A nurse practitioner is an advanced practice nurse who has more clinical independence and authority than some other types of nurses such as registered nurses (RN) or licensed vocational nurses (LVN). Because NPs have a broader scope of practice than many other nurses, they are sometimes classified as a “mid-level” provider. However, many consider that term to be obsolete or even derogatory, as NPs provide a high level of quality care, and many are able to practice on almost a completely independent basis in some states.Due to the growing demand for healthcare providers, and an increase in the insured population of the U.S. following the implementation of health reform, nurse practitioners are seeing a surge in popularity since the passage of the ACA in 2010.
Depending upon the state laws and regulations governing the practice of NPs in a given state, nurse practitioners can diagnose and treat patients much like physicians can, and they can bill health insurers for their office time and procedures, although sometimes at a lower reimbursement rate than physicians. Therefore, NPs are direct revenue producers for practices and hospitals, and as such, they have even more job security than other types of nurses and can demand higher salaries. NPs allow a medical practice to treat more patients and become more efficient without adding a proportionate amount of overhead expense to the practice.
Nurse Practitioners as Physician-Extenders
Although it’s not a popular term for many, some consider NPs to be “physician extenders,” because, in many cases, NPs can provide many of the same services and care as a physician. Particularly in primary care, some healthcare facilities are now hiring NPs to fill needs for primary care providers when they cannot obtain a primary care physician to fill the need.
Some people in the medical community and patient community feel that these “physician extenders,” as NPs are sometimes called, are the answer to the growing physician shortage. On the flip side, other healthcare experts feel that NPs should not be given the same level of independence as a physician, due to the relatively brief education and training period of NPs, as compared to physicians who must complete many more years of school and residency training before treating patients.
Clinical Authority and Autonomy of Nurse Practitioners
Nurse practitioner laws vary by state; therefore NP practices vary in the level of autonomy and clinical authority they hold. In some states, Nurse Practitioners can practice completely independently of physicians, treating patients and prescribing medications as a physician would. In other more restrictive states, nurse practitioners must work in a practice with a physician who can essentially “sign off” on all of the diagnoses, procedures, and prescriptions of the nurse practitioner. Since the implementation of health reform in 2012-2014, many states are lobbying for more autonomy for nurse practitioners so that NPs can more freely help provide healthcare to more patients in those areas most in need of care.
As with most advanced practice nurses, most nurse practitioners hold a bachelor’s degree in nursing (BSN) and often are already certified as an RN. The next step is to obtain a master’s level education in nursing with an accredited NP track and area of specialization. NPs typically will specialize with a focus in a particular medical specialty, disease area, or patient population. All of the education must be obtained at an accredited nursing school.
According to the Medical Group Management Association (MGMA), some of the most common areas of specialization for NPs are Cardiology, Gerontology/Elder Care, Pediatrics, Obstetrics and Gynecology, Primary Care, Gastroenterology, and Oncology.
According to the American Association of Nurse Practitioners, (AANP), salaries for nurse practitioners increased ten percent (10%) from 2011-2015. Again, this is likely due to the rise in demand for non-physician advanced practice providers such as NPs and PAs also.According to the AANP’s 2015 salary study, the average base salary for a full-time nurse practitioner who works more than 35 hours per week is $97,083, (up from $91,310 in 2011).Total income for full-time NPs averages about $108,643, according to the 2015 salary survey of about 2,200 NPs. This represents a considerable increase from the average total income in 2011, of $98,760.