What the Rise in Nurse Practitioner-Led Clinics Means for Nursing

In the next decade, nurse practitioners will be the fastest-growing occupation in the U.S. As practice authority for nurse practitioners continues to expand, nurse practitioner-led clinics offer nurses the opportunity to lead in healthcare, fill the physician shortage, and provide accessible preventative care to patients.

Nurse practitioner-led clinics are primary care organizations led by NPs that provide comprehensive care to communities, including assessment, diagnosis, treatment, and preventive care. Lisa Williams, MSN, ANP, AGPCNP-C, owns her own primary care clinic and believes these clinics will have a positive impact on the profession due to nurse practitioners’ unique skill sets.

But nurse practitioner-led clinics will encounter barriers. For one, these clinics can lead nurses away from the bedside, potentially worsening the already pervasive nurse shortage. Additionally, healthcare professionals and the public continue to scrutinize NP’s scope of practice.

These barriers will need to be addressed to continue to support the growth and movement of NPs. Find out what the rise in NP-led clinics means for the nursing profession.

There are many advantages to NP-led clinics. Because nursing and NP education is focused on health promotion and prevention, NPs provide patient-centered care in an accessible manner.

Another advantage is collaboration. Despite no longer needing physician supervision to provide care in many states, NPs continue to collaborate with physicians and other experienced NPs in their field to provide the best, evidence-based practice care for their patients.

There is also evidence that NP-led clinics can improve health outcomes. A systematic review performed in 2018 showed that community-based clinics run by advanced practice registered nurses (APRNs) have better outcomes than traditional physician-led primary care offices. These outcomes include:

Healthcare systems are designed to care for very sick patients. NP-led clinics are designed to prevent disease and manage patients’ chronic conditions, so they don’t end up in hospitals.

As NPs gain more practice authority, Willimas feels nursing will be more attractive to prospective students.

“I feel that the nursing profession would be given more respect as a sought-after field,” Williams says. “It would be the segway into not only a great career, but the start of a new wave of entrepreneurship, as opposed to just a job.”

The impact of NP-led clinics in nursing is already contributing to the wave of nurse entrepreneurship. NPs are not only opening their own private practices, but other nurse entrepreneurship ideas include nurse consulting and coaching businesses, Medispas, and homecare agencies.

Williams envisions NP-led clinics will begin to open independent specialties like cardiology, endocrinology, or hematology.

The CVS MinuteClinic is a well-established clinic primarily run by NPs. Additionally, The Good Clinic opened its doors in Minneapolis in February 2021 and is run by an all-NP staff. The clinic is scheduled to add additional ones in other states, too.

With nurses voted as the most trusted profession year after year, along with a physician shortage in primary care, an NP-led clinic like The Good Clinic has a competitive edge with all stakeholders. This model of filling in the physician gap, increasing patient engagement, and continuing care will keep costs down and patients out of the hospitals.

The U.S. Bureau of Labor Statistics projects employment of APRNs to grow 45% by 2032. This is a big win for the profession developed by Loretta Ford, Ed.D., and Dr. Henry Silver in the mid-1960s when they opened the first NP program at the University of Colorado.

What’s more, practice authority is expanding alongside the profession. Twenty-eight states, Washington D.C., and two U.S. territories have already established their state regulations on NP full-practice authority.

Having the ability to run your private practice without a collaborating physician agreement may attract more nurses to pursue their master’s degrees as an NP. From 2020 to 2021, more than 36,000 new NPs completed their NP master’s program, the American Association of Nurse Practitioners (AANP) reports. New NPs will also have more opportunities to seek out experienced NPs as nurse mentors and role models.

“As the autonomy of the NP continues to expand, the path for other advanced practice nurses to open their own clinics will be easier to navigate,” Williams says.

But more nurses leaving the bedside to become NPs will add to the nursing shortage crisis in hospitals. AANP reports 88% of NPs are certified in primary care, and 70.3% deliver primary care. This is a major part of the nursing workforce providing bedside care who may leave in the coming years.

Nurses leaving the bedside to become NPs will also impact patient care. The American Association of Colleges of Nursing (AACN) reports that inadequate nursing staff impacts safe patient care. In a recent update, the AACN gathered reports that reveal the impact of inadequate nursing staff:

In March 2011, Jack Needleman, Ph.D., FAAN, and colleagues reported data showing a 6% increase in patient mortality on floors with fewer nurses. With registered nurses leaving the bedside to become NPs, the nurse staffing in patient care could worsen, and nurses’ workload at the bedside could increase.

“The other downside is that there will be few-to-no seasoned or experienced nurses left at the bedside within the next 8-10 years, if not sooner if this trend continues,” Williams says.

The rise in NP-led clinics faces barriers, like varying practice limits and pushback from medical groups. Because NP’s practice authority varies from state to state, it is difficult for NPs to work in their full scope of practice. There needs to be a standardized practice so that NPs can provide their full range of care, and so patients can know what care to expect.

Another barrier is criticism from the American Medical Association (AMA). Many physicians are concerned that NPs who don’t have physician supervision at the start of their careers may lead to major problems, such as worsening patient outcomes and increased health costs.

The AMA believes physicians should provide patient care. As recently as April 2021, the AMA wrote a letter to the Louisiana House of Representatives opposing the expansion of full-practice authority to APRNs.

The letter says, “On behalf of the American Medical Association (AMA) and our physician and student members, I am writing to express our strong opposition to House Bill (H.B.) 495, which would allow all advanced practice registered nurses (APRNs) the ability to provide medical care without any physician involvement, including diagnosing and treating patients and prescribing medications.”

Williams believes new NPs who need physician supervision at the start of their career should be considered on a case-by-case basis.

“The collaborative supervision would need to be individualized based on the number of years of RN experience, setting, and hours worked,” Williams says.

This would require a peer review board (the office of the profession should consider creating one if there isn’t one already in place). The work experience of this new grad NP can be reviewed and a determination can be made as to what kind of collaborative supervision agreement is needed, if at all.

Williams says the collaborative/mentoring agreement could range from 6-18 months, depending on the case. Recommendations for the time frame should be made by the NP peer review board upon completion of the review.

Williams believes that another huge barrier for NPs is securing funding for their clinics. Other barriers include:

To improve the financial growth of NP-led clinics, the National Nurse-Led Care Consortium (NNCC) encourages these clinics to qualify for payment under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). According to the NNCC, qualifying for MACRA would reimburse clinicians based on patient health outcomes. This would solidify the important role NPs provide to communities and their well-being.

To secure funding, NPs who are starting their businesses need to write a well-researched and data-driven business plan. Williams advises prospective NPs to: