Nurse Practitioners

A nurse practitioner (NP) checked the eyes of a teen boy during a youth sports physical at Gilpin Resource Center in Richmond in 2016. More than 11,800 NPs provide health care services to patients in Virginia.

By Kristen Johnson and HoChong Gilles

President Donald Trump recently issued an executive order designed to protect and improve Medicare for our nation’s seniors. Part of this order calls for removal of outdated barriers to practice so that all health care providers can practice to the full extent of their education, training and certification.

In states like Virginia, where all nurse practitioners (NPs) don’t have the ability to evaluate, diagnose and treat patients under the exclusive licensure authority of the state board of nursing, the president’s order is important because it increases access to care by giving NPs the authority to treat Medicare patients free from individual state restrictions.

NPs are advanced practice registered nurses who have master’s or doctorate degrees and extensive clinical training in the diagnosis and management of common and complex medical conditions. There are more than 270,000 NPs in the United States, including more than 11,800 in Virginia, who provide a full range of health care services, guide patients in making educated health care decisions and promote healthy lifestyle choices every day. The confidence patients have in NP-delivered care is evidenced by the more than 1 billion visits made to NPs every year.

NPs consult and collaborate using a patient care team approach and work everywhere from large hospital settings and medical offices to free and mobile health clinics, where they focus on adult and pediatric care, women’s health, mental health and other specialties. They treat physical and mental ailments by diagnosing and treating acute and chronic conditions; ordering, performing and interpreting diagnostic tests; prescribing medications and other treatments; and counseling and educating patients about smart lifestyle choices.

With the Department of Health and Human Services expecting a shortage of more than 20,000 primary care physicians in the U.S. by 2020 and approximately 79 million people with inadequate access to primary care (as of the first quarter of 2019 according to the federal government), NPs can serve as a patient’s primary health care provider and treat patients of all ages depending on the NP’s designated scope of practice. Studies show that patients whose primary care providers are NPs have fewer emergency room visits and shorter hospital stays, resulting in lower out-of-pocket costs.

Although the president’s executive order helps seniors, it does not address access to care for other underserved populations in states where NPs have reduced or restricted practices. However, during the 2017 and 2018 General Assembly sessions, Virginia’s legislators showed their support for reducing some of these barriers by enacting legislation that further supports care by NPs. Under regulations that took effect in January of this year, NPs with five or more years of clinical experience are now eligible to apply for autonomous practice licensure. This licensure encourages NPs to increase access to care, particularly in rural and underserved areas where physician shortages are even greater than those in urban areas. It also allows NPs to develop innovative practice models, volunteer in free or mobile clinics without the restriction of a mandated collaborating physician and expand access to care in all specialties, including mental health and substance abuse treatment.

This year, U.S. News & World Report’s Best Jobs rankings listed nurse practitioner as the seventh best job and fifth best health care job, and the Bureau of Labor Statistics is projecting 36.1% employment growth for NPs between 2016 and 2026. Last week was National Nurse Practitioner Week, a time dedicated to recognizing these special health care professionals and the valuable work they do every day. We hope you’ll join us throughout the year in thanking Virginia’s nurse practitioners for their dedication to enhancing the health of all citizens in the commonwealth.

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Kristen Johnson is the Richmond region president of the Virginia Council of Nurse Practitioners.

HoChong Gilles is president of the Virginia Council of Nurse Practitioners.

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