Nurse Practitioners and Prescribing Medication

 
 
 
 
This paper is an examination of the effects that managed care and newer health delivery systems have had on the growing profession of nurse practitioners. As nursing as a whole has become increasingly professionalized, the health care field has come to recognize that advanced specialization within nursing is of vital importance. Some hospitals are beginning to experiment with allowing nurse practitioners to prescribe medications and take on other responsibilities formerly restricted to physicians alone. At the same time, health management organizations (HMOs) and other forms of managed care are changing the ways in which health care is funded and delivered. The impact of fiscal and other kinds of accountability, streamlined delivery, and increased public awareness of health care costs, benefits, and challenges are all working to expand the role of nurse practitioners. Because these highly trained specialists can fill in many of the gaps in routine care, the profession of the nurse practitioner will continue to develop well into the 21st century.

The profession of nurse practitioner (NP) began to emerge during the 1960s. The title designates a nurse whose advanced training, usually a masters degree in nursing, has taken him or her beyond a general nursing background and into a specific area of specialization. According to the American Nurses' Association, the recognized nurse practitioner specializations as of 1986 were (in order of numbers of nurses certified in the


     
 
 
 
    

 

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ital" (p. 23). According the Bureau of Labor Statistics, more than one million nurses worked in U.S. hospitals in 1986 and 264,000 worked in health services outside of hospitals. By 1995, while in-hospital nurses had increased to 1,294,000, the number of outside nurses had also grown, to 496,000, a substantial increase. Nurses and nurse practitioners are especially useful in non-hospital settings, in part because they are less expensive. Although NPs generally earn more than most other nursing specialists except nurse anesthetists, their salary levels are still below those of MDs. Some managed care programs have begun experimenting with allowing NPs to bill patients directly, a move which often eliminates one level of paperwork and saves additional costs. Some MDs are beginning to experiment as well with using NPs in place of an additional doctor. Nurse practitioners are becoming partners with single doctors and first assistants in the operating room, adding to the medical effectiveness of the team without doubling the cost. Ellen D. Baer (1997), writing in the American Nursing Journal's Career Guide for 1997, observes that nurses in general face two primary trends: changing business practices and the use of assistive s

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