While most nurses begin in the profession by providing bedside care, many advance their career by pursuing additional training. One option is to become a nurse practitioner.
"Nurse practitioners are a huge part of the solution for the lack of primary care providers in rural areas," said D'Ann Somerall, DNP, FNP-BC. The assistant professor and family nurse practitioner specialty track coordinator at the UAB School of Nursing is an advocate for nurse practitioners, despite the perception that jobs can be difficult to find.
"My students are able to negotiate a wage," she said. "When I finished school in 1999, there were very few providers hiring nurse practitioners, and most of the people who got jobs were earning exactly the same wage they had been making in hospitals. Some were even taking jobs for less, just to get the experience under their belt. Students now are asking for $85,000 to $115,000 and getting it.
"I agree that for every opening there are probably 15 to 20 applicants, but the same thing is happening in nursing overall. There may be a glut in Birmingham, but there are many jobs for nurse practitioners in underserved areas."
Alabama requires that nurse practitioners work with a collaborating physician. For the first two years, they must spend at least 10 percent of their time with the physician. Eventually they can collaborate with the physician as needed, enabling a clinic to extend hours without the physician being present.
"The additional oversight required of the physician with young nurse practitioners can lead to employment barriers," Somerall said. "When physicians decide to hire a nurse practitioner, they tend to look for someone with experience because this necessitates less of the physician's time."
"I review charts for quality improvement," said Somerall's collaborating physician, William Curry, MD, MACP. "When there is a question or an interesting case to discuss, D'Ann and I will talk about those. But for most of the routine care, the nurse practitioner sees the patient, takes care of him, makes a plan, and decides when to bring the patient back without my having to be involved at that moment."
Nurses desiring to be a nurse practitioner must earn their Masters of Science in nursing with a specialty. While it is possible to make the transition from RN at any time, Somerall urges nurses to begin the process sooner rather than later.
"If students enroll in the nurse practitioner program after practicing 25 or 30 years, it can be difficult for them to become an order giver rather than an order receiver," she said. "If someone comes to the program after about three to five years' experience, they can easily integrate into the role of making independent clinical decisions that are evidence-based."
All coursework for the UAB program is online, making it distance accessible, but it also requires a degree of comfort with technology.
While nurses find the extra degree to be beneficial, doctors also discover advantages in having nurse practitioners as part of their practice.
"We don't have enough primary care physicians now. The demand is increasing, and the workforce is aging faster than we are producing new physicians," Curry said. "Just from the standpoint of capacity and being able to manage the patients, having nurse practitioners is advantageous.
"Nurse practitioners also bring a different set of skills. I tend to be more grounded in basic science, pathophysiology, mechanisms of disease and pharmacology. Nurse practitioners have some of that, but are more oriented toward behavioral problems, counseling, patient engagement and care management. So we have a slightly different set of skills that complement one another."
Somerall and Curry agree that typically, patients spend more time with the nurse practitioner discussing barriers to care and other personal and behavioral issues including diet and exercise. "Patients often tell nurses things they don't want to 'bother' physicians with," Somerall said.
Curry, who is professor of the Division of General Internal Medicine and associate dean for primary care and rural health at the University of Alabama School of Medicine, says his clinic is moving toward a model that will significantly expand the number of nurse practitioners over the next three or four years. He also sees their number increasing in specialties such as cardiology, intensive care units and emergency departments.
He suggests that Alabama may be a little slower than other states in embracing the concept of nurse practitioners. "Our law was not well-defined for a number of years, so we had a generation of physicians who were not familiar with how to make the best of collaboration with nurse practitioners. That's becoming more standardized and physicians are becoming more comfortable with that style of practice," he said.
For nurses seeking to become nurse practitioners, an increasing interest in making them part of the medical team is good news.