NP Week 2024: We've come a long way baby!

NP Week 2024: We've come a long way baby!
By: Terri Schmitt PhD, APRN, FNP-BC, FAANP
Executive Director, NPACE

Upon becoming a nurse practitioner 23 years ago, I practiced in one of the most restrictive states, specifically within one of only two nurse practitioner-owned clinics in the entire state. We were rural. We were predominantly serving a population that was primarily uninsured, along with adults and children covered by Medicaid. I vividly recall the strategies we employed to navigate the complexities of obtaining DME; we would meticulously draft paperwork to present to the physician who visited our clinic weekly. This physician was compensated hourly for reviewing and signing charts, assisting with orders that could only be authorized by a doctor, and providing consultations as necessary. During that time, reimbursement rates from Medicaid and insurance were suboptimal, we were prohibited from prescribing controlled substances, and our collaborative practice physician was required to reside within a specific radius of the clinic. 

Back then, I encountered significant challenges when attempting to fill prescriptions at certain pharmacies, which often refused to accept them in the absence of a DEA number—an authorization I was unable to obtain due to stringent state prescription laws (I spent many NP lobby days at the capital with little fruit of labor on this). Additionally, many pharmacies would erroneously attribute my prescriptions to my collaborative practice physician, as his name was listed on the prescription pad, even though he had likely never engaged with the patient. The hospitals in our area denied us admission privileges, while insurance companies prioritized the physician collaborator in their contracting processes. Moreover, we learned which specialists we referred to would warn patients not to see a nurse for primary care. 

We served that rural community, and we did it well! Our patients otherwise lacked access to care because larger hospital conglomerates felt they would not make enough money to justify a clinic in the area, but the NP I worked for built one anyway. We were there every day seeing patients and doing all sorts of things on our own to save them money like spinning blood, giving their allergy shots from specialists, vaccinating, dipping urine, running our own rapid point-of-care tests, doing wet mounts and looking under microscopes, running IV fluids, giving nebulized treatments, stitching, putting in pessaries for older women, and more.  The NP even had a counselor there 1 day a week to provide mental health services. She was definitely ahead of her time and the clinic still thrives today as a pillar of that community.

 We are still working on access to care and providing it as advanced practice providers! Today there are more entrepreneurial opportunities, improved state laws with full-practice authority in 27 states, and controlled substance prescribing rights in all states! We are diverse. We have many specialty areas and we serve to advise clinics, health systems, municipality and other government entities.  We are educators of patients, nurses, nurse practitioners, and other team members and champions for access to care, considerations for better care and wellness, and thought leaders in multiple areas. We mentor, serve, work, advise, and so much more!

We are healthcare.

Each of you give so much to this profession in so many ways! I personally want to thank you for continuing to persevere. As a part of November, NPACE wants to give back to you with a free course to raise your spirits, but also to offer you a discount to one of our 2025 events. Read on for more on how we are working to support you in. your work.

Thank you for all you do and Happy NP Week November 10^th to 16^th 2024!