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Evidence Supporting NP Clinical Outcomes and Cost Effectiveness

The percentage of the U.S. population 65 years of age or older reached 16.8% in the year 2020; according to the 2020 Census information, the number of people in this group grew almost 5 times faster than the total population between the years 1920-2020 (United States Census Bureau, 2023). It takes nearly a decade for physicians to complete their education and training; the lengthy educational journey of physicians, coupled with the growing population of aging adults needing an increasing amount of care, is expected to contribute to a projected shortage of between 37,800-124,000 physicians within 12 years (Robeznieks, 2022).

Nurse Practitioners are utilized in almost every area of medicine in the United States from acute care settings (ICU, ER, Urgent Care, etc.), to outpatient clinics, educational institutions, and more. There has, however, been enormous controversy regarding the quality-of-care patients receive from NPs compared to physicians, and whether NPs are qualified to provide care that overlaps into the medical domain. There is a lack of consistency between states (and even between different hospital systems in the same state) regarding NP practice allowances and supervision requirements with some states allowing NPs to practice independently immediately after becoming licensed, some states requiring a transition period prior to obtaining independent status, and some that do not ever permit NPs to work independently. In California, for example, prior to 2020 when Governor Gavin Newsom introduced Assembly Bill 890, NPs in California were restricted to practice under the direct supervision of a physician or surgeon, required to operate under standardized protocols, and were not permitted to perform any duties beyond the scope of practice of a registered nurse (RN) without the use of these predetermined protocols (State of California DCA, 2011).

The American Medical Association (AMA) has pushed back against the movement to grant NPs full practice authority, arguing that NPs don’t have adequate training to operate independently, that NPs provide a lower quality of care, and increase health care costs in the Emergency Department by approximately 7% (O’Reilly, 2023), however, this argument is staunchly different than the results published in current studies. Current research has found that the outcomes of patients under the care of NPs is comparable, or in some cases, more favorable, compared to the outcomes of patients receiving care from physicians (American Association of Nurse Practitioners, 2020). Patients under the care of NPs have been found to have fewer unnecessary hospital readmissions, fewer preventable initial hospitalizations, higher patient satisfaction rates, and fewer unnecessary ER visits compared to patients managed by physicians. Additional findings from these studies demonstrated similar quality of care in the management of chronic diseases between NPs and physicians with slightly lower costs associated with NP managed care (Liu et al., 2020). Another study noted that the cost of NP managed care for complex patients was approximately $2,000 lower than physician managed care (Hegwer, 2019).

Marketable Nurse Practitioner Skills for Effective Practice

In addition to the skills acquired during the time spent in an accredited nurse practitioner program (clinical assessment skills, procedures, critical thinking and synthesizing appropriate treatment plans), successful nurse practitioners will need to possess excellent interpersonal skills (communication, understanding, building trust and rapport), conflict resolution skills, and the ability to integrate into their new environment and role, including the ability to work well with all members of the interdisciplinary team. Other necessary skills include effective time management, flexibility/adaptability to change or unpredictable situations, knowledge of proper charting and documentation procedures, effective leadership skills, knowledge of state and federal laws and scope of practice, and self-awareness (Jacobson, 2023).

While the above skillset may seem daunting, I believe one of the most important things to remember as a novice NP is to always ask for help; new NPs should be (as stated above) self-aware and “know what they don’t know”. No practitioner will ever know everything, and this is not a job that can be done alone; finding a work environment that offers adequate support and resources and understands the need for adequate supervision in the initial transition period is imperative for a successful transition to practice.

Thoughts About Moving into Active Practice

During my time in this program, I have alternated between excessive fear of inadequacy, excitement, and varying levels of confidence in my capabilities as a nurse practitioner. I have reflected on my initial years as a registered nurse and have tried to remind myself that I felt the same way then as well, and that with experience, confidence grows. My first job as a nurse was in the ICU in a small, 80-bed, rural hospital that cared for extremely sick and complicated patients, despite having a lack of adequate resources. My first day ended in tears and I honestly considered quitting nursing all together; I worked in that hospital for 1 year and left after being hired for an ICU position in a large hospital system in the city. When I transitioned to my new hospital and saw the difference in the availability of resources and support and compared this to my previous job, my passion for nursing was renewed and I felt such a sense of relief and safety; and honestly, I think any job would’ve felt like a piece of cake after my first experience!

I wanted to share this story because it made me realize the importance my work environment has on my success; I can want to succeed with all my heart, but if I work in an environment that does not support learning and success, this can have a negative impact on my efforts. I know that while I must be committed to continuous learning and improvement throughout my career, I must also protect myself, so I can protect my patients.