National Nurse Practitioner Week 2022: Interview & Advocacy Guide

The Evolution of the Nurse Practitioner (NP) Role

“In the last 20 years, we’ve seen a huge shift,” Dr. Hays says. “NPs are taking care of more complex patients, and we’re seeing NPs in more settings and in more specialties.”

The rapid evolution of the NP role can be viewed as an ongoing adaptation to the needs of America’s patients. The majority of today’s NPs still practice family or adult primary care, but some NPs are choosing to specialize in areas like acute care, gerontology, neonatal care, pediatrics, psychiatric/mental health, or women’s health. 

Further subspecialization is also now available in practically every area of medicine, from cardiology to orthopedics to oncology. For a young profession, this is incredible progress: 80 percent of American adults have now either been treated by an NP or know someone who has been treated by an NP.

The NP role itself is also evolving with the increasing adoption of the doctor of nursing practice (DNP) degree. While not yet a requirement for NPs to practice, the rise of the DNP exemplifies the ongoing maturation of the NP profession as a whole. NPs who earn their DNP develop deep foundational and clinical knowledge, but also become an expert at leading teams and influencing policy, two areas that are key to the modern NP role. 

Collaboration, leadership, and team-building are particularly important skills in today’s healthcare settings, which are often more team-based and fluid than the top-down, doctor-nurse hierarchies of the 20th century. More complex patients have necessitated more specialized care providers, and it’s critical for physicians, NPs, physician assistants (PAs), respiratory therapists (RTs), pharmacists (PharmDs), registered nurses (RNs), and other members of the healthcare staff to work together effectively. 

The NP role itself was born out of collaboration—between Loretta Ford, a public health nurse, and Dr. Henry Silver, a pediatrician—and it has carried that spirit of allyship into the 21st century. 

“Research shows us that the more diverse a group you have, the better you are at solving problems because you’re looking at it from all angles,” Dr. Hays says. “Healthcare is embracing that sort of thinking. We’re seeing team-led care, we’re seeing NP-led care, and in the future, I think there’s going to be a lot of NP-led teams.”

Advocacy Issues for NPs

As NPs continue to grow in both numbers and in scope of practice, they are using their collective voice to push for policy changes that benefit patients. One of the ways that push manifests itself is in the fight for full practice authority (FPA), which gives patients full and direct access to NPs. So far, 26 states, two territories, and the District of Columbia have granted NPs full practice authority, but 24 states still place additional restrictions on NPs that prevent them from practicing to the full extent of their education and training. Such restrictions limit the ability of NPs to provide care, especially in rural and underserved areas; inversely, FPA increases access to care for those who need it most. 

“In states with full practice authority, you’ll find NPs who have gone out to the more rural communities and improved access to healthcare,” Dr. Hays says. “Empowering NPs allows them to address a lot of unmet healthcare needs.”

Even in the states with FPA, there’s an ongoing struggle to modernize the language used in the policies of private companies and in the state governments’ laws. It’s not uncommon to still see some references to the need for a physician when a more inclusive term, one which includes NPs, could be used. 

Worse, exclusionary terms, such as “midlevel provider” or “physician extender,” have no real meaning but still manage to inhibit NPs and other healthcare professionals from providing care. Changing that language to something more inclusive primarily serves a practical function, but it’s also important symbolically: recognizing the NP as a unique and crucial component of the healthcare system.

“Today’s NPs understand that this is a true profession,” Dr. Hays says. “We have independent licensure and board certification. We’re embracing that and saying we have the education and the training and the skills and the critical thinking to be able to manage big problems. I think that’s leading us to more advocacy.”

Over the last few years, more and more NPs have begun to realize the strength of their own voice. Their efforts have helped pass FPA laws in 26 states, and they’re continuing to push into progressive new areas: today’s NPs are fighting to right-size the healthcare system, expand access for vulnerable populations, and improve patient and provider education. 

DNP programs, like the one Dr. Hays teaches in, have hands-on policy courses that teach students how to talk to legislators and influence meaningful change; professional societies—e.g., AANP, NAPNAP, and state-level organizations—give them a common platform.

“I am passionate about improving access to care and patient outcomes,” Dr. Hays says. “One of the best ways to do this is advocating for nursing and the NP role. I’m also passionate about helping students to get out there and understand what we can do, and how we can break barriers. It’s getting people to not be afraid and see that policy doesn’t mean you have to stand up holding a sign or always be meeting with legislators. There are other ways to approach advocacy.”

The Future of the NP Role

The Bureau of Labor Statistics (BLS) projects the need for NPs to grow 46 percent between 2021 and 2031, making NPs the fastest-growing profession in the nation. As the need for and number of NPs continues to increase, the role will continue to evolve in tandem. Dr. Hays sees DNP programs gaining wider acceptance and becoming the standard; she’s hopeful that dual DNP-PhD degrees will also gain traction, allowing NPs to lead research and translate findings into clinical practice. 

“To demonstrate what we know we can do, I think we need to move to a doctorate model,” Dr. Hays says. “I don’t think we have a choice.”

The growing sophistication, maturation, and acceptance of NPs will see them placed in new settings, and one area where Dr. Hays sees NPs having a strong impact is in long-term care facilities. Long-term care facilities, in many ways, resemble intensive care units of the past, and many residents are chronically ill; NPs are ideally suited to lead a care team in such a setting. These facilities have been neglected over time, and ravaged by the Covid-19 pandemic; as more Baby Boomers enter into old age and need consistent long-term care, NPs could be part of the solution. 

Other settings where NPs can make a big impact reach beyond the clinical environment. Increasingly, veteran NPs are being invited onto—or pushing their way into—leadership positions in federal and state health agencies, such as the Advisory Committee on Immunization Practices (ACIP). They’re also making their way into government positions: Gale Adcock, a family nurse practitioner (FNP), has served in the North Carolina House of Representatives since 2015; more will follow in her footsteps. 

More than 36,000 NPs completed their academic programs in 2019 and 2020, and the pace won’t slow anytime soon. Recent graduates, current students, and those just beginning their nurse practitioner journey have the opportunity to make significant changes to both the NP role and the American healthcare system.

“Today’s NP students have the opportunity to really change things,” Dr. Hays says. “They have a different way of looking and things, and what they bring is really exciting.”

Resources for NP Week

To learn more about the NP role’s future and connect with other NPs across the country, check out the resources below.

• American Association of Nurse Practitioners (AANP): With over 121,000 members, AANP is the largest national association for NPs, and aims to empower all NPs to advance quality healthcare through practice, education, advocacy, research, and leadership. Find their resource guide for NP Week 2022 here. 
• National Association of Pediatric Nurse Practitioners (NAPNAP): Established in 1973, NAPNAP was the first national professional society for NPs, and it remains the only national organization dedicated to both advancing the APRN role and improving the quality of health care for infants, children, and adolescents. NAPNAP is celebrating its 50th anniversary in 2023.