Expanding the Scope of Advanced Practice Registered Nurse Practice Research Paper

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Primary Care: Advanced Nurse Practitioners

In recent years, there has been a notable shortage of primary care physicians due to a number of systemic factors within the healthcare system, including the rising cost of medical school, which is driving many young physicians to choose specializations rather than the field of primary care. Yet primary care is on the front lines of protecting the health of patients. Primary care can prevent the festering of chronic diseases and is less expensive and less intrusive to the healthcare system and the patient as a whole than is secondary or tertiary care. This paper will examine the existing literature on the role of nurses in primary care and evaluate the role nurses can play in improving this area of medicine.

Synopsis of Studies

According to a 2012 study in Health Affairs journal, physicians groups have strongly opposed the expansion of the role of the advanced nurse practitioner (APRN) into primary care, arguing that physicians have unique capabilities that cannot be replicated and this will threaten patient safety. However, the objectivity of this claim has been questioned, given that a systematic review of 26 studies “found that health status, treatment practices, and prescribing behavior were consistent between nurse practitioners and physicians” (“Nurse Practitioners and Primary Care,” 2012, par. 13). In fact, arguably, the use of physicians for routine primary care overtaxes the healthcare system’s scarce resources of physicians, which can be better employed in other areas.

Unfortunately, many states still limit the scope of APRNs. But given that it takes a much shorter period of time to educate an APRN than a physician, the journal Health Affairs argues that since there is no substantive difference in quality of care or patient satisfaction and considerable cost savings and benefits, expanding the scope of primary care on a nationwide basis is vital to address the shortage. A study by Bauer (2010) likewise confirmed that, in the wake of the passage of the Affordable Care Act (ACA) which, if it continues to stand as a matter of law, will increase the demand for primary care physicians as more and more individuals have health insurance and see providers on a regular basis, APRNs offer a cost-effective alternative to primary care physicians.

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Although there still is a shortage of nurse practitioners, the rate of APRNs is still projected to grow in the future at a faster rate than primary care physicians. As noted by Auerbach (2012), the number of nurse practitioners is projected to grow by 13% by the year 2025.

Qualitative research has also been found to validate the inclusion of APRNs. A study by Poghosyan (et al. 2017) of primary care NPs recruited from the Massachusetts Coalition of Nurse Practitioners found that the distinction between the role of NP and physician was clearly defined and that they were able to function effectively within their scope of practice without encroaching upon the physicians’ exclusive roles under the law. When APRNs are supported, their roles with other healthcare providers were described as being characterized by “favorable relationships, characterized by ongoing communication, trust, respect, and willingness for collaborative practice (Poghosyan et al., 2017, par.15). But in Massachusetts, APRNs are given wider scope of practice than in many other states. As noted by Xue (et al. 2016) in a systemic review of state laws, scope of practice laws are one of the most critical barriers in expanding APRN’s ability to practice to the full range of their ability, regardless of individual institutional support.

This is significant, given the need for interdisciplinary communication in healthcare and is testimony to the importance of dialogue rather than hostility between providers. Although the results from qualitative research are not always widely generalizable, the Poghosyan (et al. 2017) study highlights how positive relationships between APRNs and patients can be fostered within primary care without threatening physicians. Massachusetts has also had universal healthcare for all of its citizens for longer than most of the nation and thus functions as a useful test case example of cost savings in using APRNs.

This qualitative study likewise confirmed an earlier quantitative study by Poghosyan (et al. 2015), which compared practice environments in Massachusetts and New York state using the Nurse Practitioner Primary Care Organizational Climate Questionnaire in which NPs reported having….....

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