Role of Family Nurse Practitioner in Primary Care

The scope of work of family nurse practitioners varies depending on the state where they live and work.

Due to the growing complicatedness of health care and the dwindling number of available primary care physicians, family nurse practitioners have been increasingly called upon to provide the primary care needs of numerous patients of late. In general, nurse practitioners aid in the management of acute and chronic illnesses of patients, as well as conduct physical exams and diagnostic tests and procedures. Family nurse practitioners focus on the diagnosis and treatment of patients from childhood to adulthood.
Federal and state laws, as well as other policies, impose limitations on the way these specialists can help satisfy the growing need for primary care.

Primary Care

Primary care is composed of various health care services such as the preliminary assessment of new symptoms, continuing care for chronic diseases, as well as immunizations and screenings. Primary care is typically provided by physicians, as well as a variety of nonphysician practitioners, to include physician assistants and nurse practitioners. These nonphysician practitioners are required to complete graduate degrees in order to become authorized to examine, diagnose and treat patients. Physician assistants are required to practice in collaboration with a physician. On the other hand, the ability of a nurse practitioner to work independently of a physician is determined by state law.

Scope of Responsibilities

Nurse practitioners are registered nurses who have completed advanced training. Under state regulations, they are allowed to provide a lot of of the same services performed by physicians, with the exception of surgeries, such as diagnosing and treating health issues, performing prenatal, well-child and adult care checkups, diagnosing and treating minor trauma (e.g., suturing and splinting), prescribing medicines and teaching the promotion of health and prevention of diseases.

As recently as 2012, 18 states and the District of Columbia have allowed nurse practitioners to perform various duties including diagnosing and treating patients and prescribing medications without the involvement of physicians in response to the growing demand for medical services. However, 32 states still require physician involvement for the diagnosis and treatment of patients or prescription of medications, or both.

The Debate

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There has been a long-standing and controversial debate over independent practice for nurse practitioners. This debate has started to heat up again due to the predicted shortage of primary care as the population grows, not to mention the millions of people who will become newly insured beginning 2014.

The Institute of Medicine (IOM) recommended changes at the state and federal levels to permit nurse practitioners to perform duties to the full extent of their education in a 2010 report. The IOM noted in the report that each state’s laws on the scope of practice should dictate the services nurse practitioners are allowed to perform instead of their education and training.

On the other hand, some physician groups, such as the American Medical Association, are opposed to expanding the role of nurse practitioners. The group claims that encouraging patients to see nurse practitioners instead of primary care physicians may put the patients at risk even though there is no evidence to support this.

As states implement provisions of the Affordable Care Act they will have the chance to consider the need for primary care practitioners as well as weigh the need for new health care delivery models to meet the growing demand for primary care.