This is part three of our three-part series dedicated to the growth of the nurse practitioner profession. Be sure to check out parts one and two. Check back next week to download a PDF version of the entire series!
Nurse practitioners (NP) have traditionally worked in the primary care setting. Of the 157,000 licensed NPs in the country, 88% practice in the primary care space, according to the American Academy of Nurse Practitioners (AANP) while others pursue opportunities to fill needs outside primary care. Pursuing specialties In the past, NPs didn’t have options outside the primary care umbrella: family medicine, pediatrics, and women’s health. However, that has changed and more NPs are beginning to pursue careers in various medical specialties, such as dermatology and oncology. Although all NPs essentially receive a degree in primary care, they now have the option to complete additional rotations in certain medical specialties, says Renee Dahring, MSN, RN, CNP, a family nurse practitioner and career coach. In many cases, nurses who have practiced in a specialty such as dermatology or oncology will pursue specific training in the same specialty.
“Only a few years ago this would have been unheard of in NP programs, we just didn’t think beyond primary care as a work setting,” Dahring says. “This just goes to show how we as NPs have branched out.”
NPs who have already completed their graduate work can also pursue specialties in areas such as acute care or dermatology through certifications. Many associations provide certification programs for NPs who are interested in those areas as more NPs look to specialize. Michelle Perron Pronsati, Editor for ADVANCE for NPs and PAs, expects more certifications to become available. Primary care NPs have increasing opportunities to practice outside the traditional doctor’s office setting, including corporate wellness clinics and retail clinics. NPs’ skill set makes them ideal candidates for these positions because they require nursing and clinical skills, say Dahring. Dahring works in an extraordinary setting herself, a correctional facility.
“As an NP it’s a great job,” she says. “It’s an area that pushes problem solving skills and people skills.”
Locum tenens opportunities Here at Barton Associates, demand for locum tenens NPs has increased significantly in the last year, in both primary care and the specialties. In fact, the number of NP placements more than doubled between Q2 2011 and Q2 2012. Many Barton Associates NPs, like Barbara Laidman, were attracted to locums because it offers freedom from bureaucracy and the ability to travel.
“I wanted to be a free agent and travel. This is my idea of retirement,” Laidman said.
Locum tenens NPs can choose from opportunities in all 50 states; however, some narrow down their list of desirable locations based on the state’s scope of practice laws. Laidman, who has practiced in Connecticut, Colorado, Hawaii, Wyoming, and Iowa, chooses to take locums assignments in states that give NPs plenary authority, which means NPs can practice as an independent provider and use all of his or her NP expertise without added licensure restrictions. Although their education and experience makes them capable of practicing autonomously, state law dictates how independently NPs can practice. In 16 states (Alaska, Arizona, Colorado, Washington, Hawaii, Idaho, Iowa, Maine Montana, New Hampshire, New Mexico, North Dakota, Oregon, Rhode Island, Vermont, and Wyoming) and the District of Columbia, NPs have plenary authority. The 34 remaining states require NPs to either collaborate or be supervised by a physician.
“We find that locums or travel NPs have the greatest challenges when they practice in one state and move to another state where state laws are more restrictive,” says Tay Kopanos, DNP,NP, Director of Health Policy, State Government Affairs for the AANP. “We see state laws influencing where NPs choose to live, practice, and accept locum tenens positions,” Kopanos says.
Fortunately Kopanos and the AANP work to lobby state legislators to adopt modern nurse practice laws. Most notably, the ANNP successfully lobbied legislator in Colorado, Vermont, and North Dakota to allow NPs plenary authority in those states. Right now, they are working with legislators in Michigan to pass a bill that would modernize the state’s nurse practice laws.
