Point 1: Introduction:
Source:
American Association of Nurse Practitioners:
https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/aprn/
APRNs are nurses who have met advanced educational and clinical practice requirements, and often provide services in community-based settings. APRNs’ services range from primary and preventive care to mental health to birthing to anesthesia. To learn more about the four types of APRNs and what they do in practice, read these profiles of APRNs at Work.
APRNs include nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse midwives, and all play a pivotal role in the future of health care. APRNs are often primary care providers and are at the forefront of providing preventive care services to the public.
APRNs treat and diagnose illnesses, advise the public on health issues, manage chronic disease, and engage in continuous education to remain ahead of any technological, methodological, or other developments in the field. APRNs hold at least a Master’s degree, in addition to the initial nursing education and licensing required for all Registered Nurses (RNs).
APRNs Practice Specialty Roles
• Nurse Practitioners provide primary, acute, and specialty health care across the lifespan through assessment, diagnosis, and treatment of illnesses and injuries.
• Certified Nurse-Midwives provide primary, gynecological, and reproductive health care.
• Clinical Nurse Specialists provide diagnosis, treatment, and ongoing management of patients; provide expertise and support to nurses caring for patients; help drive practice changes throughout the organization; and ensure use of best practices and evidence-based care to achieve the best possible patient outcomes.
• Certified Registered Nurse Anesthetists provide a full range of anesthesia and pain management services.
Scope of practice
In the document Nursing: Scope and Standards of Practice, scope of practice is defined by the “who,” “what,” “where,” “when,” “why,” and “how” of nursing practice, including advanced practice nursing. Day to day, this defines the services that an APRN is permitted to undertake – in keeping with the terms of their professional license. The nursing profession, including professional and specialty organizations, is responsible to its members and to the public to define the scope of practice and standards of practice. ANA remains committed to fighting barriers to nursing practice, to ensure that nurses may practice to the full extent of their expertise and education.
Point 2: Brief overview or introduction to primary care in your community. Include the number of NPs, physicians, and PAs in your local community or region if local community data is unavailable.
Source 1: Florida Health Department.
2021 Physician Workforce Annual Report November 2021
Link: https://www.floridahealth.gov/provider-and-partner-resources/community-health-workers/HealthResourcesandAccess/physician-workforce-development-and-recruitment/2021DOHPhysicianWorkforceAnnualReport-FINALREPORT-10-25-2021.pdf
Key findings based on the 2020–21 survey cycle include:
• Almost one-third (31.3%) of Florida’s 67 counties have a per capita rate of less than 10 physicians per 10,000 population
• Over 60% (33,773) of physicians are age 50 and older
• The top three specialty groups for physicians providing direct patient care in Florida are internal medicine (28.2% or 15,339), family medicine (14.6% or 7,951) and pediatrics (8.1% or 4,411)
• The top three specialty groups for physicians providing direct patient care in Florida are internal medicine (28.2% or 15,339), family medicine (14.6% or 7,951) and pediatrics (8.1% or 4,411)
•
Source 2: The State of Primary Care Physician Workforce: Florida
https://www.graham-center.org/content/dam/rgc/documents/maps-data-tools/state-collections/phys-workforce/Florida.pdf
• In the United States, primary care physicians (PCPs) currently represent less than one-third of the total physician workforce.1 States are under increasing pressure to create solutions that bolster the number of physicians practicing primary care in both rural and urban settings.2 This factsheet characterizes the primary care physician workforce in Florida.
• In 2018, Florida had 13,662 PCPs in direct patient care, of which 4,914 were family physicians. In other words, 36% of its primary care workforce consisted of family physicians
• On a per capita basis, there were about 65 PCPs per 100,000 persons in Florida, compared to 76 per 100,000 in the U.S. as a whole.
Source 3: The Advanced Practice Nurse Solution
https://www.flanp.org/page/TheAPRNSolution
• Millions of Floridians have inadequate access to basic health care.Forty-eight percent of physicians in Florida are expected to retire in the next 10 years. Florida needs an estimated 3,000-5,000 primary care providers over the next 5-10 years. Medical schools cannot graduate enough physicians to meet the need.
