Have Nurse Practitioners Reached a Tipping Point?: Interview of a Panel of NP Thought Leaders

Peter I. Buerhaus, PhD, RN, FAAN


Nurs Econ. 2010;28(5):346-349. 

In This Article

Turf Battles

Iglehart: Is there a schism between organized medicine's relentless efforts to limit the scope of practice for NPs and other providers and what you find on the ground where NPs are collaborating well with physicians?

Hanson: Physicians and NPs at the grassroots have worked out a comfortable, collaborative, professional relationship that benefits both. But, the relationship at the policy and organizational state and national levels is much more divisive.

Pilon: I think you are exactly right, John, and I will give you some numbers. Vanderbilt directly employs over 400 APNs to help manage day-to-day care in our medical center. In addition, the school of nursing and school of medicine employ NPs as faculty who are billing services under the auspices of their respective practice plans. NPs work in specialty and primary care practices, and acute care NPs are the backbone of the ICUs here and in many other hospitals. We have a thousand physicians and a very powerful administration who have said, "NPs are important in what we do." But, at the state political level, the story is much different; that is where we experience conflicts with organized medicine who wish to regulate our practice.

Iglehart: You have all been in the game for a long time and if you compare today to 10 years ago, there has obviously been evolution and some progress in the roles of APNs, but has it been enough? Are you discouraged about the progress that has been made or do you feel emboldened?

Hansen-Turton: Tremendous progress. I think to some degree the stars are in alignment now to really make a mark for NPs and the advanced practitioner's profession. But, we are at a tipping point.

Barton: I agree, especially with the looming primary care shortage. We are at the point now where NPs have demonstrated their value and achieve comparable outcomes of care and should be a major player at the table figuring out how to meet the care needs of patients across America.

Hanson: Yes, marked progress although we still have a ways to go. It is gratifying to see NPs are slowly being invited to the table to develop practice guidelines and included in primary care solutions. I think the new model regulation that will bring states together from a regulatory standpoint will have a great impact.

Pilon: I see the same pattern, and in terms of the tipping point, I point out the Tennessee experience when the state's Medicaid program (TennCare) began nearly 20 years. That was exactly the catapult that broke all kinds of barriers constraining APNs in the state.