The number of advanced nurse practitioners (NPs) working in the US more than doubled over the past decade – increasing more rapidly than any other health profession. This has significant implications for the nursing workforce and health care delivery, according to a recent research study.
Expanding nurse practitioner workforce
The report “Implications of the Rapid Growth of the Nurse Practitioner Workforce in the US” was published recently in Health Affairs. According to the figures from the National Census Bureau, the number of NPs active in their profession increased from around 91,000 in 2010 to 190,000 in 2017.
This growth had occurred across all states in the US, but particularly in those states that license NPs to practice independently. During the same period, the inflation-adjusted average income for NPs increased by around 5.5%.
According to the authors of the report, the growth was largely driven by the increase in the number of educational programs to qualify as an NP. There were 467 masters or doctoral programs in 2017 compared to 356 programs in 2010.
Millennials are particularly attracted to these courses. They work in hospitals for two or three years to gain the experience required for admission to one of these programs, many of which are offered through distance education.
Nurse practitioner’s role in primary care settings
Advocacy by public and private sector policymakers for increasing the use of nurse practitioners also contributed to the rapid growth in their numbers. There is a shifting focus of health care – away from acute care settings to primary care – and also escalating physician shortages, particularly in rural areas.
Around two-thirds of nurse practitioners were working in primary care settings in hospitals, physician offices, and outpatient care centers where they were filling critical gaps in health service provision.
Compared to the growth in the nurse practitioner workforce, there was an increase of only 9% in the physician workforce. The Bureau of Labor Statistics projects that by 2026 there will be further growth in nurse practitioners of 36%, compared to 13% for physicians.
“The Affordable Care Act elevated the role of PAs and NPs. Lots of education and programs through the Health Resources and Services Administration provided a jolt of energy and states have loosened regulations on scope-of-practice laws,” said Peter Buerhaus, co-author of the study.
The American Association of Nurse Practitioners reported that legislation in 22 states provides for independent practice by NPs and another 16 for independence with some restrictions.
However, independent practice by nurse practitioners is not generally supported by the medical profession.
In 2019, the American Medical Association reported that it had won over 50 victories in opposing extended scope of practice legislation and eliminated the Multistate Licensure Compact for Advanced Practice Registered Nurses by effectively opposing every proposed state bill to date.
Implications of the growing number of nurse practitioners
While the number of nurse practitioners grew by 109% between 2010 and 2017, the number of registered nurses grew by only 22% during this time. This implies a net loss of around 80,000 RNs across the country.
“Most RNs work in inpatient hospital settings, whereas the majority of NPs practice in primary care—typically in ambulatory care practices,” co-author David Auerbach reported. “Thus, when RNs become NPs, this can lead to a net shift of labor out of the acute hospital setting.”
The authors advise hospitals to innovate and come up with creative solutions to replace the RN’s who leave to become NPs. Educators should also take note of any fall in the average earnings of NP’s which could be a sign of overproduction.