effectiveness. It also revealed that patients experienced similar treatment outcomes.

Economic Benefits of Integrating Nurse Practitioners

In addition to providing high-quality care, nurse practitioners may deliver this high standard of care at a lower cost, providing several economic benefits to patients and the larger healthcare system.

Cost-Effectiveness of Nurse Practitioner Care

Research suggests that, in many settings, nurse practitioners provide comparable services at a lower average cost than physicians. For example, one study looked at various categories of care provided to various patient populations (low risk, moderate risk, and high risk). The research found that the cost of low-risk care from primary physicians was 34% higher than similar care provided by nurse practitioners, and 21% and 28% higher, respectively, for high and medium-risk care.

Another study compared healthcare costs between states that allow nurse practitioners a full scope of practice and those that restrict the scope of practice. It found that states where nurse practitioners are allowed a full scope of practice had 17% lower outpatient costs and 10.9% lower prescription drug costs.

Impact on Healthcare System Efficiency

Primary care nurse practitioners can contribute to greater efficiency and effectiveness across the healthcare system, for example, by reducing hospital readmissions and emergency department visits. Aside from lowering healthcare costs, interventions from primary nurse practitioners have been shown to decrease hospitalizations, lower readmission rates, and reduce visits to the emergency room.

Collaborative Practices Between Physicians and Nurse Practitioners

Collaboration between nurse practitioners and physicians may be particularly beneficial in providing patients with high-quality, accessible care in areas experiencing access limitations. This collaborative model, where nurse practitioners and physicians work side-by-side, is especially necessary in states where nurse practitioners are restricted to a limited scope of practice.

Models of Collaboration in Primary Care Settings

Multiple healthcare providers work together in collaborative care models, striving to improve patient experiences and treatment outcomes.

In functional and integrative medicine, collaborative care is commonplace, with a variety of practitioners (primary care physicians, specialists, nutritionists, physical therapists, mental health professionals, and other providers) working together to provide a holistic approach to wellness, disease prevention, and chronic disease management.

Nurse practitioners collaborating with physicians in a primary care setting may look to the example of these collaborative models for inspiration in the establishment of team-based care.

Overcoming Barriers to Effective Teamwork

Collaborative practice models may be highly beneficial to patients and the healthcare system. However, they are complex and require sophisticated processes and tools in addition to a deep commitment to success from all parties. To facilitate effective teamwork, joint patient care planning, and shared decision-making, collaborative practices should establish written agreements that outline the responsibilities and duties of all involved parties — in addition to documenting policies, procedures, processes, tools, technology, and communication protocols.

Legal and Regulatory Considerations

Nurse practitioners must be mindful of the legality of their practices and ensure they maintain compliance to operate and practice legally. State-level governing bodies are primarily responsible for rules and regulations pertaining to nurse practitioners. However, federal laws and institutional policies may also impact a nurse practitioner’s scope of practice, collaborative agreements, prescribing authority, and insurance reimbursement policies.

State-Specific Practice Authority Laws

Each state has its own Nurse Practice Act that establishes the state’s practice environment and defines the scope of care that all nurses (including nurse practitioners) are authorized to provide. Additionally, state regulations set forth rules regarding nurse practitioner signature authority and licensure requirements.

Nurse practitioners must be familiar and up to date with all the rules and regulations that pertain to their practices to ensure they are operating safely and legally.

Recent Changes and Advocacy Efforts

As the need for primary care persists, the rules and regulations pertaining to nurse practitioners will continue to shift. While some reports are calling for additional education and training requirements for nurse practitioners, others are advocating for increased access in states with restricted and reduced authority. In addition, many nurse practitioner advocacy groups are promoting legislation designed to improve access to care provided by nurse practitioners.

Perspectives on the Future of Nurse Practitioners in Primary Care

As previously stated, a substantial need has been projected for the nurse practitioner profession, specifically in response to the increasing need for primary care physicians. This is expected to make nurse practitioners a key component of the overall healthcare workforce, and new trends are emerging that are poised to impact the industry.

Emerging Trends in Healthcare Delivery

As the healthcare landscape and patients’ needs shift, so does the delivery of healthcare. For example, the COVID-19 pandemic brought about a surge in the use of and demand for remote, telehealth options. Additionally, patients are increasingly looking for greater personalization in their primary care through customized, collaborative, integrative approaches. Nurse practitioners may step in to help provide patient-centered care through a variety of means.

The Role of Technology and Telehealth

During the pandemic, telehealth use increased significantly, spurring the development of new technologies, tools, and platforms to securely facilitate the remote delivery of healthcare services. Nurse practitioners are increasingly using the internet, video chats, messaging, email, and other forms of telecommunication alongside remote health monitoring tools to provide long-distance care and patient education.

 

 

Addressing Challenges in the Field

The nurse practitioner field faces several challenges — such as setting and ensuring a high standard of education and training to preserve the quality of care and patient outcomes. Once licensed, professionals working in the field must navigate the shifting healthcare landscape and changing rules and regulations to establish a successful practice.

Ensuring Quality Education and Training

Since the profession’s inception in the 1960s, several associations and governing bodies have been established to help regulate and improve the industry. They have established standards for curriculum and certification in addition to advocacy and education for legislative bodies.

• The American Association of Colleges of Nursing (AACN) has set high standards for curriculum and education requirements that schools must meet in order to receive accreditation and promote CCNE-accredited nurse practitioner training programs.
• The American Academy of Nurse Practitioners Certification Board is responsible for testing and licensing NPs to ensure and maintain a high standard of competence, knowledge, and training within the industry.
• The American Association of Nurse Practitioners provides advocacy, support, and a wealth of resources for licensed nurse practitioners.

Navigating the Changing Healthcare Landscape

To remain effective and compliant in their practices, nurse practitioners need to stay abreast of the changes that occur in the healthcare industry. This includes keeping up with shifting regulations, industry needs, and patient demands to provide the best possible care. Maintaining association memberships, attending conferences, participating in continuing education, training, and working in a collaborative setting help nurse practitioners keep up with medical advancements, new research, emerging technology, and industry changes.

Ready to Learn More About the Unique Role of Nurse Practitioners in the Healthcare Industry?

At Post University, students may discover the benefits of nurse practitioners in primary care and the greater healthcare industry through our online Master of Science in Nursing program.

With nurse practitioner specialization options in areas of study such as family medicine, adult gerontology, and psychiatry and mental health, students explore the knowledge, skills, and focused training they need to thoroughly understand what it means to be a nurse practitioner in the context of primary care and clinical settings.

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Thank you for reading! The purpose of this blog is to provide general information to the reader, and as such, this information may not directly relate to programs offered by Post University.

Please note jobs and/or career outcomes highlighted in this blog do not reflect jobs or career outcomes expected from enrolling in or graduating from any Post program.