• Nurse Practitioners (NPs) provide primary and acute health care services by diagnosing illnesses, prescribing medications and treating diseases. They also provide inpatient hospital care, emergency and urgent care, and provide psychiatric care. NPs must earn Masters and Doctoral degrees and pass national certification examinations to qualify for a license to practice and care for patients in Florida.
Numerous studies show that Nurse Practitioners deliver safe high quality cost effective care equal to that of physicians. They are available to immediately meet the needs of medically under served Floridians, without added costs.There are 21,000 Nurse Practitioners in Florida. State wide Florida graduates 300-500 new NPs each year.
NPs can save Florida millions annually. Florida’s Medicaid expenditures are projected to be 22 billion dollars. Florida’s Office of Program Policy Analysis and Government Accountability issued a Research Memorandum of December 30, 2010. It stated that if NPs were utilized to their full scope of education and training, the state would save hundreds of millions of dollars each year.
Point 3: Discuss the early foundations of your chosen specialty.
Source 1: American Association of Nurse Practitioners
https://www.aanp.org/about/about-the-american-association-of-nurse-practitioners-aanp/historical-timeline
1965*
Dr. Loretta Ford and Dr. Henry Silver develop the first nurse practitioner (NP) program at the University of Colorado.
1967
Boston College initiates one of the earliest master’s programs for NPs.
1968
Directed by a nurse and physician team, the Boston-based Bunker Hill/Massachusetts General Nurse Practitioner Program begins.
1971
One of the first family NP programs, PRIMEX, opens its doors at the University of Washington.
1973
More than 65 NP programs exist in the U.S.
2019
AANP builds and moves into its first fully owned corporate headquarters in Austin, Texas
AANP surpasses 100,000 members.
There are more than 270,000 NPs in the U.S. (AANP).
Source 2: History of Nurse Practitioners in the United States [Slideshow]
https://online.simmons.edu/blog/history-nurse-practitioners/
Throughout the country, a consensus formed among nursing leaders that nurses were experienced and knowledgeable about the health care needs of children and families. This led to an expansion of their roles to parallel the roles and responsibilities of a primary care physician. In 1965, one of these leaders, Loretta Ford, partnered with a physician, Henry Silver, to create the very first training program for Nurse Practitioners. Their program, offered at the University of Colorado, focused on family health, disease prevention, and the promotion of health.
The introduction of the first Nurse Practitioner program was met with resistance. Ford, Silver, and their students faced opposition from nurses who worried that the title “Nurse Practitioner” was misleading and would be misinterpreted by both the medical and nursing community as well as the public. Health care professionals were concerned that NPs were not qualified to provide medical care that physicians usually delivered without the supervision of a physician.
During the 1970s and 1980s, Nurse Practitioners took up the task of validating their profession. The lack of a credentialing process and training paired with the improvements in health care put pressure on NPs to showcase their abilities and their overall benefit to health care. NPs used this time to document patient satisfaction with their care and create criteria and standards of practice. They also monitored the overall increase of the availability of primary care to patients throughout the country via evidence-based studies.
As time went on, Nurse Practitioners became a more valuable and essential part of health care, and they began to work for economic and professional acknowledgement. Between 1973 and 1985, more than 11 NP organizations were created in the United States. Through these organizations, NPs took certification examinations to earn credentials and adhere to federal regulations and reimbursement policies.
Point 4: Talk about diversity/inclusion/equity in your specialty area.
o What are your biases?
Source:
Article: Cultivating diversity in the advanced practice registered nurse workforce: An exemplar from an advanced practice registered nurse fellowship program.
Authors: Raghu, Natalie DNP; McNamara, Mary DNP; Bettencourt, Emily; Yingling, Charles DNP. Journal of the American Association of Nurse Practitioners. Mar2022, Vol. 34 Issue 3, p542-549. 8p. DOI: 10.1097/JXX.0000000000000679.
Diversity in the health care workforce is an important driver of patient satisfaction, adherence to care, and quality outcomes (Gomez & Bernet, 2019). Furthermore, racially concordant care (i.e., care received from a provider who is of a similar racial or ethnic background) may improve satisfaction (Takeshita et al., 2020) and adherence to care (Adamson et al., 2017). Systemic barriers exist that prevent individuals from underrepresented minority groups entering and advancing in the nursing workforce.
