2 days ago
Nurse Practitioner Identity and Recognition Key to Success
Over time, the public has begun increasingly recognizing and embracing nurse practitioners as healthcare providers.
Perhaps that's not surprising, with more than 385,000 licensed nurse practitioners delivering care in the United States. The US Bureau of Labor Statistics even includes nurse practitioners among what it says will be the top 20 fastest growing occupations in the United States from 2023 to 2033. And nurse practitioners are increasingly common in rural areas, where physician shortages persist.
'I think we've come a long way,' said Ulrike Muench, PhD, MSN, an associate professor at the University of California, San Francisco's School of Nursing. 'Patients are more used to seeing nurse practitioners now for their primary care needs.'
She continued, 'But at the same time, I think many times that people are not aware if they are seeing a doctor or seeing a nurse practitioner.'
Many experts agree there's still room for improvement when it comes to nurse practitioners getting recognized for their unique role.
'I think we should be recognized as nurse practitioners, practicing at the full scope of our licenses, practicing as an integral part of the healthcare team,' said Kelly Keefe Marcoux, PhD, CPNP-AC, PPCNP-BC, CCRN, an executive board member for the National Association of Pediatric Nurse Practitioners.
Creating a New Professional Identity
The first people who must recognize the unique identity of nurse practitioners are the people who become nurse practitioners themselves. Although their role is informed by the nursing perspective, it's still a new role. And, as they transition into it, they have to make a mental shift.
'You're so invested as a bedside nurse. You're very competent at that point. You know what you're doing and the expectations and how to deliver on them,' said Keefe Marcoux. 'Then you become a nurse practitioner and all of a sudden, your responsibility shifts.'
Marcoux, who has been a pediatric nurse practitioner for 30 years, remembers making that shift. For example, instead of maintaining central lines, Keefe Marcoux found herself inserting central lines. She was no longer giving antibiotics; she was deciding when antibiotics were necessary for patients and which antibiotics to prescribe.
'It's a very different perspective,' she said.
Rhoda Owens, PhD, RN
It does take some time to make that mental shift, noted Rhoda Owens, PhD, RN, president of the International Society for Professional Identity in Nursing and an associate professor at the University of North Dakota. Her own research found that it took new rural nurse practitioners a year after finishing their formal education to begin to really feel like a nurse practitioner.
Plus, as the authors of a 2021 study in Nurse Education in Practice noted, maturity in thinking and experience will continue to drive a nurse's professional identity over time.
'[P]rofessional identity is a dynamic and flexible process leading to a growth in understanding about professional practice and a commitment to the profession,' they wrote.
Finding a mentor can also help nurse practitioners as they develop and nurture their professional identity, according to Anne Derouin, DNP, APRN, CPNP-PC, PMHS, vice dean of academic and student affairs and clinical professor at the Duke University School of Nursing in Durham, North Carolina.
'This mentor could be a physician colleague who says, 'I want you to come work with me.' But it can also be another advanced practice nurse who's already in that role,' she said. 'They should definitely think of their (nursing school) faculty as mentors, too.'
'We're Not Physicians'
One challenge that has persisted: the comparison of nurse practitioners to physicians.
Both are considered providers, in that they both provide patient care. But the training requirements are different, and the approach toward care is different.
Carole Mackavey, DNP, MSN, RN, FNP-C
'We're not physicians,' said Carole Mackavey, DNP, MSN, RN, FNP-C, master's program coordinator and the post master's nursing education track coordinator at the Cizik School of Nursing at UTHealth Houston, Texas. 'We don't try to be physicians, and we don't think we are. But we can fill a role in primary care as a very valuable member of the healthcare team.'
Added Keefe Marcoux, 'We are our own entity, providing a very valuable service.'
Many nurse practitioners explain that they consider themselves partners with physicians, not replacements.
'We are in this together, and we have a unified goal of providing care to everyone who needs it,' said Derouin.
She often explains that partnership to patients and families, letting them know if they want to see a physician, she can connect them with one.
Healthcare system leadership can help alleviate some confusion and ensure that nurse practitioners are recognized for what they do — and that patients understand that nurse practitioners are educated and prepared to provide care.
'I think it's really important that the facility they work for portrays them as a provider,' said Owens. That includes making sure that everyone, from the leaders to the physicians to the medical assistants to the receptionists, understands and uses the appropriate language to refer to nurse practitioners.
'I think just using that terminology will help,' Owens said.
Another Complicating Factor
Another complicating factor is the lack of consistency for what nurse practitioners are legally able to do, noted Mackavey.
'There is no standard scope of practice,' she said. 'It varies from one state to another.'
Nurse practitioners now have full practice authority in 28 states, meaning they're not required to work under a supervising physician. But even in those states, they are not guaranteed equal reimbursement for the same services as provided by a physician.
In the wake of COVID-19, many began calling for reimbursement parity for nurse practitioners, noting that the pandemic illustrated how the temporary removal of restrictions to practice led to greater access to care for more people.
For example, in 2022, the National Association of Pediatric Nurse Practitioners issued a statement, saying, 'NPs are recognized as independently licensed providers of primary, specialty, and acute care and have demonstrated the ability to provide high-quality health care and incur the same overhead costs as physicians providing care to patients. Therefore, it is imperative that NPs be reimbursed commensurate with physicians for the services they deliver across all federal, state, and health care agency payers and settings, including telehealth.'
Advocates continue to call for legislation to enable nurse practitioners to be able to practice at the top of their scope of practice and training, which research suggests is necessary to provide access to quality healthcare. Their education and preparation are what should enable them to have full practice authority, they say.
'It should not vary by state, but rather the education, certification, and experience of nurse practitioner practice (that) prepares them for full practice authority,' said Keefe Marcoux.
