Nurse Practitioner Practice and Education: Then & NowThe Recent Growth and Future Trends of NP Practice and NP Education Programs
Nurse practitioner practice is one of the fastest growing segments in healthcare practice and healthcare education. From BSN to NP to DNP, the number of graduated nurse practitioners is still outpaced by demand and NP programs are adopting new solutions to meeting demand - or they must turn away qualified candidates every year. In this article, we'll look at the history, recent growth, and future trends of nurse practitioner practice and formal NP education programs.
The Evolution of the Nurse Practitioner Practice
In 1965, Medicare and Medicaid coverage was expanded to low-income women, children, elderly, and people with disabilities via the Medicare Act of 1965. As a result, a physician shortage was created, particularly for pediatrics in rural and urban settings.
The profession of Nurse Practitioner began as a response to this, with the first NP program founded at the University of Colorado in 1965. Initially, NP’s were focused on pediatrics, and it was a type of advanced practice RN. (APRN).
1967 – first master’s degree program for Nurse Practitioners founded at Boston College.
1971 – first Family Nurse Practitioner program opens at University of Washington.
1973 – There are now 65 NP programs across the United States.
1974 – Council of Primary Care Nurse Practitioners founded, the first NP association.
1985 – American Academy of Nurse Practitioners founded, first national association level organization for organizing and lobbying for NP practice.
1989 – The Omnibus Reconciliation Act of 1989 created reimbursement for NP’s, ushering the profession into direct health care provider status.
1993 – AANP forms the first certification program for NP’s.
1997 – Balanced Budget Act of 1997 creates direct reimbursement of NP’s from Medicare (similar to physicians)
1999 – The number of NP programs now outnumbers all other nursing specialties. NP programs are much smaller than RN programs however. It just means that every nursing program now has multiple NP tracts.
2000 – NP’s are now legally able to practice (for money) in all 50 states.
2002 – acute care NP’s join the AANP (which is why the AANP is the certification regime for ENP’s now)
2004 – American Association of Colleges of Nursing (AACN) launches initiative requiring that all NP programs transition to DNP programs by 2015 – By 2015, only 1/4th had made the transition to a doctorate level program.
At that time, the AACN projected that there would be 244,000 NP’s by 2025. In fact, in just four years, 2019, the number was 270,000. NP growth, as they gain provider and scope of practice authority in states is much faster than projected.
2013 – American Association of Nurse Practitioners founded by merger of the American Academy of Nurse Practitioners and the American College of Nurse Practitioners. AANP is the driving force behind NP scope of authority and unrestricted practice.
2019 – 22 states now allow unrestricted practice by NP’s (they can function identically to a physician, with no physician supervision required).
The Growth of Nurse Practitioners
Tracking the approximate number of nurse practitioners between 1979 and 2019 gives us some idea of expansion in the NP practice - and the number of increasing enrollees to NP programs. Over the past 40 years the number of NPs has grown eighteen fold from 15,000 to 270,000, but look at the add rate just over the last 10 years. The rate of graduated NPs over the last 10 years is twice the rate seen over the previous 30.
Approximate number of NP's
Higher NP add rates impact NP education
You'll see the Nurse Practitioner population as of 2019, barring retirement waves, is on track to double in size every nine years.
That's assuming, of course, that the faculty, facilities and physical plant could maintain that growth rate. Which it can't.
This is why the number of online NP programs is proliferating.
The only way to keep up with demand for NPs - or progress to newly recommended DNP level education - is via online programs.
Image: Online education platforms like Med-Challenger (shown) are helping NP programs satisfy increasing demand.
NP enrollment and employment data indicate no problems with demand - the problem is NP education program throughput.
According to AACN’s report on 2018 - 2019 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, U.S. nursing schools turned away 75,029 qualified applicants from baccalaureate and graduate nursing programs in 2018 due to an insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints. Most nursing schools responding to the survey pointed to faculty shortages as a reason for not accepting all qualified applicants into baccalaureate programs.
According to a Special Survey on Vacant Faculty Positions released by AACN in October 2018, a total of 1,715 faculty vacancies were identified in a survey of 872 nursing schools with baccalaureate and/or graduate programs across the country (85.8% response rate). Besides the vacancies, schools cited the need to create an additional 138 faculty positions to accommodate student demand. The data show a national nurse faculty vacancy rate of 7.9%. Most of the vacancies (90.7%) were faculty positions requiring or preferring a doctoral degree.
