President's Point

NONPF Newsletter, Volume 11, Number 3, 2000

A Glut of NPs?

Ah, yes, as nurse practitioner (NP) faculty, we are asked about this issue on a regular basis. Cooper et al. (1998) raised the issue with reports of NP numbers in the marketplace. The AMA responded to the threat of competition with their “Citizens’ Petition” to HCFA, asking the federal agency to track NP-MD collaborative agreements for NPs with Medicare provider numbers. NPs looking for the idealized primary or acute care role also feel the pinch of competition among themselves for the same jobs. In some parts of the country, they wonder why we continue to educate so many NPs. Nurse educators and nurse regulators also question the wisdom of more NPs.

One answer to the glut/competition question is that most NPs don't prefer to practice as independent clinicians (and unintentionally create competition). Instead, the majority of advanced nurses prefer to work on teams of professionals with varied talents and skills. Or, when there is no team available, as in many rural and inner city areas, NPs access consultation and support from telehealth modalities, itinerant health care specialists, and increasing numbers of well-developed and evidence-based guidelines on the web. In contrast, some NPs prefer solo practice or group practice with other NPs to create a certain atmosphere, approach, or flow of care. Additionally, a few NPs prefer to be at the forefront, offering alternatives (legal) to traditional health care. Entrepreneur NPs offer care to niche markets, often when the existing need has been ignored or missed.

Regardless of the approach, these NP health care delivery models reflect a high level of healthcare quality, cost-effectiveness, and increased access.

Notwithstanding the accuracy of this response, it fails to address fully the question—why do you continue to educate NPs when we have "so many" already? I would like to propose a different line of thinking that also reveals the breadth of the NP role and the many future opportunities for our graduates. NP education serves as a major pipeline not only to advanced nursing practice but to all advanced nursing roles.

Because of the efforts of NP faculty and organizations such as NONPF (1995), AACN (1996), and NP specialty groups, nurse practitioner education has continually evolved to a higher order. Collectively, we ensure that NPs have graduate preparation in a broad spectrum of biological sciences, healthcare therapeutics, research and theory, health policy, and community health. Depending on the individual program of study, the student may have more emphasis on research, public health, or another core or specialty area. Our students also enjoy supervised clinical practice, usually in a variety of settings and with different types of clinicians as preceptors. Through this training, they learn to practice in varied settings and to adapt to the changing health systems. I estimate that about half of our NP graduates entered the workforce within the past 10 years. Therefore, our recent graduates, even those who entered programs at mid life or older, have gained current knowledge and skills, critical thinking skills, and computer literacy. Students in programs today are increasingly masters of active learning and no longer expect to learn mostly from lectures and directed readings--they turn to the Internet to maintain current clinical knowledge.

Added to the significance of this training and the contemporary NP graduate profile is that the majority of current graduate nursing students are in NP programs. As we face a major shortage of all types of leaders in nursing, this pool of current master's graduates will necessarily fill many roles in the foreseeable future. In today's general work world, the expert in any field is often simultaneously the manager and maybe the researcher and/or teacher. Therefore, in addition to providing much needed direct advanced nursing practice, NPs will face a tremendous demand to be teachers, researchers, administrators, care managers, entrepreneurs, health care systems analysts, healthcare informaticists, and the list goes on. NPs will fill a wide variety of roles with the basic graduate nursing preparation, and others will earn doctorates and second master's degrees to meet their career goals.

The point of this message is that NPs are exceptionally well-prepared healthcare professionals in a time of increasing demand for clinicians who think critically, command a broad knowledge and skill base, and are flexible in filling role expectations. I predict that NP education, contemporary work changes, and the shortage of nurses will erase the concern that there will be a glut of NPs. Those who fear competition and/or oversupply of NPs will see the bigger picture instead—more NPs as clinicians and leaders will result in more quality, cost-effectiveness, and access in healthcare for all.

Ever onward,

Lucy Marion, PhD, APRN, BC, FAAN

References

American Association of Colleges of Nursing. (1996). The essentials of master's education for advanced practice nursing.  Washington, DC: Author.

Cooper, R.A., Laud, P., & Dietrich, C.L. (1998).  Current and projected workforce of nonphysician clinicians.  JAMA 280(9), 788-794.

National Organization of Nurse Practitioner Faculties. (1995) Advance nursing practice: curriculum guidelines & program standards for nurse practitioner education.   Washington, DC: Author.