New Roles for Advanced Practice Nurses

September 2012
David Vlahov

As the country gears up for the 2014 implementation of the Affordable Care Act, which will open up access to care for 32 million currently uninsured people, advanced practice nurses (APNs) will play an important role.

Working with other health care providers in a variety of settings, APNs can meet many essential needs of a modern health care system, including health promotion, disease prevention and primary and specialty care. In addition, nurse practitioners are a significant part of the solution for improving access to underserved populations.

Perhaps most importantly given the urgency of the situation, evidence exists that APNs take less time to train, provide less expensive care and in the many areas for which they are trained deliver equal or better quality of care and patient satisfaction than physicians. 

The catch is that there is a shortage of expert teachers to prepare the next generation of APNs. At the moment, there are 1,200 vacant APN faculty jobs nationwide, and this year we are seeing a rash of retirements in among nursing faculty across the country. Looking ahead five years, between one-third and one-half of APN faculty at our school alone will be eligible to retire. Replacing them will not be easy.

Returning to school for a doctorate requires a special dedication, especially for nurses who have practiced and taken on financial and family responsibilities. Tuition has increased as federal and state funding for advanced education has eroded, making higher-paid clinical positions like nurse practitioner more appealing. Those who choose to teach make personal sacrifices so that we can have a new and more responsive health care system.

Some of those who remain in clinical positions do serve as volunteer faculty and preceptors. Often alumni, they too do a remarkable job of training the next generation of nurses. Yet here again, their role demands sacrifice, and we do not have the numbers to meet the need.

To fill the gaps, most schools are experimenting with new strategies, including advanced simulation labs, online education, and partnerships with other professionals in nutrition and pharmacology as well as among formerly competitive nursing schools.

All of these strategies are important, but none can fully replace the human interaction – the nurse educators who have made personal sacrifices to nurture and guide the clinician who will provide outstanding frontline care, the administrator who will supervise the positive patient experience, and the educator and scholar who will advance knowledge in the university setting.

These individuals deserve more than our thanks. They need concrete support in the form of better wages – not just to show our appreciation, but also to entice others to fill these crucial roles. Schools need more endowed chairs to recognize faculty excellence. And we must maintain and strengthen our relationships with volunteer alumni and other community clinicians who teach students in real-world clinical settings.  

Because the flattened economy has caused some nurses to put off retirement or return to work, job vacancies are low in some areas, causing some debate about whether a nursing shortage actually exists. But when the economy recovers, many nurses will again leave the clinical and academic settings, depleting our ranks at a time when the aging of the population will demand more nursing care than ever before. We need nurse educators now to be prepared for the future that is already upon us.

David Vlahov, PhD, RN, FAAN
Professor and Dean, UCSF School of Nursing

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