The same source says that the average age of faculty holding professor rank is 62. A wave of faculty retirements is expected in the coming decade.
Average pay for faculty is $78,000. Average pay for an NP in practice is $97,000.
DNP programs are not producing replacement faculty - they are producing health care providers.
Where does the NP growth rate level out? No clue. But last year NP programs turned away 75,000 applicants rated as 'qualified' to 'highly qualified.'
"The only way to keep up with demand for NPs - or progress to newly recommended DNP level education - is via online programs."
NP Distribution by Certification Area
- Family, 66.9%
- Adult, 12%
- Adult-Gerontology Primary Care, 6%
- Acute Care, 4.8%
- Pediatrics-Primary Care, 4%
- Adult-Gerontology Acute Care, 3.1%
- Women’s Health, 2.7%
- Psychiatric/Mental Health-Family, 2.1%
- Psychiatric/Mental Health, 2.0%
- Gerontology, 1.8%
Note that NP's are not quite like doctor certifications (no residency requirement). Certification areas are not exclusive - it's much easier to be both a Family / Women's Health NP, for instance, than for a physician to be double boarded in FM and OBGYN.
NP Gender Distribution
- 146,176 - female
- 13,247 - male
- 6,057 - not specified
NP Certification Organizations
- American Nurses Credentialing Center (ANCC)
- Adult-Gerontology Acute Care
- Adult-Gerontology Primary Care
- Pediatric Primary Care
- Psychiatric-Mental Health
- Pediatric Nursing Certification Board (PNCB)
- Pediatric Primary Care
- Pediatric Acute Care
- National Certification Corporation (NCC)
- Women's Health-Gender Related
- American Academy of Nurse Practitioners Certification Program (AANPCP)
- Adult-Gerontology Primary Care
- American Association of Critical-Care Nurses (AACN)
- Adult-Gerontology Acute Care
Additional NP Certifications:
- ONP – Orthopedic Nurse Practitioner, Orthopaedic Nurses Certification Board
- ENP – Emergency Nurse Practitioner, American Nurses Credentialing Center (ANCC) (no test)
- ENP – Emergency Nurse Practitioner, American Academy of Nurse Practitioners National Certification Board (AANPCB) (certification test)
- Hospice and Palliative Care NP, Hospice and Palliative Credentialing Center
- Oncology Nurse Practitioner, Oncology Nursing Certification Corporation
- Dermatology Nurse Practitioner, Dermatology Nurses Association
- Psychosomatic Medicine
- Holistic Care
NP Scope of Practice / Practice Authority
Scope = Services competent to perform
Authority = what type of treatment is allowed based on (mostly) state regulations
There are three categories of practice authority – full practice, reduced practice, and restricted practice. These deal with how much supervision of a nurse practitioner is required by law, and what types of patient environments the NP may practice in.
- Full Practice = anything, unsupervised clinical treatment
- Reduced Practice = must have doctor supervision of practice, which covers a lot of different arrangements by state, from ‘doctor must be in the building’, to ‘doctor signs off on cases once a month’.
- Restricted Practice = NP may only work as part of a physician-led healthcare team.
Most states do restrict scope of practice in regards to prescribing opioids.
As of 2019, 22 states offer NP’s full practice authority and unlimited scope (except for the opiods exceptions).
NP Population vs. Specialization
Nurse practitioners generally graduate within what’s called a population group – adult, gerontology, pediatric. Then the sub-specializations apply. It’s a little different from physicians and specialization (where you have medical school, then specialty selection).
An NP, for instance, attends a pediatric program, then may specialize in pediatrics, or acute care pediatrics.
NP Program Cost
Program costs are all over the map. An NP master’s degree generally requires 45 to 50 credit hours if you are going BSN to NP.
Instate tuition for 50 hours might be as low as $18,000. Out of state tuition as high as $31,500. Online programs average $22,000 – but with wide variation depending on the type of NP certification and the school offering the program.
In 2019, programs are aiming to graduate 27,000 new NP’s.
The total tuition expenditure for the programs being completed may be as high as $500 million. It follows that the ability for programs to supply education to larger numbers of tuition paying enrollees is the key to the success of individual NP programs right now and in the future.
And that's where the leading online nurse practitioner education capabilities and online NP curricula resources come into play. There's just not enough time for traditional NP programs to respond, much less build online curriculum and assessment analytics, all on their own.
Learn about Med-Challenger's online NP courses & NP education platform here.