Nurse Practitioners in Community Health Settings Today
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During a typical week as a Family Nurse Practitioner, I provide primary care to uninsured immigrant patients on a mobile van, teach an undergraduate nursing course entitled Community and Environmental Health Nursing at the Catholic University of America, screen Hispanic women for breast and cervical cancer through Celebremos La Vida (Celebrate Life) at Georgetown University's Lombardi Cancer Center and lead continuing professional education programs for health care providers who work with the poor and underserved through the Association of Clinicians for the Underserved (ACU)'s Pediatric Asthma Prevention Project and Early Childhood Caries Prevention Project.
As a Family Nurse Practitioner, I am trained for a variety of practice settings, including primary care, teaching, research, and management. It is this flexibility and variety of work that I thrive on and that allows me the opportunity to be part of many exciting public health projects, while still having time for my family and community. This varied skill set allows me and other Nurse Practitioners to take on multiple roles in the evolving health system.
The ACU is a non-profit, transdisciplinary organization of clinicians, advocates, and health care organizations united in a common mission to improve the health of America's underserved populations and to enhance the development and support of the health care clinicians serving these populations. The ACU defines transdisciplinary care as a holistic approach to patient assessment and treatment through a highly collaborative team of health care professionals.
This approach only allows health care professionals other than physicians increased decision-making powers in patient care; furthermore, through continuing cross-disciplinary education and regulated overlapping roles, greater efficiency in patient care can be achieved. This collaboration is beneficial to patients and could be a cost-effective way to improve the U.S. health system, and to expand it to treat those who currently go without regular health care. Furthermore, for people living with long-term illnesses such as HIV, hypertension and diabetes, Nurse Practitioners (NPs) can help provide long term patient education and preventive care. [End Page 1]
Training and Roles of Nurse Practitioners
An NP is a registered nurse (RN) with additional training, usually at the masters level (some NPs have certificates, but those programs are being phased out). The graduate training builds on nursing roles in patient advocacy and education, and incorporates physical assessment and diagnostic skills, along with management of acute, chronic and episodic diseases. This includes taking a patient history, performing a physical exam, ordering and interpreting laboratory tests, providing medication, referring to specialists and promoting healthy lifestyles.
The first NP program dates back to 1965 in Colorado where nurses were trained to provide pediatric care to underserved populations In 1996, it there were estimated to be over 40,000 NPs, and by 2000 that number had climbed to over 62,000. Official figures for 2004 are not yet available, but national organizations estimate the number is over 100,000.1
Some NPs specialize in areas such as women's health, pediatrics, school health, psychiatry, neonatology, and oncology, while others seek a broader focus in family medicine. While NPs work in specialty private practices and in-patient units, this article focuses on roles and opportunities for NPs in the community health setting.
Like members of many other professions, NPs are regulated by the state, in accordance with state laws, and through certification with national credentialing organizations. Some states allow NPs to practice completely independently, others require a collaborative agreement with an MD that defines the scope of practice for that work site, while others do not recognize practice by NPs at all. While the level of prescriptive authority also varies by state, NPs have prescriptive authority in most states, including the opportunity to apply for a Drug Enforcement Agency (DEA) number, allowing them to prescribe controlled substances. One of the many policy issues NP organizations are focusing on is that of allowing managed care patients to choose an NP as their primary care provider.
Nurse Practitioners, along with Physician's Assistants (PAs) and Certified Nurse Midwives (CNMs), are often referred to as midlevel providers or physician extenders. Some NPs and PAs object to these...
