The Role of the Nurse Practitioner in Primary Care: 45 years of practice Judy Didion PhD, RN

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1 The Role of the Nurse Practitioner in Primary Care: 45 years of practice Judy Didion PhD, RN

2 NP s are a vital element of the primary care workforce with a major role in making high-quality, patient centered health care available to the broadest range of consumers. American Academy of Nurse Practitioners 89% of nurse practitioners are prepared with a primary care focus serving the adult, elderly, family, woman and children.

3 They are nurses who are educated at the academic graduate level Didactic and clinical courses that include intense clinical practice hours Progression is based on clinical primary care competency achievement not hours spent in a clinical rotation In Ohio, they complete additional education and an externship to receive a Certificate to Prescribe They are prepared to care for populations across settings which include: First contact for undifferentiated conditions Management of acute and chronic conditions Health promotion and care coordination

4 Diagnose and Manage acute and chronic conditions Emphasize disease prevention and health promotion Services include interpreting diagnostic tests, prescribe medications and nonpharmacological treatments, teach, counsel and collaborate with other health care providers

5 Compared to other Primary care providers NPs are more likely to practice in rural communities and serve the underserved populations such as low income, uninsured and disenfranchised.

6 Outcome evaluation and research findings conclude there is extensive evidence that NP s provide high quality care at a lower cost (Bauer (2010), Office of Technology Assessment (1981), Spritzer (1991),Sears, Wickizer, Franklin, Cheadie and Berkowitz (2007) and more). Over 100 studies support the quality of their care. The recent IOM Report The Future of Nursing: Leading Change, Advancing Health validates the proven track record of Advanced Practice Nurses in providing care across populations. American Academy of Nurse Practitioners

7 In Ohio there are approximately 9,000 APN s licensed to practice. These include Certified Nurse Practitioners, Certified Nurse Midwives, Clinical Nurse Specialists and Certified Nurse Anesthetists. The Nurse Practitioner is the fastest growing primary care workforce in the US.

8 Enrollment Graduation

9 Approximately 5,440 NP s practice in Ohio This equals 3% of the total number of nurse practitioners in the USA

10 There are 47 NP s per 100,000 people in Ohio. We rank 42nd in the USA including the District of Columbia. Compared to New Hampshire, Washington DC, Massachusetts and Alaska who have over 100 NP s per 100,000 people. The 2012 Pearson Report, The American Journal for Nurse Practitioners, NP Communications LLC

11 Ohio APN Schools Capital University : Clinical Nurse Specialist Adult, Gerontology Case Western Reserve : Nurse Practitioner (adult, gerontology, family, pediatric, neonatal, woman s health and population Cedarville University : Family Nurse Practitioner Franciscan University of Steubenville : Family Nurse Practitioner Kent State University: Adult, family, pediatric, mental health, woman s health, geriatric, acute care Nurse Practitioner Lourdes University College of Nursing: Nurse Anesthesia Malone College - School of Nursing : Family Nurse Practitioner and Adult Clinical Nurse Specialist Mount Carmel College of Nursing : Family Nurse Practitioner The Ohio State University : Nurse Practitioner (adult, family, oncology, neonatal, midwife, pediatric, mental health and woman s health Ohio University : Nurse Practitioner (family, acute care)

12 Ohio APN Schools Otterbein College : Family Nurse Practitioner and Nurse Anesthesia University of Akron : Nurse Practitioner (Psychiatric, Family) University of Cincinnati: Nurse Practitioner (adult Ambulatory and Acute care, family, occupational health, pediatric) Ursuline College : Nurse Practitioner (Adult and Family) Wright State University : Nurse Practitioner (Adult, Gerontology, Family, Pediatric Youngstown State University: Clinical Nurse Specialist and Nurse Anesthesia University of Toledo: Nurse Practitioner (Adult, family, Pediatric), Mental Health CNS Xavier University: Family Nurse Practitioner

13 An aging nursing workforce decreasing the supply Greater demands and complexity in healthcare demanding higher educated nurses and coordination of care An aging population in general increasing the demands for primary care

14 Shortage of Doctoral prepared Nursing Faculty Discrepancy in pay for service vs. academics Educational level of the current workforce. The supply of BSN prepared nurses to enter graduate education (Ohio Action Coalition and the BSN in 10 initiative) Workforce Development Funds to support NP program development in Universities and student tuition loan and scholarship programs

15 Nurse Practitioners are Underutilized to their full Scope of Practice Recognition and utilization of NPs as PCPs in communities Recognition by insurance for reimbursement Inconsistent use of NPs and their autonomy

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17 Interdisciplinary Collaboration Diverse and Innovative problem solving Legislative support for educational funding Working as Teams for Care Coordination and Planning Utilization of all Care Providers to the full extent of their education and training