Nursing & Health

Health care shortages: How DNPs and nurse practitioners are the solution

DNPCalifornia will need almost 5,000 more primary care health care providers by 2030, according to a new study. Demands are expected to be the greatest in the greater San Francisco Bay area, Sacramento, Sierra and Northern region and the Central Valley and Central Coasts regions, while the study anticipates the supply of physicians will decline.

One of the report’s recommendations is to enable nurse practitioners to “maximize their capacity to provide primary care and work at the highest level of their education and knowledge.” I couldn’t agree more! It’s a cause I’ve been advocating since I earned my Doctorate in Nurse Practice (DNP) in 2016. 

“Oh, you’re a nurse practitioner? Are you planning on being a doctor some day?” 

The presumption most people have when they ask questions like these is that for some reason, nurse practitioners are working towards being somebody else, instead of realizing that a NP is a valuable and important position, working at a level many don’t understand.

Adding a “doctorate” to an advanced practice nurse’s credentials not only demonstrates the completion of a terminal degree, it indicates they have achieved the highest level of education in their chosen field. It says the nurse practitioner you are seeing or speaking to really is an expert in practice! It’s not TV’s depiction of bedpans and giving shots and it’s more than following a physician taking notes. The DNP is the next step in the evolution of nursing and health care with seemingly limitless possibilities.

We are holistic providers who look at the whole person – their physical, spiritual and psychological well-being. Whereas physicians look at a disease and disease process – the science – NPs look at those factors too, and ask, “How are you, as a person, in addition to the disease?”

Growth and progress in health care, like the development of the Doctor of Nursing degree to better prepare nurse practitioners, doesn’t come without some resistance to change.  California has always been known as a progressive and cutting-edge state when it comes to health care and health-provided services. Unfortunately, nurse practitioners have been blocked from gaining the ability to have what’s called autonomous practice. Also known as independent practice, this allows NPs to have the ability to establish themselves as an individual entity, providing health care in areas where currently there are shortages (as California will face soon). This allows the ability to open more clinics and offer more care to more patients. Right now, California is one of 27 states that requires NPs to work as a subordinate to physicians in their practice, limiting their capabilities. The other 23 states have granted independent practice and have demonstrated positive results without increased costs or a decrease in the quality of care.

Nurse practitioners in most states can practice and prescribe medications, including narcotics for pain management (such as Vicodin and Percocet), but in order to do so in states like California, she/he is required to enter into a collaborative agreement (contract) with a physician. Medical supplies can be ordered for use in clinics, but a nurse practitioner can’t order a needle to inject medications without a physician’s authorization and co-signed contract. 

Another growing pain nurse practitioners have experienced as they grow in their knowledge and capabilities, is the acceptance of the terminal doctoral degree. Other health care professionals such as psychiatrists, pharmacists and chiropractors earn their doctorate degree and frequently referred to as “doctor.” As they should, they earned the degree. But unfortunately, when nurses earn their doctorate, they often are told they cannot use the same designation of “doctor” because some groups have deemed it “deceiving” to patients.

The word doctor is in reference to a degree. Those who earn that degree should be allowed to use its designation. They worked hard for it.  The exclusion of one profession from using the designation where others are allowed is unfounded and discriminatory.  No one profession owns the word.  We do own our occupation. I ensure that anyone who hears my designation of doctor also knows I am a nurse practitioner. I am proud of it, as we all are. Those with a medical doctorate also are doctors, but their profession is a physician. Rather than exclusion of one particular group, anyone with a doctorate should ensure they are clear about their profession as well. 

The good news is we have had one small but significant victory in recognizing our knowledge and expertise. Just three months ago, as published in the Cal Health Report, the Department of Veterans Affairs Long Beach Health Care System became the first California facility to take advantage of an amended rule that allows nurse practitioners to provide services that a primary care physician may typically provide, without a supervising physician.

In 2017, the Department of Veterans Affairs granted full practice authority to Certified Nurse Practitioners, (CNP). This rule supersedes existing state restrictions. In making this change, the VA noted it will increase access to care, improve health care quality and reduces the cost of health care for all VA patients. The American Academy of Family Physicians passionately disagrees with this move, saying that granting NPs independent practice authority puts patients at risk by not requiring health care decisions to be led by a physician. 

We are not the same as physicians, nor do we claim to be. We are completely capable of being independent on the front lines of primary, urgent and acute care, and have demonstrated time and time again we can step into that role and effectively care for people. We will always need physicians to collaborate with us. After all, isn’t it about the welfare of the patient?

Above all, we need to be recognized as an equal partner in health care. By achieving our doctorate level of education, we are demonstrating to the world that we are adapting to the changes and demands of health care in this nation and have the experience, knowledge, and drive to support its infrastructure.

Bryan Webb, DNPBryan Webb, DNP, AGPCNP-BC, CNOR, RNFA is an assistant professor and director of the PM-DNP program for Brandman University's Marybelle and S. Paul Musco School of Nursing and Health Professions, as well as an 2016 alumnus of the DNP program.


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