Nurse Practitioners (NPs)

History

The nurse practitioner movement began in the United States in the mid-1960s, with the preparation of pediatric nurse practitioners at the University of Colorado. Initially, the profession was developed in response to a shortage of physicians, especially in rural areas where healthcare access was limited. Over time, other states also began nurse practitioner training programs, and their role in healthcare greatly expanded. Today, nurse practitioners are integral to all kinds of practices, including those located in underserved, rural, and inner-city areas and in private collaborations, independent practices, hospitals, and continuing care and nursing home facilities. Additionally, other countries such as the United Kingdom, Canada, Australia, and New Zealand have embraced nurse practitioners.

Clinical Roles

The most significant clinical role of nurse practitioners relates to their professional efficacy and autonomy in practice. They can diagnose, treat, prescribe medications, order diagnostic testing, and refer patients to other healthcare professionals. Nurse practitioners monitor and adopt evidence-based practice and bring the framework of prevention, early intervention, and patient/family health education into their work. In the United States and other countries, nurse practitioners [Page 855]have a specific license for practice. In the United States, most such licenses are granted and supervised by a state's board of nursing. This licensing distinguishes nurse practitioners from physicians' assistants, who typically practice under direct supervision of physicians and whose practices are authorized by a state's board of medicine.

While nurse practitioners can and often do work independently, most have collaborating physicians who review cases and provide ongoing consultation. The nursing board in a particular state may or may not require the existence of a relationship with a physician colleague. However, most advanced-practice nurses and physicians alike find the relationship stimulating and informative. The teamwork nature of such collaboration often is visible in primary-care practices or hospital specialty services, where physicians and nurse practitioners work in the same setting. Patient satisfaction and patient outcomes in these collaborative practices are similar to or better than in many traditional, physician-only practices.

Preparation

Nurse practitioners are prepared at the master's level or beyond. The educational programs are designed to make the graduate eligible for certification as a nurse practitioner in a specific area, such as care of families, children, or adults, in psychiatry, or in women's health. Certification is gained by completing the requisite educational program and passing an examination offered by specific certifying bodies. These entities are generally associated with a specific practice, such as midwifery. A significant educational requirement is actual practice under the close supervision of a licensed and certified nurse practitioner, with a minimum of 1 year of practice, or a physician. Four hundred or more hours of such practice are required. Some specialties require additional training, such as working with a minimum number of mothers in childbirth to qualify in midwifery.

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