Reflections on independence in nurse practitioner practice
Article first published online: 4 JUL 2008
© 2008 The Author(s) Journal compilation © 2008 American Academy of Nurse Practitioners
Journal of the American Academy of Nurse Practitioners
Volume 20, Issue 7, pages 345–352, July 2008
How to Cite
Weiland, S. A. (2008), Reflections on independence in nurse practitioner practice. Journal of the American Academy of Nurse Practitioners, 20: 345–352. doi: 10.1111/j.1745-7599.2008.00330.x
- Issue published online: 4 JUL 2008
- Article first published online: 4 JUL 2008
- Received: December 2006;accepted: September 2007
- physician extender;
- professional competition;
- healthcare policy;
Purpose: To examine factors that influence the ability of nurse practitioners (NPs) to practice as independent primary care providers.
Data sources: Extensive literature search on CINAHL, OVID, MEDLINE, Internet journal sources, and professional association Web sites.
Conclusions: The legal authority for NPs to practice independently is recognized; however, the ability to put that authority into practice is undermined by the historical failure of political, professional, and social entities to recognize NPs as providers capable of providing primary care autonomously. Nonrecognition is responsible for complex reimbursement policies (both federal and state) that economically and professionally restrain the NP role; hence, NPs remain in a financially dependent relationship despite 40 years of proven safe practice. NPs must articulate their independence as practitioners more vociferously in order to meet society’s healthcare requirements, as well as to attain professional fulfillment and forge collegial relationships.
Implications for practice: NPs will never be seen as members of a profession by either themselves or others without the practicality of independence and autonomy. Although legal independence is a fact, real practice independence in the pragmatic sense is contingent upon reimbursement. Without fiscal sustainability, practice independence is an impossibility. And, without professional autonomy, NPs will have only an employee’s voice in the dynamic healthcare system in which they are really key players in providing healthcare services to the poor and undeserved populations.