What the Rise in Nurse Practitioner-Led Clinics Means for Nursing
- In the next decade, nurse practitioners (NPs) will be the fastest-growing occupation in the U.S.
- Having the ability to run your private practice without a collaborating physician agreement may attract more nurses to become NPs. This could contribute to the nursing shortage.
- The rise in NP-led clinics face barriers like physician pushback and securing funding.
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.
"Medical care [at these clinics] is provided by someone who learned how to treat the entire patient and family as one unit, which is a much-needed approach in today's changing healthcare setting," Williams says.
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.
How NP-Led Clinics Benefit the Healthcare System
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.
"[Clinics] provide the ability for nurses to care for the patient from a holistic approach, not only the physiological care but to include the psychosocial care as well," Williams says.
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:
- Patient satisfaction
- Positive impact on health outcomes
- More cost-effective
- Better access to care
- Behavioral changes in patients
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."
Nurse Entrepreneurship Increases as More NPs Gain Practice Authority
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.
"I [also] foresee NP-led centers opening up that will have every specialty under one roof. A one-stop service-oriented practice," Williams says.
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.
Impacts of NP-Led Clinics on the Nursing Profession
The U.S. Bureau of Labor Statistics projects employment of APRNs to grow 40% by 2031. 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-six 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:
- Increase in infections
- Decrease in quality of care
- Increase in nurse-to-patient ratios
- Increase in readmissions
- Increase in nurse burnout
- Increase in mortality
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.
Physicians Push Back Against NP Practice Authority
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.
Overcoming Anticipated Barriers to NP-led Clinics
Williams believes that another huge barrier for NPs is securing funding for their clinics. Other barriers include:
- Changes related to reimbursement
- Denials from insurance companies without prior notice
- Changes related to prescription plans without prior notice
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:
Research the area they are looking to open their clinic. Ensure that the service they would be providing is a much-needed service for that demographic and why that service is needed.
Create the Plan
NPs should include the research done before creating the plan.
Identify Services and Patient Population
NPs should include not only the services they seek to provide but the demographic population for which services would be rendered.
Hire Experienced Medical Billers
In terms of denials from insurance companies, Williams strongly suggests NPs hire experienced medical billers.
"Hire a very knowledgeable medical biller who can assist with not only billing but would manage denials, reimbursements, and appeals," Williams says.
Hire Experienced Office Practice Manager
Lastly, regarding changes related to prescription plans without prior notice, Williams suggests having an experienced office practice manager.
"[The office practice manager should be] solely responsible for maintaining credentialing, insurance changes, prescription plan changes, and review of all report cards per insurance companies," Williams says.
Meet Our Contributor
Lisa C. Williams, MSN, ANP, AGPCNP-C
Lisa C. Williams' career began in 1990 when she started working with South Nassau Communities Hospital as a full-time LPN. She continued her education and graduated with a bachelor degree in nursing from Adelphi University in 1999 and became the nurse manager of a 40-bed medical-surgical unit in 2000. In 2006, Williams graduated with her master's degree in nursing with an advanced certification as an adult nurse practitioner all the while maintaining her full-time position as a nurse manager with South Nassau Communities Hospital. In 2009, Lisa C. WIlliams, MSN, Nurse Practitioner in Adult Health P.C. was founded. She is the proud owner and president of LCWPC. Williams is nationally certified as an adult-gerontology primary care nurse practitioner by the ANCC and is currently pursuing the nurse executive advanced certification.
AMA opposition to Louisiana H.B. 495. (2021). https://searchlf.ama-assn.org/letter/documentDownload?uri=%2Funstructured%2Fbinary%2Fletter%2FLETTERS%2F2021-4-30-AMA-Letter-Opposing-LA-HB-495-FINAL.pdf
Gooch K. (2022). Nurse practitioner will be fastest-growing job over next decade.
Historical timeline. (2012-2022). https://www.aanp.org/about/about-the-american-association-of-nurse-practitioners-aanp/historical-timeline
NP fact sheet. (2022). https://www.aanp.org/about/all-about-nps/np-fact-sheet
Nursing shortage. (2022). https://www.aacnnursing.org/news-information/fact-sheets/nursing-shortage
Sofer D. (2018). Nurse-led health clinics show positive outcomes.
U.S. Bureau of Labor Statistics, Occupational Outlook Handbook. (2022). Nurse anesthetists, nurse midwives, and nurse practitioners. https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm
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