Emergency Nurse Practitioner, St. Mary Medical Center, Long Beach, CA
Emergency Clinical Nurse Specialist, Proehl PRN, LLC, Cornish, NH
Disclosure: The editors report no conflicts of interest.
On January 1, 2013, the American Academy of Nurse Practitioners (AANP) and the American College of Nurse Practitioners (ACNP) merged to form a new organization called the American Association of Nurse Practitioners (AANP). This new association is now better positioned to advocate for nurse practitioners (NPs) both nationally and internationally.
There is strength in numbers. The new AANP brings the total number of association members to more than 40,000 NPs. In 2001, there were 87,000 NPs in the United States; today there are 155,000 NPs. This represents an 80% increase in the past decade. Approximately 11,000 NPs graduated from NP programs in 2012 (AANP National Database, 2011). As more new NPs graduate, the AANP will have an opportunity to strengthen their membership.
Although there is strength in numbers, there continues to be barriers to NP practice, and these barriers must be addressed. These barriers include the provider shortage, practice variations state by state, and the role of NPs in the Affordable Care Act (ACA).
Primary Care Provider Shortage
The shortage of primary care physicians continues. This shortage will exceed 52,000 physicians by 2025 (Annals of Family Medicine, 2012). The newly formed AANP concur that NPs and physician assistants are providers who also have the education and experience to meet the needs of this patient population. However, the American Academy of Family Physicians (AAFP) continues to advocate for “physician-only” leadership of health care teams and have concluded that NPs should not practice independently. In a statement made after the recent merger, however, the AAFP remarked, “We look forward to working with them (NPs) and other health care professional organizations to improve the quality of care for all patients.” (Frelick, 2012).
Practice Still Varies by State
Nurse practitioners have been working toward consistent national guidelines for scope of practice. According to Tay Kopanos, Director of Health Policy and State Government Affairs for AANP (personal communication, January 18, 2013), currently 16 states and the District of Columbia have independent NP practice. Some states continue to require physician involvement in plans of care, whereas other states allow some form of independent practice. However, there are states where NPs are still not allowed to prescribe independently or even sign death certificates. In addition, some states allow NPs to prescribe only certain classes of drugs independently.
On a federal level, the ability to order home health care for patients is crucial. Advanced practice registered nurses presently can order home care only through physicians to obtain reimbursement from Medicare. This is an area where NPs are working in their legislators to effect change and streamline care.
Advanced practice registered nurses are also working toward practicing to the full extent of their scope in every state in the United States. This initiative has elicited protests from some physician groups who state that NPs should not be granted independent practice.
Affordable Care Act Mandates
In the near future, it is estimated that more 30 million more patients will enter the health care system in the United States, as insurance coverage is mandated for all Americans by the ACA. Nurse practitioners can provide cost-effective comprehensive quality health care to these patients. (Health Affairs & Robert Wood Johnson Foundation, 2012). With the implementation of the ACA, states are planning health exchanges primarily for individuals without health care insurance and small businesses that currently do not provide insurance for their employees. Nurse practitioners are poised and ready to step up to the plate and fill this health care gap.
SO-UNITED WE STAND!
The formation of the new AANP is strategic and far-reaching in that it will heighten the influence of NPs nationally as they reposition themselves with players (patients), payers (insurers), and other health care providers as part of a united front. The merger into one organization sends a clearer message to these groups. It is an exciting time for NPs with the new AANP. United we stand. Now, let's get to work!
—K. Sue Hoyt, PhD, RN, FNP-BC, CEN, FAEN, FAANP, FAAN
Emergency Nurse Practitioner
St. Mary Medical Center
Long Beach, CA
—Jean A. Proehl, RN, MN, CEN, CPEN, FAEN
Emergency Clinical Nurse Specialist
Proehl PRN, LLC