The goal of this article review is to explore the role of Nurse Practitioners (NP) in closing the gap to health care access for underserved communities. It will address their role as clinical provider, educator, and advocate for programs to improve community outcomes. Nurse Practitioners through additional education and professional training are licensed to provide health care directly to patients. As an educator, Nurse Practitioner spend hours of educating patients on treatment plans, medication administration and preventive care. Nurse Practitioners advocate for resources in a manner to improve the well-being of the underserved communities at the local, state, and national level. Nurse Practitioners have a core value of promoting healthier lifestyles but that isn't enough if the community lacks access to health care. Nurse Practitioner's willingness, advanced education and skills set places them in a unique position to assist and expand health care access.
Nurse Practitioner, Accessibility, Advocate
Access to health care has become increasingly challenging for many Americans due to social and economic determinants. Determinants such as the lack of accessibility and affordability for vulnerable populations created a large gap in receiving quality care. The pandemic of 2020 created a great strain on communities with businesses closing, causing employees to lose their health benefits and access to health care becoming further limited. The challenge of medical conditions, access to care and the rising cost of health care, vulnerable populations are at increased risk of declining health . For health care to be accessible it must be affordable and convenient. With the rising cost of healthcare, The Patient Protection and Affordable Care Act or commonly known as Obama care was created, this health care reform law made affordable health insurance available to more Americans and it expanded the Medicaid program to adults with incomes below 138% of the federal poverty level . Through decades of inequalities nurses have played a key role in providing quality health care for vulnerable populations. Of the health care professionals nurses work in a wide variety of settings and are trained to deliver care to diverse communities . “The nursing profession has amplified and articulated its role in educating nurse to understand and promote population health” . Additional education and training equips Nurse Practitioners with the skill set to meet the increasing needs of the patients and families in their communities.
The shortage of primary care providers is leaving rural area across the U.S. at greater risk for health problems . Considering nurses make up a large number of the health care profession working in a variety of settings and providing care to diverse populations , Nurse Practitioners have the potential fill the shortage of primary care providers. There are some states that limit the scope of practice for Nurse Practitioners, with requirements to practice under direct supervision of a medical doctor. Allowing Nurse Practitioners to practice to the fullest extent of their training, would help bridge the gap in health care and satisfy the health-care needs of those living in underserved communities . There are some states that allow Nurse Practitioner’s to practice autonomously, and other states require Nurse Practitioners to practice under direct supervision of a medical doctor. Research shows that relaxing or removing the restriction on the scope of practice could help Nurse Practitioners to meet the critical demand of primary care services in rural areas . The Nurse Practitioner’s training in assessment, diagnosing, and treatment places them in a unique position to provide medical care for underserved communities. To use the full scope of practice of their clinical expertise can result in a fair healthcare system that caters to the needs individuals, families, and communities.
One could argue that limited access to health care drives the vulnerable population into crisis resulting in poor health outcomes. As the shortage of primary care providers persists, underserved communities are at risk for declining health conditions . The underserved communities struggle with not only rising cost and but lack of access to quality health care. Covid-19 demonstrated the lack of preparation and insufficient workforce to manage the magnitude of a public health crisis, thus placing an additional strain on our healthcare system. As a result of loss of employment for many Americans there was a loss of insurance cover age creating additional disparities in access to health care resources and services. For these families the lack of insurance placed a barrier to having a primary care physician, thus delaying treatment for acute and chronic illnesses. According to article written by J. Rosenberg , with the addition of Nurse Practitioners, medical practices are in a suitable position to improve access to quality health care. Primary Care Nurse Practitioners could ease the strain of an already overburdened healthcare system by providing quality primary care through assessment, diagnosis, and treatment of complex health conditions. Nurse Practitioners working in primary care settings deliver care that is both safe and effective through additional education and training . Regular examinations, disease immunizations, health screenings, and routine testing are some examples of primary care services Nurse Practitioners are trained to perform. According, to one study “person’s residing in the full practice states, 62% had higher geographic accessibility to primary care clinicians” .
