Nurse practitioners, like other healthcare workers, have been on the front lines of the COVID-19 pandemic. They helped battle a virus they at first knew little about and saw its disparate impact on communities of color, all while dealing with mental health and burnout issues among their own ranks.
At the same time, some NPs were granted greater practice authority amid rollbacks meant to free up the nation's supply of healthcare workers, such as those waiving requirements that NPs must sign a contract agreement with a supervising physician before they can practice. But those rules will soon be reinstated — or already have been, as public health emergency declarations expire.
A practice agreement isn't needed in about half of the states. And states that rolled them back had greater access to desperately needed staff when traveling nurses, respiratory therapists and others were in short supply as COVID-19 swept the country, advocates for granting NPs full practice authority say.
One such advocate is Sophia Thomas, whose two-year term as president of the American Association of Nurse Practitioners just came to an end. In this interview, she reflects on the state of the profession in the wake of a historic public health crisis, and discusses how eliminating barriers NPs face can give patients greater access to the care they need.
Editor’s note: This interview has been edited for clarity and brevity.
Healthcare Dive: What exactly do nurse practitioners do?
SOPHIA THOMAS: Nurse practitioners are advanced practice registered nurses who complete a prerequisite as a bachelor's degree registered nurse, go back to get their education at the master's or doctorate level, and then receive national certification in population-specific specialty areas. So nurse practitioners assess, diagnose, treat and prescribe for patients of all ages across the healthcare spectrum.
Right now there are about 325,000 nurse practitioners in this country, so nurse practitioners are really offering healthcare choice and access to patients. We're meeting the needs of more than 80 million people that live in areas without access to care, what we call Health Professional Shortage Areas. Many of these areas are rural, and what's interesting is nurse practitioners practice in these areas because they oftentimes are living in these areas while they're getting their education, so they come back and practice in the areas where they live and they're treating their own communities.
What are the biggest shifts or changes you've witnessed for the profession in the past two years in your role?
THOMAS: Nurse practitioners have really stepped up to the plate to treat patients during COVID, and have been on the front lines testing and treating COVID patients in primary care, hospitals, long-term care settings and even at-home visits. We've also really stepped up and embraced telehealth services and we know that that is truly going to be the way of the future, to be able to provide access to care for just more people.
I think over the last couple of years and in light of COVID, nurse practitioners' role in healthcare was not only about improving access but taking a leadership role and being sure that we're vocal and let communities and the public understand that there are health disparities, and social determinants of health, and all this needs to be acknowledged and recognized. And it's really time for us to revisit and reimagine our nation's healthcare system to improve the outcome of the people that are dying of COVID, the people that have the most disparate care. We really need to do something and nurse practitioners just recognize that.
What are some of the biggest challenges facing the profession?
THOMAS: Nurse practitioners are licensed in all 50 states, the District of Columbia and U.S. territories, and we practice under the rules and regulations of each individual state that we're licensed in.
We're nationally certified and have specific specialty areas. In certain states, nurse practitioners are not able to practice at the top of their education and training. They're kind of outdated practice laws, and in those states, we don't have what's called full practice authority, which is the ability for an NP to practice at the top of their education and training without regulatory restrictions.
Outdated practice models and outdated regulatory red tape require nurse practitioners to have a written agreement with a specific division called a collaborative agreement, and if we don't have that piece of paper, we're unable to practice.
So I would say the biggest challenge is removing those outdated regulatory barriers that are unnecessary. They restrict access to care for patients in that they don't allow nurse practitioners to practice at the top of their education and training. Most recently, Louisiana had a bill that would allow NPs to fully practice and really give them the ability to move into more rural areas.
Eighty-percent of Louisiana is a health professional shortage area, and it's just hard to find physicians to go into the rural areas. And we do know that the U.S. faces a shortage of as many as 90,000 physicians by the year 2025, and physicians just aren't going into primary care. So that's where nurse practitioners really excel, a large majority of NPs are primary care providers on the front line really providing access to care for patients.
Who is the new AANP president?
THOMAS: Her name is April Kapu. She is phenomenal, she comes out of Vanderbilt, she served on the AANP board for several years and she's going to continue to work with AANP, obviously, highlighting the role of nurse practitioners in healthcare and access to care, but really also working on highlighting and speaking out against healthcare disparities, and the populations that so desperately need access to care.
We feel like these populations — the ones that were so hardest hit from COVID-19 — deserve care, they deserve preventive care and screenings, and so we're going to continue our work to help improve healthcare access for all Americans.