However, an array of systemic barriers exist that prevent individuals from underrepresented minority groups entering the health care workforce in sufficient numbers to be reflective of the population at large. Structural racism is the driver of many of these barriers, including difficulty competing for university admission due to disinvestment in primary and secondary schools, long-standing economic policies that reinforce the cycle of poverty in minority populations, and implicit bias in admissions processes (Sullivan Commission on Diversity in the Health Care Workforce, 2004).
The lack of diversity that affects the health care workforce at large is evident in the nursing profession as well. Despite people of color accounting for more than one third of the US population (US Census Bureau, 2021), the registered nurse (RN) workforce in the United States is largely made up of White people. Approximately 80% of US RNs are White (Figure 1). Other racial groups are underrepresented in nursing ranks: 6.2% are Black or African American, 7.5% are Asian, and 0.4% are Native American, 0.5% are Native Hawaiian or Pacific Islander. Ethnically, only 5.3% of US nurses identify as Latinx (Smiley et al., 2019).
The same barriers that make entry into the nursing profession more challenging for people of color also make entry into advanced practice nursing roles challenging. Among the nurse practitioner (NP) and certified nurse midwife (CNM) workforce, Black and Latinx people are significantly underrepresented. Although non-Latinx Black people make up approximately 13% of the US population (US Census Bureau, 2021), only 7% of NPs and CNMs are non-Latinx Black (US Bureau of Labor Statistics, 2021). Similarly, although Latinx people account for ap- proximately 18% of the US population, only 6.3% of NPs identify as Latinx (US Bureau of Labor Statistics, 2021).
Point 5: Explain the process required to become an advanced practice nurse.
Source: https://storage.aanp.org/www/documents/research/Pathway-to-Becoming-an-NP-Infographic_FINAL-002.pdf
Point 6: What does an FNP do? What does a WHNP do? Roles?
Source 1: Article: Advanced Practice Registered Nurses
https://doi-org.frontier.idm.oclc.org/10.1016/j.nwh.2022.12.001
Journal: Nursing for Women’s Health Volume 27, Issue 2, April 2023, Pages e1-e4
The role of NPs
Women’s health NPs (WHNPs) are APRNs who provide evidence- based primary, reproductive health, gender-specific, gynecologic, and obstetric care with a holistic focus. WHNPs are unique because they bridge the gap between primary and obstetric care through interdisciplinary collaboration. Because of their distinctive position of caring for women throughout their lives, WHNPs, family NPs (FNPs), and adult–gerontology NPs (Adult Nurse Practitioners [ANPs]/Adult-Gerontology Nurse Practitioners [A-GNPs]) play a pivotal role in identifying risk factors during pregnancy and the postpartum period by optimizing perinatal, maternal, and neonatal health care outcomes (Nurse Practitioners in Women’s Health [NPWH], 2020). All NPs (e.g., WHNPs, FNPs, and ANPs/A-GNPs) can assess, diagnose, and treat a range of health conditions. Additionally, they have extensive expertise in promoting optimal health care practices (e.g., disease prevention, interventions, and education).
Source 2: Are You Considering a Career as a Family Nurse Practitioner?
What Is an FNP?
An FNP is an advanced practice registered nurse (APRN) who provides a wide range of family-focused health care services to patients of all ages, including infants, adolescents, adults and seniors. FNPs maintain patient records; perform physical exams; order or perform diagnostic tests; prescribe medications; develop treatment plans; and treat acute and chronic illnesses, conditions and injuries that fall under primary care. FNPs practice in a variety of health care settings, including community health centers, private practice, health care systems and universities. Although FNPs have a broad scope of practice, from educating patients on disease prevention to treating serious illnesses, they can also obtain additional certifications in areas such as diabetes, pain or obesity management. FNPs are not required to have these additional certifications. Instead, they are available to many APRNs seeking to meet the needs of their patients and enhance their careers.
Source 3: Family Nurse Practitioner (FNP) Career Overview
by Courtney Smith-Kimble
Updated September 30, 2022
Reviewed by
Elizabeth Clarke, FNP, MSN, RN, MSSW
What Does a Family Nurse Practitioner Do?
