Episode 119: Nurse Practitioner Week - a podcast by Rio Bravo Family Medicine Residency Program

Episode 119: Nurse Practitioner Week

Amy Arreaza is a family nurse practitioner who explains what this career is all about. She tells the history and the future of this profession.  

By Amy Arreaza, FNP. Comments by Hector Arreaza, MD.

Hector: When I moved to Utah from my home country, I went to a clinic to investigate why I was so fatigued. I wasn’t a practicing physician at that time. I got seen by a family physician who was very brief and somewhat cold. During my follow-up appointment, I was attended to by a very pleasant lady doctor. She made good eye contact, smiled, and explained the results in a simple and easy way. In summary, my second visit was very enjoyable. Later, I learned that this lady was a nurse practitioner. I had no idea what it meant, but after many positive interactions, I became a fan of nurse practitioners in general. Today, I want you to learn more about this profession, and I invited my favorite nurse practitioner in the whole world, my wife Amy. Welcome, Amy Arreaza.

Tell us who you are.

Amy: First of all, thank you for inviting me to your podcast to talk about this wonderful profession. And second, I must reciprocate in kind, you are my favorite family physician. So, as you said, I am a nurse practitioner, but more specifically, I am a family nurse practitioner, or FNP for short. I’ve been an FNP for 14 years and currently work in central CA in a federally qualified health center as a primary care provider for the medically vulnerable.  Caring for this patient population is where my passion truly lies. 

What is a Nurse Practitioner?

A nurse practitioner is an advanced practice registered nurse. This means they are RNs who have completed either a master's degree or a doctorate degree in nursing practice. With their extra education and training, they have similar job duties as a physician, and there is actually a lot of overlap in the roles of nurse practitioners and physicians. NPs' serve as primary care providers or as specialty care providers. They examine and assess patients’ needs, order and interpret labs and imaging tests, diagnose disease, and provide treatment, which includes prescribing medication. In the United States, the scope of practice of a nurse practitioner is regulated by state law. As of this year, NPs have full practice authority in 26 states, the District of Columbia, and 2 US territories. This means that NPs can work independently in those states without the supervision of a physician. In the remaining states, NPs need to have a collaborative agreement with a physician or work under the supervision of a physician. 

How was this career created?

Well, in the 1960s, Loretta Ford, a public health nurse in Colorado, recognized a deficit in health care in rural communities. She believed nurses could fill the healthcare gaps in rural America, and through the Western Interstate Commission for Higher Education in Nursing, she was given an opportunity to help develop a specialized clinical curriculum for community health nurses.  In 1965, Loretta Ford joined forces with Dr. Henry Silver, a pediatrician, to create the first pediatric nurse practitioner program at the University of Colorado.  So, 57 years ago, the NP profession was created to help alleviate the physician shortage at that time. And today, with a continued shortage of physicians, the NP profession has become essential in meeting primary care needs across the United States. 

Hector: There are 24 states that still do not offer full practice authority to NPs. Those states are more likely to have “geographic health care disparities, higher chronic disease burden, primary care shortages, higher costs of care and lower standings on national health rankings.”

Amy: That’s right, research shows that states with full practice authority for NPs' rank highest in the nation for best access to care, while 9 of the bottom 10 states ranked as the least healthy states in the US have not yet granted NPs full practice authority.

How do you become an NP?

The first step in becoming an NP is to become a registered nurse with either an Associate's Degree or Bachelor's Degree in Nursing Science. You can then enroll in an associate’s-to-master’s degree NP program or a bachelor's to master's  degree NP program.  At the minimum, you must complete a Master of Science in Nursing (or MSN) Degree. However, you may choose to advance your education with a Doctorate of Nursing Practice (or DNP) degree.  After graduation, NPs take a national certification exam to get certification from the specialty board that oversees their practice area. For example, I graduated from the University of Utah family nurse practitioner program and then took the national Family Nurse Practitioner Certification Exam from the American Nurses Credentialing Center. This makes me a board-certified FNP. 

How many kinds of NPs are there?

There are multiple kinds of NPs. I am a family nurse practitioner, meaning I can treat patients from infancy through their golden years to the end of life. Many FNPs work in family practice clinics; however, FNPs have a broad scope of practice which makes them very versatile, and they can work in different specialty care clinics as well. For example, as an FNP, besides working in family practice, I have worked in wound care and in urgent care. FNPs work in cardiology, pulmonology, dermatology, orthopedics, and various other specialty clinics. NP programs are generally patient-population focused, so besides the family nurse practitioner program, there are Adult, Emergency Care, Gerontology, Pediatric, Neonatal, Nurse Anesthetist, Nurse Midwife, Psychiatric, and Women’s Health nurse practitioner programs. 

How can IMG MDs become NPs?

I understand that it can be very difficult for an international medical graduate to be able to practice as an MD in the United States. If an IMG is interested in becoming an NP, I would recommend that they look for a university nursing program that offers an accelerated RN option for those who already hold a bachelor’s degree in another field, then find out if the program will accept their international bachelor’s degree. They will most likely need to validate their international degree before applying to the accelerated RN program. After graduating with a Bachelor of Science in Nursing degree, they could apply to a nurse practitioner program. Another option for IMGs is to look into physician assistant programs. 

Current statistics about NPs': 

In 2020, there are about 210,00-270,000 practicing NPs in the United States. The number of nurse practitioners is expected to grow in the following years by about 52% between 202 and 2030, according to the U.S. Bureau of Labor Statistics. Currently, Americans make more than 1 billion visits to NPs'every year. The growth of NPs' is expected to address the current physician shortage.  

Thank you, Nurse Practitioners.

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Conclusion: Now we conclude episode number 119, “Nurse Practitioner Week.” Amy Arreaza, FNP, explained the basics about Nurse Practitioners and how they contribute to the health of our patients. This episode is a tribute to all the nurse practitioners who work shoulder to shoulder-as key members of the healthcare teams across the United States. We thank all of you and look forward to your continued support for healthier communities.

This week we thank Hector Arreaza and Amy Arreaza. Audio edition by Adrianne Silva.

Even without trying, you go to bed a little wiser every night. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you. Send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week!

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References:

1. Royalty-free music used for this episode: Simon Pettersson – good vibes_ Fashionista, downloaded on October 1, 2022, from https://www.videvo.net

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