ANALYSIS | BY CAROL DAVIS | FEBRUARY 06, 2023
NP demand is quickly growing because nearly 100M Americans lack access to primary care, AANP president says.
KEY TAKEAWAYS
An aging U.S. population, increasing infectious diseases, and rising chronic disease are creating high NP demand.
With the decline of physicians in rural areas, NPs are purposefully stepping into those underserved areas.
More states are granting Full Practice Authority to NPs, no longer requiring them to have a practice agreement with a physician.
Growing demand for nurse practitioners (NPs) is among the profession’s key trends for 2023, its national organization says.
“The future of our profession is bright, and we stand ready to deliver the care patients need,” says April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, president of the American Association of Nurse Practitioners (AANP).
As the NP profession looks toward the future, AANP has identified five key healthcare trends to watch:
1. DEMAND FOR NPS IS GROWING ALONG WITH THE NP ROLE.
An aging U.S. population, increasing infectious diseases, and rising chronic disease are among reasons NPs are in high demand, the AANP says.
“We’re at 355,000 NPs today and we continue to grow steadily,” Kapu says. “We’re estimated to grow by 46% between 2021 and 2031.”
Indeed, NP ranks No. 1 in top healthcare jobs and No. 2 of all jobs, says U.S. News & World Report.
“We are in high demand and that is because we have 99 million Americans today that are lacking access to primary care and wait times are longer than ever before,” she says.
“NPs are stepping up to meet those needs in terms of access. You’re seeing the rise in NPs because we’re helping to meet that demand and that’s across all settings—rural settings, urban settings, in the hospital, the clinic, through telehealth, mobile sites, skilled nursing facilities, and schools.”
NPs’ focus on preventive healthcare also is a driver in demand, Kapu says.
“Nurse practitioners are focused on meeting the patient where they are and engaging people in healthcare. We’re very focused on the reduction of healthcare disparities, increasing access to care, and healthcare equity,” she says. “The reason for that is, if we have high-quality healthcare immediately available where we’re working with individuals and families on a regular basis, and providing screenings, immunizations, and regular chronic disease management, this helps to prevent urgent care visits and emergency department visits.”
With nearly 90% of nurse practitioners educated and trained in primary care, “We’re focused on healthier lives for everyone everywhere,” Kapu says.
2. NEARLY 100 MILLION PEOPLE LIVE IN PRIMARY CARE SHORTAGE AREAS, AND THE NUMBERS ARE RISING.
Primary care shortages are more severe in rural areas, where more than 130 hospitals have closed in the past decade, with nearly 20 in 2020 alone, according to AANP.
A recent AANP survey found nearly 50% of patients waited longer than one month—and 25% waited more than two months—for a healthcare appointment in the previous 12 months.
A 2020 study on the importance of building a strong rural workforce noted that NPs in 2016 represented more than 25% of providers in rural areas—an increase from 17.6% in 2008. During this time period, the percentage of physicians practicing in rural areas declined 12.8%.
With the decline of physicians practicing in rural areas, NPs are purposefully stepping into those underserved areas, Kapu says.
While, as the study says, NPs represent 25% of the primary care providers in rural practices, that percentage is even greater in the states that allow NPs to practice to the full extent of their education and clinical training—Full Practice Authority (FPA), she says.
FPA is the authorization of NPs to evaluate patients, diagnose, order, and interpret diagnostic tests, and initiate and manage treatments under the exclusive licensure authority of the state board of nursing, rather than requiring them to hold a state-mandated contract with a physician as a condition of state licensure.
“For those states that allow NPs to practice to the full extent of their education training, we’ve seen an increase in the NP workforce, and we’ve seen an increase in people working across all settings,” Kapu says.
“Arizona is a great example of a state that moved to FPA in 2001,” she says. “Within five years, they saw their workforce of NPs double across the state, and they saw a significant increase in NPs working in healthcare provider shortage areas.”
April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, president, AANP
3. NPS ARE TAKING ON LEADERSHIP ROLES IN RESEARCH AND THE DIAGNOSIS AND TREATMENT OF ILLNESSES.
NPs are leading the effort to diagnose and treat illnesses of all types, as well as participating in research to develop new treatments and combat emerging diseases, Kapu says.
“We’ve seen NPs rise in terms of their clinical expertise, so organizations and associations are seeking out NPs to help with putting out studies and articles or present the findings of their research on a national level through publications and presentations,” she says.
AANP emboldens its members to take on leadership roles by offering ongoing courses in developing leadership skills.
“It’s so important that NPs have a voice not only in their practice setting but that they have a voice in their healthcare system, in their state, and on a federal level,” Kapu says. “So, we encourage NPs to take leadership positions, certainly on boards, in health policy, and health systems management. The perspective of the NP is very important.”
Indeed, at the recent 2023 AANP Health Policy Conference, attendees heard from Jennifer Kiggans, an NP serving her first term in the U.S. Congress as a representative from Virginia.
“We think it’s wonderful that NPs are stepping into different types of leadership roles,” Kapu says.
4. MORE STATES ARE GIVING PATIENTS FULL AND DIRECT ACCESS TO NPS.
More states—26 plus Washington, D.C., so far—are granting FPA, which gives patients full access to NPs without requiring a practice agreement with a physician.
Momentum for FPA increased during the pandemic, when states temporarily suspended practice agreements and allowed NPs to practice at the top of their education, giving patients direct access to care.
Though some states allowed that executive order to expire, four states— Massachusetts, Delaware, Kansas, and New York—elected to adopt FPA permanently.
“[These] states put into place those executive orders and that continues to show that we provide high-quality care,” Kapu says. “The momentum is definitely there, because several states have legislation in action now to move their state toward full practice authority.”
FPA makes a difference in the health of a state’s residents, she notes.
“The states that have the healthiest outcome are states that have full practice authority,” Kapu says.
“Many of the states that have the lowest healthcare outcomes are states that still have restricted, outdated laws in place that are completely unnecessary, such as retrospective chart review or collaborative contracts where you have to pay fees,” she says. “Those fees can be a barrier to an NP being able to practice in the community.”
5. MENTAL HEALTH NPS ARE INCREASING ACCESS TO MENTAL HEALTH SERVICES.
With 158 million people living in Mental Healthcare Health Professional Shortage Areas, NPs are leading the charge to meet this demand for care.
Nearly 100 new psychiatric mental health nurse practitioner (PMHNP) programs have been added to U.S. schools of nursing in the past 10 years, producing more than 13,000 new providers, according to the American Association of Colleges of Nursing Enrollment and Graduation Reports 2012-2022.
The number of NPs treating Medicare beneficiaries for psychiatric and mental health conditions grew 162% between 2011 and 2019, compared with a 6% decrease in the number of psychiatrists treating Medicare patients, according to a 2022 study.
“We have nurse practitioners who are educated, trained, and national board certified as mental health NPs, and they are providing those vitally needed services, but there are still barriers [to practicing],” Kapu says.
“Anything we can do to increase the amount of workers out there to provide mental healthcare and anything that we can do to reduce unnecessary barriers are the only ways that we’re going to be able to address the mental health challenges that we’re seeing today.”
“MANY OF THE STATES THAT HAVE THE LOWEST HEALTHCARE OUTCOMES ARE STATES THAT STILL HAVE RESTRICTED, OUTDATED LAWS IN PLACE THAT ARE COMPLETELY UNNECESSARY.”
— APRIL KAPU, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, PRESIDENT, AMERICAN ASSOCIATION OF NURSE PRACTITIONERS
Carol Davis is the Nursing Editor at HealthLeaders, an HCPro brand.