Dahrouge, et al.,  writes “there is an ongoing search for better ways to organize primary health care to increase population access while maintaining or improving cost effectiveness through the use of inter professional teams”. The lack of availability of primary care physicians creates a gap in access to health care for vulnerable populations. The growth of the total population exceeds the supply of physicians practicing. Over the next 15 years, the aging population, 65 years and over is expected to grow by 40% . In the article U.S. Physician Shortage Growing, by 2033 there will be a shortage of 139,000 physicians . Physician shortage creates a delay in care and a delay in overall patient wellness. With physicians retiring early and fewer medical students going into primary care, Nurse Practitioners and Physician Assistants are filling in the gap. Nurse Practitioners are licensed practitioners that have the clinical knowledge and training to serve as a critical element in filling the gap to health care access. According to a 2018 Cochrane review of 18 randomized controlled trials suggested that “nurses provided care equivalent to physicians and achieved similar patient outcomes” . Nurses Practitioners are more likely to practice in vulnerable populations compared to physicians and serve as primary care providers to underserved patients . There are over 200,000 Nurse Practitioners in the U.S. who are playing a critical role in rural and nonrural primary care practices [5,9]. The goal of Nurse Practitioner practice is to place emphasis on prevention, risk reduction and health promotion through evidence based practices. Nurse Practitioners with less restrictive scope of practice will increase primary care access for communities in need of health care .
As an educator, Nurse Practitioners assess the knowledge, values, and beliefs of the community they serve and provide health education based on the appropriate knowledge level. Since the beginning of nursing, education has been a large part of the profession. Nurses have spent hours educating and teaching patients about their illness, treatment, and other health care needs . Communicating effectively improves health literacy in patients leading to improvement of health care outcomes. As a clinician, Nurse Practitioners are not just prescribing medications, but they are educating their patients on how to take medications, when to take the medication, and what to expect with the medication as well as making sure they leave with a clear understanding of their visit. Positive patient outcomes depend on a patient’s ability to manage their own care, this goes beyond prescribing medication but teaching self-management skills and improving health literacy.
There are other ways nurse practitioners can lessen the gap of access to health care for underserved communities. Nurse Practitioners are ideally positioned to maximize access to healthcare with a positive impact on communities through patient advocacy along with collaboration with community leaders. Nurse Practitioners are in a unique position to represent their communities and advocate for community changes consistently seeking the best for their patients. Collaborating with community public health agencies lays the foundation for patients to connect with community resources and services to improve their health. Community Health Centers are nonprofit community governed organizations that deliver array of community services using members of an inter-professional team, employing both family physicians and nurse practitioners . In the article Why Nurse Practitioners Play Such anImportant Role in the Community , as community leaders, Nurse Practitioners are able to initiate projects that enhance public health and assistance to the resident’s dealing with changing local health issues . “As the largest single group of health professionals, nurses are often closest to the point of care and comprise the only health profession that the majority of the public trusts to reform health systems” . Networking with community health centers provides preventive health care services and resources to help improve the community’s well-being. A positive community relationship ensures patients’ views are respected and voices are heard.
Most of the literature used in this article discussed the Nurse Practitioners scope of practice when it came to patient care. While some states require Nurse Practitioners to practice with restrictions and other states grant complete autonomy, the quality of patient outcomes was not affected when the restriction was lifted, and the scope of practice was expanded. Other studies in the article compared the role of the Nurse Practitioner and the medical doctor in a controlled primary care setting, with the Nurse Practitioner having greater patient satisfaction.
In conclusion, the future for vulnerable populations seems precarious without the assistance of Nurse Practitioners. Nurse Practitioners can play a pivotal role in supporting individuals’ health needs, and delivering care across every community, especially those ones disproportionately experiencing limited access to health care. Nurse Practitioners are educated, trained, and licensed to provide quality health care to vulnerable populations. Advocating for policy change to remove scope of practice restrictions increases accessibility to quality health care . Advocating for resources in a manner to improve the well-being of the disadvantaged population on local, state and national levels can alleviate many of these challenges. Fostering effective communication and collaborating with community health centers Nurse Practitioner work to ensure people are receiving appropriate and evidence based treatment, have access to supportive services and resources to improve the health care outcome. Health disparities are perpetuated by the lack of access to adequate health care and Nurse practitioners are an asset to medical practices because of their education and additional training can improve access to health care . Nurse Practitioners are in a unique position to ensure positive outcomes are the main goal by merging all aspects of patient care, making certain the patients concerns are addressed and that standards are maintained. Caring for vulnerable populations is intrinsic to nursing. Nursing focuses on caring for the person holistically, their family and the community which they live. With the formal training to diagnose and manage medical conditions, Nurse Practitioners are undoubtedly capable to meet the primary care needs of underserved communities and bridging the gap to quality health care. As community leaders’ Nurse Practitioners play a critical role in initiating projects that enhance local public health, working with community health centers in creating programs focused on prevention and promotion of healthier lifestyles. Nurse Practitioners have the competence, intelligence and power to change policies for better health care access. Through the development of strong and trusting relationships Nurse Practitioners make an enormous impact on a patient’s behavior to make better decisions and lifestyle changes. In bridging the gap to health care Nurse Practitioners can raise awareness to promote change and safeguard the health and wellbeing of the underserved populations by serving on advocacy boards and educating those in the legislature with the power to make change.