Return to APN Home Page
Nurse Practitioner

Bottom page

According to the American Nurses Association (ANA):

• 48,237 NP's estimated currently to be in practice.
• There are approximately 150 NP education programs in the Unites States.
• Average salary in 1992 was $43,636.
• 36 states require national certification by the American Nurses Association (ANA) or a specialty nursing organization.
• Most are educated through master's level programs in nursing or in postgraduate level study.

• The concept of Nurse Practitioners (NPs) grew out of a need for primary care providers at a time when little emphasis was placed on containing heath care costs. (McGrath,1990, p40) The need was recognized in the 1960's in response to a national physician shortage and as a means of increasing availability and accessibility of trained, professional health care service providers. (McGrath,1990,p40)

• Theoretically, the quality of health care may be divided conceptually into two categories, "technical care" and the "art of care". (Schmitt,1994,p17) Technical care is concerned with diagnostics and therapeutic components of care whereas the art of care includes communicating, interpersonal manner and behavior in caring for the patient. Studies suggest that NP's and MD's provide comparable technical care. Randomized trial of NP's and MD's in the family practice settings also found that commensurable technical care was given to patients of both providers. (Schmitt,1994,p17) Studies performed in joint practice settings have found that NP's and MD's provide a different focus of care from one another. NP's exhibited significantly more psychosocial concern for the patient. A recent investigation showed that MD's tended to neglect the medical history and chose to prescribe costly medications with potential side effects without seeking more details regarding the patient's background. The investigation showed that NP's were more likely to gather needed patient information and prescribe appropriate behavioral changes to alleviate the complaint instead of using medications as the initial treatment. Overall, patients are satisfied with the care they receive from NP's. They appear to be more satisfied with the care they receive from NP's than the care received from MD's in regard to several factors: personal interest exhibited, reduction in the professional mystique of health care delivery, amount of information conveyed, and cost of care.

Some studies suggest the following regarding effectiveness of NPs:

• As copractitioners, consumers readily accept them.
• Health outcomes of patients seen by NP’s are similar to those of MD.
• Utilization of NP’s increased numbers of new patients seen, saved MD time, decreased cost, and was accepted by patients and staff.
• Appropriate use of NP’s in primary care produced savings.
• NP-MD comparisons favored NP for history taking, advising correct therapy, and communicating with patients.
• Quality of NP care for common illnesses comparable to MD care but less costly.
• Spent more time and saw fewer patients then Physicians Assistants.
• Use of NP’s in primary care reduced use of emergency room services.
• NP care is less costly than MD care but equally effective.
• NP is more likely to provide patient education.

Cost Effectiveness:

• In determining the cost-effectiveness of NP’s, it was estimated that 50 to 90 percent of the primary care provided by physicians could be provided by NPs working at an annual salary of approximately one-third of the physicians’. (McGrath,1990, p41) One study used an NP clinic that cardiac patients could use as often as they wished for examinations instead of going to their MD's or the emergency room. After 12 months the estimated savings of medical expenses was 76 percent compared to the previous year when the patients only had access to MDs.

    Feldman, M.J., Ventura, M.R., & Crosby, F. (1987) Studies of Nurse Practitioner Effectiveness. Nursing-Research,36, 303-308.

    McGrath, S. (1990) The Cost Effectiveness Of Nurse Practitioners. Nurse Practitioner, 15, 40-41.

    Schmitt, M. (1994). Nurse Practitioners’ Research Review: Quality of Care. Nurse Practitioner, 19, 17,21.