Legislation and regulatory changes are influencing the first change. The scope of practice, regulated by individual states, varies greatly. Currently, there are 23 states in which NPs can practice independently of physicians (Mack, 2018, p. 419). The other 27 states continue to have some restrictions on the scope of NP practice; some states more than others. However, as the aging population continues to grow, there is an increased demand for physicians, but a decrease in the availability of them. Bodenheimer and Bauer (2016) noted, “workforce experts agree on the growing gap between the population’s demand for primary care and the number of primary care physicians available to meet that demand” (p. 1015). Suggestions to meet the growing gap include an unrestricted scope of practice for the NP across all states. Although the change is slowly occurring, the trend appears to be a shift in this direction.
Additionally, trends indicate an increase in primary care NPs, which will benefit the patient population in having access to healthcare. However, trends also indicate an increase in home-based healthcare versus the acute-care setting. This trend is also effecting where NPs practice. Fitzgerald (2018) indicated the healthcare system evolution is turning the focus of care from institutionalized to community and home-based settings (p. 55). These trends are indicating a transition in the type of care provided by the NP.
The final trend for discussion in this forum is the difference in reimbursement of care provided by a NP versus care provided by a physician. Depending on the state in which the NP practices the reimbursement rate for the care provided is around 85% of the physician rate. According to Phillips (2018), only one state has passed legislation regarding the reimbursements of NPs, this state was Vermont (p. 30). Legislation regarding reimbursement for NP is currently lacking, but the consensus of full autonomy for NPs is a trending topic, as is the reimbursement of their services.
My personal philosophy: As an adult-gerontology nurse practitioner I will provide patient and family-centered care to all patients. My care will be based on evidence-based interventions from strongly supported research. I will provided holistic, collaborative, culturally competent care. In an effort to ensure my care is consistent and using the best practices I will continue to update and research new methods of providing care.