MSN REQUIRED
CERTIFICATION OPTIONAL
Family nurse practitioners (FNPs) provide primary care for patients at all life stages, often in collaboration with healthcare teams. While FNPs prioritize preventative care, they can also treat serious illnesses. Other responsibilities may include ordering and interpreting lab tests, diagnosing patients, and managing treatment plans. Whether an FNP online program or an in-person one, FNP coursework focuses on these topics:
Primary Skills and Responsibilities
• Ethical decision-making
• Critical thinking
• Effective communication
• Diagnosing patients
• Creating care plans
• Collaborating with healthcare teams
While FNP training is broad, nurse practitioners may get certifications in specialized areas.
Where Do FNPs Work?
FNPs can work in nearly any healthcare facility, including hospitals, urgent care establishments, or emergency rooms. However, nearly 14.5% of FNPs work in hospital outpatient departments, while 13.3% work in inpatient areas in hospitals.
• Hospitals
FNPs conduct checkups, order tests, and treat illnesses; they also perform procedures or assist in them, both surgical and bedside.
• Private Practice
FNPs record patient health history, observe and assess symptoms, and prescribe medication.
• Internal Medicine Clinic
FNPs perform exams, treat illnesses and injuries, and prescribe medication.
Point 7: Is collaboration with a physician requirement for practice?
Source1: Autonomous Practice Q&A
Florida Association of Nurse Practitioners. 10/7/2022 Update
https://www.flanp.org/page/AutonomousPractice
Source 2: The 2022 Florida Statutes (including 2022 Special Session A and 2023 Special Session B)
Copyright ©95-2023 The Florida Legislature
Copyright © 1995-2023 The Florida Legislature
http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0464/Sections/0464.0123.html
In Florida APRNs can work autonomously
Do I have to become an autonomous APRN? No, you can continue working with/under a collaborative agreement.
Are ALL nurse practitioners able to practice independently? Unfortunately, no, but with the updated definition of primary care most are included. Nurse Practitioners who are issued a licensed to practice autonomously must engage only in primary care practice, including family medicine, general pediatrics, and general internal medicine, as defined by board rule.
Point 8: Is it an HRSA-designated Health Provider Shortage area? If yes, what type? (primary care, older adult care, mental health care, or dental care???
Source: Data HRSA.gov. HPSA Find
https://data.hrsa.gov/tools/shortage-area/hpsa-find
Retrieve 4/21/2023
There are several areas designated as Health Provider Shortage Areas in Miami-Dade county where I live. The most affected type of services are primary care, dental and mental health.
The following is a list of full-time practitioners needed per area to achieve the population/practitioner target ratio needed in primary care.
(Please copy this table)
Area: # of FT practitioners needed
- Dade Correctional Institute. 1.48
- Everglades Correctional Institution Reentry Center 1.72
- Biscayne Park Low Income Population 3.65
- North Miami Low Income Population 3.06
- Norland Low Income Population 6.46
- FDC Miami Correctional 1.64
- North Beach Low Income Population 5.26
- Homestead Correctional Institution 0.54
- FCI Miami Correctional 1.12
- Wyndwood Low Income Population 10.39
- Little Habana Low Income Population 36.5
- Liberty City Low Income Population 17.39
- West Perrine Low Income Population 9.98
- Homestead Low Income Population 21.8
- Kendall Low Income Population 9.93
- South West Dade Low Income Population 5.53
- Golden Glades Low Income Population 16.78
- Opa Locka Low Income Population 17.23
- Hialeah Low Income Population 29.63
Total: 200.09 full time Primary Care providers are needed
Point 9: What is the average primary care physician’s salary in your area? Focus on family practice or general medicine.
Source1 : Primary Care Physician Salaries. Glassdoor.com
https://www.glassdoor.com/Salaries/florida-primary-care-physician-salary-SRCH_IL.0,7_IS3318_KO8,30.htm
How much does a Primary Care Physician make in Florida?
The estimated total pay for a Primary Care Physician is $237,954 per year in the Florida area, with an average salary of $207,443 per year. These numbers represent the median, which is the midpoint of the ranges from our proprietary Total Pay Estimate model and based on salaries collected from our users. The estimated additional pay is $30,512 per year. Additional pay could include cash bonus, commission, tips, and profit sharing. The “Most Likely Range” represents values that exist within the 25th and 75th percentile of all pay data available for this role.
