Geri C. Reeves, PhD, APRN, FNP-BC, Editor
Sharon L. Holley, DNP, CNM, FACNM, Editor
Linda J. Keilman, DNP, GNP-BC, FAANP, Editor
Imelda Reyes, DNP, MPH, APRN, CPNP-PC, FNP-BC, FAANP, Editor
1
The US primary care system is a good example of the trend of using more NPs in clinical practice settings.2
For example, currently there are approximately 2000 primary care retail clinics in the United States. In these clinics, NPs are used almost exclusively to provide basic primary services.3
In addition, most physician-centric primary care practices have NPs on staff providing care to patients. As NPs continue to grow in numbers, they also continue to gain regulatory support to expand their work roles. Twenty-one states and the District of Columbia currently have awarded NPs some level of ability to practice independently from physicians. This includes the ability to prescribe and see patients without physician supervision.4
In general, NP role expansion is driven by physician workforce shortages, pressures to expand access to care, patient satisfaction with NP care, and the shift to less expensive value-based reimbursement models of health care delivery.5
, 6
, 7
More specifically, access issues as a result of the Affordable Care Act’s insurance expansion, the aging of the US population, and increased morbidity of the general population in areas such as chronic disease have led to increased demand for health care services, particularly in the workforce arena.8
The impact of role expansion on how NPs experience their work continues to be examined. Literature is quite robust on data demonstrating that NPs and Physician Assistants, as a result of the increased job demands accompanying role expansion, may experience a reduction in perceived levels of internal motivation around their jobs, become frustrated in their ability to feel empowered, and exhibit lower job satisfaction, increased burnout, and greater role strain.
9
,10
Alternatively, there is evidence that role expansion not only enriches jobs but also may create a more empowering organizational environment for NPs, which in turn leads to greater feelings of perceived support, self-efficacy, and satisfaction among workers.11
This empowerment comes from the expanded array of resources, power, and social supports that may accompany the new or expanded roles.12
To help support the expanding NP role, in this issue, you will find practice tools and information on prevention and assessment of falls in older adults, extended-spectrum beta-lactamase treatment, serious illness conversations with older adults, Parkinson disease, atrial fibrillation, type 2 diabetes, sexual violence screening, self-management apps, hypertension in pregnancy, caring for women, along with circumcision, insomnia, vaping, autism spectrum disorder, human trafficking, encopresis, childhood obesity, and best practices to address HPV vaccine hesitancy. Resources to support the expansion of NP practice are important for role satisfaction and positively affect patient outcomes. In addition, NPs must engage in self-care behaviors that support work life balance. For example, techniques such as yoga and meditation have been shown to decrease exhaustion, stress, fatigue, and burnout.
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NP role expansion is a privilege that warrants being responsible to our patients and ourselves. Take time to reflect on how to improve patient outcomes, work-life balance, and in becoming the best you can be—for you!References
- NP fact sheet.(Available at:) (Accessed September 20, 2019)
- US retail health clinics to nearly double by 2017 according to Accenture Analysis.(Available at:) (Accessed September 20, 2019)
- Convenient care, but at what price? The rise in retail clinics. Healthcare Dive.(Available at:) (Accessed September 20, 2019)
- State practice environment.(Available at:) (Accessed September 20, 2019)
- Physician shortage and projections.(Available at:) (Accessed September 20, 2019)
- MACRA.(Available at:) (Accessed September 20, 2019)
- Tapping nurse practitioners to meet rising demand for primary care.(Available at:) (Accessed September 20, 2019)
- Satisfaction, burnout, and turnover among nurse practitioners and physician assistants: a review of the empirical literature.Med Care Res Rev. 2019; 76: 3-31
- Literature review of role stress/strain on nurses: an international perspective.Nurs Health Sci. 2001; 3: 161-172
- Job burnout.Ann Rev Psychology. 2001; 52: 397-422
- The relationship between structural empowerment and psychological empowerment for nurses: a systematic review.J Nurs Manag. 2010; 18: 448-462
- Using empowerment to build trust and respect in the workplace: a strategy for addressing the nursing shortage.Nurs Econ. 2005; 23: 6-13
- Qualitative and quantitative evaluation of a pilot integrative coping and resiliency program for healthcare professionals.Explore. 2013; 9: 44-47
Article info
Publication history
Published online: February 22, 2020
Identification
Copyright
© 2020 Published by Elsevier Inc.
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