Hospital beds are nearly full and waiting times in emergency departments across the U.S. are often untenable. However, April Kapu, DNP, president of the American Association of Nurse Practitioners, recently told Becker's that nurse practitioners can provide solutions for hospitals facing clinician shortages.
That said, there are two issues getting in the way of hospitals fully employing nurse practitioners as a meaningful solution. Dr. Kapu said there is not widespread understanding among hospitals and other healthcare practitioners about the full value nurse practitioners can provide — especially in acute care settings and rural hospitals, where access to care is reaching critically low levels.
The second reason hospitals are not looking to nurse practitioners to fill provider gaps and augment medical teams is because there are not enough to meet demand.
While nurse practitioner is at the top of U.S. News and World Report's list of best healthcare jobs, not enough people are pursuing this career, Dr. Kapu said, adding that this is true when it comes to existing nurses and students entering the healthcare field.
"NPs are stepping up to meet some of the big challenges that we're seeing in healthcare today," Dr. Kapu said. "But, still, over 99 million Americans lack access to primary care. Waiting times in hospitals are longer than ever before. NP is a top job choice because I believe it offers more opportunity to achieve work-life balance. Now we have to work on getting more people to pursue this career option."
Dr. Kapu's 30-year healthcare career includes 18 years as an acute care nurse practitioner. She spoke with Becker's about the importance of making sure nurse practitioners have full practice authority in all states, ways to improve the working relationship between physicians and nurse practitioners and how the AANP is working to spread the word about the capabilities and efficacy of nurse practitioners in primary and acute care settings.
Note: Responses were lightly edited for clarity and length.
Question: What would obtaining full practice authority in all states mean for healthcare worker shortages and, ultimately, patients?
Dr. April Kapu: Right now, 26 states and Washington D.C. have granted full practice authority to NPs. This means NPs can practice to the fullest extent of their education and training in those states.
We know that NPs contribute substantially in whatever setting they are working in — especially rural settings and in providing primary and acute care. This has had an impact on improved patient care outcomes. We believe that giving NPs full practice authority will increase access to care for all patients. Further, it will offer patients more choices when it comes to seeking healthcare.
During the pandemic, we saw states putting emergency waivers in place to allow NPs to step in and provide care. During that time, four states — Massachusetts, Delaware, Kansas and New York — updated their laws to provide full practice authority to NPs.
The AANP is working with states that have not updated their full practice authority laws to remove outdated barriers to NP care.
Q: Why has it been so difficult to get nurse practitioners full practice authority across the U.S.?
AK: All NPs are required to meet national standards regarding accredited training. NPs are nationally board certified. However, decisions about licensure authority for NPs is the responsibility of individual states. There are some states that still have outdated laws in place, which are stopping NPs from being able to provide the care they are trained to provide in the places it's most needed.
We need to modernize our laws so that we can provide the care that's necessary to patients everywhere. I believe removing these outdated barriers will have an immediate increased positive impact on NPs being able to provide timely, high-quality care.
Q: How can nurse practitioners best help hospitals manage clinician shortages?
AK: NPs are able to provide primary care, including immunizations, recommended routine screenings and regular management of chronic disease conditions for all patients. If hospitals rely on the high-quality healthcare services NPs can provide, the result will be fewer patients going to the emergency department because they are being cared for on a regular basis.
To be clear, many hospitals and health systems are already doing this. They are open to exploring every possibility to include NPs. These efforts need to be expanded.
Q: Do you think nurse practitioners get the respect and recognition they deserve from physicians?
AK: It's important that we have a highly collaborative environment where we can work together. Every member of the team needs to be stepping up and working to the fullest of our education and training.
Healthcare disparities are restricting access to care. To solve these challenges, we ask all healthcare providers to look at the data that demonstrates NPs' outcomes. It is important that others recognize and acknowledge the effectiveness of our education and training. If they don't already know that we are nurses with advanced education and training and can provide care, they need to be educated about what we can do.
NPs are highly collaborative; we coordinate care and we also are very capable of diagnosing and treating patients, ordering and interpreting tests and creating a plan of care for our patients.
Q. What are some solutions being advocated by the AAPN to overcome hospital clinician burnout?
AK: We are encouraging more NPs to work in hospitals so the staffing challenges can ease up. But recruiting NPs is another major challenge. NPs could help in all departments — emergency, surgical, ICU services, medical services and hospitalist services.
At this point, there are 355,000 nurse practitioners in the United States. That's a 9 percent growth rate since this time last year. The industry is estimated to grow 46 percent between 2021 and 2031. While more people are pursuing NP careers, we need more funding from the federal government to support the necessary education. I would love to see grants and scholarships offered by the government that mirror the efforts of the American Association of Nurse Practitioners.
Q: What is the AANP doing to encourage more people to pursue a nurse practitioner career?
AK: We have scholarships available for nurse practitioner students. In fact, we just opened our most recent applications for our next round of scholarships and grants.
We want to make sure that anyone who wants to pursue a career as a nurse practitioner has access to achieving those goals. We also encourage future NPs or people who are thinking about entering the field to find ways to shadow a current nurse practitioner so they can find out if this is really the career for them.