Nurse practitioners, also known as NPs, are nurses who have an undergraduate degree in nursing plus a master's or doctoral nursing degree and board certification in a specialty such as family medicine. Nurse practitioners may work with doctors or establish independent practices, depending on their state's laws. NP career goals range from increasing cooperation with workplace colleagues to gaining more professional autonomy.
The University of Colorado established the first NP program in 1965, intending to provide advanced training in illness prevention and health promotion for public health nurses working with little or no physician supervision. Nurse practitioner programs grew rapidly in response to the U.S. physician shortage. Originally concentrated in family medicine, nurse practitioners, like doctors, began entering various medical specialties, including mental health and emergency medicine.
As of 2013, nurse practitioners can set up independent practices in 18 states and the District of Columbia. NPs must work collaboratively with physicians or under physicians' supervision in all other states. Their primary professional organization, the American Association of Nurse Practitioners, devotes substantial effort to lobbying for federal and state legislation that will allow NPs to practice independently in all states. A growing number of nurse practitioners believe that all future NPs should obtain doctorates in nursing to give themselves extra clout in their struggle for higher insurance reimbursements and professional autonomy. Some NPs are disappointed with one form of independent practice: pharmacy-based retail health clinics. Nurse practitioners who quit these jobs reported that they disliked working alone and did not want to perform non-medical duties such as helping with pharmacy advertising and cleaning floors.
A 2010 survey showed that nurse practitioners also want more financial benefits from their employers, including monetary bonuses, financial help in paying for continuing education classes and compensation for services provided outside of their normal NP duties. NPs are additionally looking for jobs where they will receive increased friendliness and respect from other health care professionals. This concern reflects the ongoing tension between NPs and physicians in some health care settings over nurse practitioners' attempts to obtain greater autonomy while working in physicians' offices, and their efforts to start independent practices of their own and increase the dollar amounts of patients' and health insurers' payments they receive to levels closer to doctors' fees.
In 2011, there were 180,233 nurse practitioners in the United States. As of 2012, they earned an average annual salary of $91,450. The five states with the largest number of nurse practitioners are California, New York, Florida, Texas and Massachusetts. Alaskan NPs earned the highest average annual salary, $112,090, while NPs in West Virginia earned the lowest average annual salary, $78,590. Nurse practitioner job openings are growing as the U.S. national physician shortage continues. Job postings for NPs increased by 128 percent between 2011 and 2012. The NPs in greatest demand in 2012 were those specializing in mental health, adult medicine, emergency department care, hospital care and family medicine.
- American Association of Nurse Practitioners: Historical Timeline
- KidsHealth: What's a Nurse Practitioner?
- U.S. Bureau of Labor Statistics: Occupational Employment and Wages, May 2012 29-1171 -- Nurse Practitioners
- The Henry J. Kaiser Family Foundation: Total Nurse Practitioners
- Journal of the American Academy of Nurse Practitioners: Nurse Practitioners’ Job Satisfaction and Intent to Leave Current Positions, the Nursing Profession, and the Nurse Practitioner Role as a Direct Care Provider
- CNN.com: Nurse Practitioners Were 'Lone Rangers,' Founder Says
- Healthecareers Network: Nurse Practitioner Employment Fact Sheet – 11/11/2012
- University of Pennsylvania: Nurse Practitioners Shaping the Future
- National Library of Medicine: Canadian Family Physician: Do Nurse Practitioners Pose a Threat to Family Physicians?
- American Association of Nurse Practitioners: 2013 Nurse Practitioner State Practice Environment
- American College of Physicians: Partner Buy-Ins
- Kaiser Health News: Nurse Practitioners Slowly Gain Autonomy
- American Association of Nurse Practitioners: Advocacy Center: Issues and Legislation
- New York Times: When the Nurse Wants to Be Called ‘Doctor’
- Medical Economics: Nurse Practitioners May Have Higher Job Satisfaction Than Physicians, Survey Says
- Clinical Advisor: Survey Explores NP Job Satisfaction in Retail Clinics
- Midlevel U: Survival Guide to Getting Started with the Nurse Practitioner Career
- Nursing Economics: Nurse Practitioner Workforce: A Substantial Supply of Primary Care Providers
- Advance Healthcare Network: Job Satisfaction in Primary Care: What Makes a Difference to NPs?
- Project HOPE: The People-to-People Health Foundation, Inc.: Health Affairs Blog: Doctors And The Bully(ing) Pulpit
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