The number of nurse practitioners (NPs) in America is on the rise. According to the U.S. Bureau of Labor Statistics, there were 189,100 NPs as of 2018 (the most recent year for which figures are available). This number is expected to grow to 242,400 by 2028, representing a 28% increase — much faster than the average for all professions.
While many reasons contribute to this growth, two in particular stand out. First, according to the BLS, is an increased need for primary care professionals arising from a new emphasis on preventive care along with an aging population. Second, and related, is a trend toward laws and regulations that give NPs in general, and FNPs in particular, more autonomy. Today FNPs have full, independent practice authority in 23 U.S. states and two territories. The remaining states and territories are more restrictive to varying degrees, allowing FNPs broad leeway in their medical activities and authority but imposing some limitations.
Whether an FNP has full practice authority or not, the growth of this profession is changing the way the healthcare field operates. FNPs are increasingly common in primary care, and they are taking on more and more responsibility and autonomy. In full-practice states, they may be owning and managing their own practices. In limited-practice states, they are playing an ever-growing role in the operation of hospitals, clinics, and practices. Either way, physicians and FNPs find themselves working together frequently — and finding the most effective ways to collaborate is increasingly important.
Preparing for collaboration among healthcare professionals is an important part of the nurse practitioner education process. The right knowledge can be obtained through Ohio University’s online MSN program, which prepares registered nurses (RNs) and other Bachelor of Science in Nursing (BSN) graduates for employment as nurse practitioners or other MSN nursing careers.
An article on the website Today’s Hospitalist spotlights a few of the many models that are working for today’s physician/FNP teams:
- The dedicated team. In this model, one FNP and one physician work together as a constant team. Together, a smoothly functioning team can manage a caseload of 25 patients per day.
- One-area authority. In some programs, FNPs are in charge of a specific area of responsibility that matches their education, experience and abilities. For instance, an FNP may be a “nocturnist,” responsible for all nighttime admissions and communication. Or the FNP may specialize in nursing home relations. Limitless iterations of this model are workable, depending on the needs of the individual practice or institution.
- Shared visits. In the shared-visit model, FNPs do the initial intake and the bulk of each patient visit. A physician then follows up briefly with each patient.
- Loose supervision. Depending on the institution, an experienced, capable FNP may earn broad authority to treat patients with only token supervision. “After I worked with [a] hospitalist group for a couple of months, they learned I had experience and they came to trust me. Now, they accept me. … [I am] treated like everyone else,” says Laura Coryat, a nurse practitioner who operates under this model.
In states where FNPs have full practice autonomy, a co-management model — where patients are managed collaboratively by more than one primary care provider — can be an effective care-delivery model. A recent study published in the Annals of Family Medicine examines this model, which it defines as a physician and NP “jointly sharing the responsibility of all tasks needed to manage the healthcare of the same patient.” Such tasks may include patient visits, medication management, diagnostic testing and interpretation, patient education and follow-up, and administrative tasks.
The study found the co-management model to be very effective, but only if three vital attributes were in place:
- Good communication. Communication is a two-way process where joint primary care providers collaborate in developing a patient care plan, setting patient goals, sharing changes in patient status, and defining the roles and responsibilities of care providers. This communication can be done in person, by telephone or email, or through careful maintenance of electronic health records. It must be timely and reciprocal, with equal sharing of ideas, information, and feedback from both providers.
- Mutual respect and trust. Traditionally, some physicians have hesitated to view NPs as professional equals. This viewpoint must be overcome for physicians and NPs to collaborate effectively. Physicians must first understand the NP’s education, training, and scope of practice. With this understanding as a jumping-off point, the basis of a positive working relationship can be established. Although it may take some time and experience — up to six months, the study suggests — a relationship of mutual trust and respect can develop.
- Shared philosophy of care. A complementary approach to patient care is a necessity for positive collaboration. Providers should substantially agree on the patient’s care plan. In the event that opinions differ, they should have a system in place for working out their disagreements. The study also highlights the importance of providers having a similar work ethic and approach. If one provider carries a much smaller patient load than the other, for example, the harder-working provider may feel resentful and even become burned out.
Benefits of FNP/Physician Collaboration
The Annals of Family Medicine study identified a long list of benefits that result from FNP/physician collaboration, including:
- A reduced workload for individual clinicians, easing the pressure of single-handedly managing clinical care and administrative tasks
- A corresponding decrease in clinician strain, burnout, and fatigue, especially in complex cases
- Better care outcomes as a result of combined experience and expertise from dual clinicians
- Increased morale among all team members, leading to more effective and efficient outcomes
- Increased patient access to care
- Better continuity of care, because patients have two clinicians familiar with their case
- Better medical service in rural areas or other underserved populations resulting from NPs as primary care providers, freeing up time for physicians to set additional appointments
- Providing more one-on-one time during appointments to address individual patients’ concerns and needs
Although the study noted these benefits specifically for co-management scenarios, they could apply equally well under supervised arrangements. Regardless of the specifics, FNP/physician collaboration can have many benefits for patients and practices alike.
Ohio University’s Online Master of Science in Nursing (MSN) Program
The online MSN program at Ohio University is designed for practicing RNs who want to advance their expertise in the nursing field. Students in the Family Nurse Practitioner concentration take courses such as Primary Care of Adults and Primary Care Practice.
For more information about the online MSN program, MSN degree benefits, and additional concentrations for MSN nursing careers, visit Ohio University’s website.
Job outlook for FNPs – U.S. Bureau of Labor Statistics
Laws and regulations governing FNP autonomy – American Association of Nurse Practitioners
Growth of FNP responsibility and autonomy – Annals of Family Medicine
Supervised collaboration – Today’s Hospitalist
Physician/FNP co-management – Annals of Family Medicine
Benefits of collaboration – Annals of Family Medicine