1. Kennedy, Maureen Shawn MA, RN


American consumers and policymakers seem in favor of NPs as primary care providers.


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Welcome to AJN's 113th January issue (the first issue of the journal was published in October 1900). Over the last 10 years or so, the January issue has included a special news section highlighting the top health care and nursing news from the previous year. In 2013, many of the top stories revolved around certain ongoing, major changes in health care, especially those brought about by the continuing implementation of the Patient Protection and Affordable Care Act (ACA), advances in technology (think electronic health records and telehealth) and treatment, and changing models of care.

Figure. Maureen Shaw... - Click to enlarge in new windowFigure. Maureen Shawn Kennedy

One significant trend has been the growing acceptance of NPs as independent primary care providers. Since the development of a pediatric NP program in 1965 at the University of Colorado, the movement has grown to include virtually all specialties and settings, though the NP's forte is still primary care. The American Association of Nurse Practitioners (AANP) notes that 68% of NPs are involved in a primary care practice.


There's no doubt that the recommendations of the Institute of Medicine's report The Future of Nursing: Leading Change, Advancing Health, the reforms of the ACA, and a health workforce shortage have dovetailed to push the NP role into the forefront of changes in the health care system. In the November issue of Health Affairs, which focuses on "Redesigning the Health Care Workforce," two articles support the use of NPs as primary providers on care teams or in nurse-managed health centers. The authors of one study conducted by the RAND Corporation note that while more medical home and nurse-led models could do much to mitigate the primary care physician shortage, restrictive scope-of-practice laws would need to change. The authors also suggest that "patients' perceptions of nurse practitioners" might slow acceptance of these new care models. But a national survey commissioned by the AANP and conducted last September by the Mellman Group found that the public is familiar with and accepting of the expanded NP role: 80% of respondents indicated they had received care from an NP or knew someone who had, 70% said they supported legislative efforts to make it easier to choose NPs as their primary care provider, and 62% said they supported allowing NPs to practice independent of physician oversight.


After 40 years of providing cost-effective and high-quality care, NPs are finally coming into their own. Although there are still major challenges, a "snowballing" of successes in recent years is noteworthy. For one, NPs now have prescriptive privileges in all 50 states and the District of Columbia-no small feat, given that this achievement required an arduous state-by-state battle (see In the News, March 2013). Currently, federal and state legislative efforts are focused on removing restrictions that prevent NPs from practicing independently. And securing the use of provider-neutral language ("primary care provider" instead of "physician") is important in legislation that governs fee-for-service payment under Medicare, which is a major factor in the sustainability of NP practices.


As a nod to the significant progress NPs have made, this month's cover offers a new image of America's family doctor: the NP. (And NPs will indeed be "doctors"; the American Association of Colleges of Nursing has endorsed changing the level of education required for preparation as an NP from a master's to a doctoral degree, beginning in 2015.) The cover illustration is in the style of Norman Rockwell, the American artist whose work graced the Saturday Evening Post for decades. Rockwell was known for his portraits of everyday American life, and one of his favorite subjects was the family doctor. But Rockwell would be hard pressed to find that physician now-according to an American Medical Association survey, in 2012 only 18% of physicians were in private solo practices, down from over 40% in 1983. In primary care, especially in rural settings, Americans are turning to NPs.