How Health Care Facilities Can Improve the Role of Nurse Practitioners

With the passage of the Affordable Care Act, there has been a lot of discussion about the role of advanced practice nurses and nurse practitioners and how they can be used to increase access to quality health care. In fact, one of the cornerstones of the ACA is the establishment of nurse-managed community health centers, in which residents of traditionally underserved regions can receive basic and preventive care from nurse practitioners close to home, rather than traveling a great distance or waiting a long time for an appointment with a doctor.


While several states have passed legislation expanding the role of nurse practitioners, and even more, like Connecticut, are considering similar legislation, a new study in the Journal of Professional Nursing suggests that while new laws are helpful, health care facilities need to make changes to their organizational structural and climate in order to fully realize the potential of NPs. The study of 16 nurse practitioners in Massachusetts, where health care reform took place several years ago and increased demand for advanced practice nurses, found several key factors that indicate the need for changes if advanced nurses will have the opportunities they expect.

Advanced Practice, Basic Understanding

According to researchers, nurse practitioners identified several areas where organizational culture and processes could be improved in such a way that would allow them to fully reach the potential of their role. Specifically:

Greater understanding of their roles. Advanced practice nurses must, at minimum, earn a master of science in nursing, and receive certification in a specialty area from the appropriate governing body. However, as the study indicates, leadership in some facilities does not fully realize that this higher level of education and experience allows nurse practitioners to take on a more advanced role in the care of patients. Advocates recommend that health care leadership take steps to gain a better understanding of what nurse practitioners can do, and allow them to do it.

Changes in medical billing procedures. While some state laws allow nurse practitioners to be listed as the provider of record, and therefore bill for their services accordingly, in many cases facilities are reluctant to do so. This is in large part because Medicare reimburses practices 15 percent less for services rendered by an NP than for those delivered by a physician. The fact that NPs are often listed as a secondary provider to a doctor contributes to what they perceive as an “invisibility” problem, and many are calling for changes in medical billing laws and procedures to increase their acceptance among patients and the medical community.

Include nurse practitioners in policy-making and organizational decisions. Some of the nurses studied indicated that they felt “out of loop” when it came to decision-making within the health care facility, and did not feel that they had a voice when it came to making policy decisions or determining the organizational structure. Facilities can remedy this by creating room for NP’s in decision-making groups that determine the day-to-day operations of the facility, and by creating an environment that respects and acknowledges their skills and accomplishments.


Create more opportunities for nurses to collaborate with physicians. As mentioned previously, a lack of understanding of the nurse practitioners abilities is perhaps the greatest deterrent to their widespread acceptance, but physicians can change this by working closely with the NPs on their staff. The more that doctors and nurses work together, the more they build trust and the greater the likelihood that nurses will be able to work autonomously and provide high quality, seamless care.

Change legislation. Currently, only 18 states allow nurse practitioners to practice independently, while the remaining 32 states and the District of Columbia require NPs to work under a physician’s supervision. Changing state laws to give advanced practice nurses greater freedom to treat patients and write prescriptions would go a long way toward increasing their utilization — and meeting the demands of an ever-increasing patient population.

A number of recent studies have indicated that patients who need basic health care services, such as preventive care, are less concerned about who provides that care than they are about actually receiving the care when they need it. As the Affordable Care Act moves into the full implementation phase and demand for health care services increases, it only makes sense to reduce physician workloads and allow qualified advanced nurses to manage that care. Changing the perception of these qualified individuals and making it possible for them to do their jobs effectively is an important first step toward that goal.