California is facing a crisis in our healthcare workforce. We lack enough primary care providers. This issue, combined with a wave of physicians getting set to retire and an expanding aging population, has created a perfect storm particularly in our rural and underserved communities.
A recent study from UCSF HealthForce highlighted the physician shortage (we need over 4,000 physicians in California) and made several reasonable recommendations, including recruiting and retaining doctors while also expanding the use of team based primary care models. However, one key piece of this study called for nurse practitioners to practice to the highest level of their education and training.
Using nurse practitioners to help cut down on trips to the emergency room is working, with some areas seeing a 50% decrease in trips to the emergency room
No matter where you stand in the healthcare debate, we can all agree that there will be no increased coverage without more trained providers in our communities.
Recently a new commission met to tackle this often-unseen healthcare crisis. The California Future Health Workforce Commission is comprised of over 24 leaders in the world of health, policy and education. It is tasked with developing a blueprint for building a modern health workforce in California. We encourage this commission to look at all options, including allowing nurse practitioners to practice to the full extent of their licensure and education.
Current regulations require that nurse practitioners have an operating agreement with a physician who may supervise no more than four nurse practitioners. This agreement does not mandate that the doctor be present, but it does require a nurse practitioner to jump through bureaucratic barriers before providing basic care – like requiring a doctor to sign a form requesting adult diapers!
There are more than 21,000 nurse practitioners in California. They are advanced practice nurses who provide care in diverse settings including rural clinics, school health centers, working with social workers to help our homeless, in our jails dealing with mental illness and even on fire engines helping first responders.
Using nurse practitioners to help cut down on trips to the emergency room is working, with some areas seeing a 50% decrease in trips to the emergency room. These are preliminary numbers, but it shows the potential.
In most of these settings the nurse practitioner is part of a team, but there is no doctor by their side or even in the building. At my community clinic the physician is usually on site for just 1½ days most weeks, but there are times when he might be out of the country for an entire month.
Kaiser Permanente recently announced a new plan to use nurse practitioners in over 30 Target stores across Southern California. These Target Clinics will provide a wide range of health services including pediatric care, women’s health care and treatment of minor illnesses like the flu. Nurse practitioners can step up and provide care that is desperately needed.
The Veterans Administration recognizes the potential of nurse practitioners and recently changed their regulations. They now allow for nurse practitioners to work with doctors on a new agreement. This new agreement will give these nurse practitioners full practice authority which will allow our nation’s veterans to receives the quality care they deserve in a timely fashion. It also means that nurse practitioners will be able to practice without outdated regulations slowing them down.
It is clear that nurse practitioners are trusted to operate in many settings without a physician being present, and know that a team-based approach is the only way we can work in medicine and provide adequate care. Like any trained professional when we run into a problem, we consult or refer the patient to another professional to assist.
As we discuss how to increase the number of primary care providers in California, better utilizing the more than 21,000 nurse practitioners is a must. Outdated bureaucratic barriers only prevent us from doing our job and providing quality healthcare for our fellow Californians. It is time for us to join twenty-two other states that have already passed legislation to allow us to practice to our full licensure and education, also known as full practice authority.
It is time for California to break down these outdated bureaucratic barriers and allow California’s nurse practitioners to be part of the healthcare solution.
Ed’s Note: Theresa Ullrich is the president of the California Association for Nurse Practitioners.