Source 2: Salary.com
Primary Care Physician Salary in Florida
https://www.salary.com/research/salary/recruiting/primary-care-physician-salary/fl
How much does a Primary Care Physician make in Florida? The average Primary Care Physician salary in Florida is $190,086 as of March 28, 2023, but the range typically falls between $159,736 and $222,235. Salary ranges can vary widely depending on the city and many other important factors, including education, certifications, additional skills, the number of years you have spent in your profession.
Point 10: How many NPs currently practice in your state? Is there a need for more, or is your state saturated with NPs?
• Source: US Bureau of Labor Statistics
• Occupational Employment and Wage Statistics
From May 2021
Florida
14,880
Source #2: The Advanced Practice Nurse Solution
Florida Association of Nurse Practitioners
https://www.flanp.org/page/TheAPRNSolution
Currently the number passes 21,000 Nurse Practitioners in Florida. State wide Florida graduates 300-500 new NPs each year.
There is a need a need for more practitioners.
NPs can save Florida millions annually. Florida’s Medicaid expenditures are projected to be 22 billion dollars. Florida’s Office of Program Policy Analysis and Government Accountability issued a Research Memorandum of December 30, 2010. It stated that if NPs were utilized to their full scope of education and training, the state would save hundreds of millions of dollars each year.
The Institute of Medicine released a report in October of 2010 that recommends removal of all scope of practice restrictions on NPs as a way to drive down costs, while increasing high quality access to primary health care.
Point 11: What is the average NP salary in your state compared to the national average?
Source: Occupational Employment and Wages, May 2021
US Bureau of Labor Statistics
https://www.bls.gov/oes/current/oes291171.htm#ind
National estimates for Nurse Practitioners:
Employment estimate and mean wage estimates for Nurse Practitioners:
Employment (1)
Employment
RSE (3)
Mean hourly
wage Mean annual
wage (2)
Wage RSE (3)
234,690 1.3 % $ 56.75 $ 118,040 0.4 %
Florida average salary NP:
States with the highest employment level in Nurse Practitioners:
State Employment (1)
Employment per thousand jobs Location quotient (9)
Hourly mean wage Annual mean wage (2)
Texas
17,810 1.46 0.87 $ 56.68 $ 117,890
California
17,400 1.05 0.63 $ 72.99 $ 151,830
New York
15,190 1.75 1.05 $ 64.39 $ 133,940
Florida
14,880 1.73 1.04 $ 50.40 $ 104,830
Tennessee
11,360 3.80 2.28 $ 45.73 $ 95,120
Point 12: What is the outlook for NPs in the next ten years? (2025) Do not use the 2013 data. Look for the 2025 data. Clearly states the meaning of what you are projecting, don’t simply put a number down,
Source:
Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners
US Bureau of Labor Statistics
Last Modified Date: Thursday, September 8, 2022
https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm
Job Outlook
Overall employment of nurse anesthetists, nurse midwives, and nurse practitioners is projected to grow 40 percent from 2021 to 2031, much faster than the average for all occupations.
About 30,200 openings for nurse anesthetists, nurse midwives, and nurse practitioners are projected each year, on average, over the decade. Many of those openings are expected to result from the need to replace workers who transfer to different occupations or exit the labor force, such as to retire.
What Is The Job Outlook For Nurse Practitioners In The United States?
Nurse practitioners are one of the fastest-growing careers in the United States. Over the next decade, there is an anticipated 54% growth for nurse practitioner job outlook, over 110,000 new jobs! These predictions are for the field as a whole, and the job outlook can vary depending on the specialty, sub-specialty, and acuity you choose to pursue. As you will see, this job outlook is for the country as a whole, and each state will have different levels of growth. As the healthcare career climate continues to change, you can expect some minor changes in these predictions.
Employment
in 2020 Projected
Employment
in 2030 Projected 10-Year
New Employment
Growth (2020-2030)
Number %
220,300 335,200 114,900 52.16%
(Source: U.S. Bureau of Labor Statistics)
Point 13: Discussion and conclusion.
