By Jane Tuttle, Ph.D., FNP-BC, FAANP

I was fortunate to have become a nurse practitioner (N.P.) in 1976, just a few years after Loretta C. Ford, Ed.D., public health nurse, developed the N.P. role with Henry Silver, M.D., a pediatrician. These visionary leaders recognized that registered nurses, with additional education and training, were in an ideal position to provide primary care to children in the face of the pediatrician shortage happening at the time, and indeed many children from that decade and beyond grew up knowing an N.P. as their primary care provider. 

Since then, N.P.s have proven themselves to be highly effective as primary care providers, and from state to state, they have varying scopes of practice. The N.P. role has successfully expanded to acute care, behavioral health, and other areas. I have been teaching others to be family nurse practitioners since 1985 and continue to practice in a primary care clinic serving adolescent mothers and their children. 
On a typically busy recent clinic afternoon, Jenna, the 18-year-old mother of a two-year-old girl I was seeing for a well child visit, told me that she had had unprotected intercourse with her child’s father two days earlier. She did not wish to become pregnant, so I was able to provide her with emergency contraception. We also discussed all of her options for family planning and contraception and made a plan for her to start a more reliable form of contraception.

Like Jenna, an increasing number of people consider an N.P. their primary care provider. Patients often describe us as more approachable than physicians. I can’t say how Jenna might have handled an office visit with a doctor, but her candor with me regarding unprotected sex helped prevent her from becoming a teen mom for a second time. Many teen moms, and others who struggle to access health care, might not have a primary care provider at all if it weren’t for N.P.s. We increase access to care, spend more time with the most vulnerable patients, and all for about 15 percent less than the cost of physician-delivered primary care.

As health care reform takes hold across the U.S., we expect to uncover increasing numbers of people who have previously unmet health care needs. Access and cost are going to be increasingly important issues in the years ahead. Nurses are poised to make a significant contribution in these areas, and we count on the support of patients and other providers.
The Institute of Medicine’s 2010 report, The Future of Nursing: Leading Change, Advancing Health, made the following recommendations which should inform our ever-evolving roles in 2014 and beyond:

• Nurses should practice to the full extent of their education and training.
• Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
• Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States.
• Effective workforce planning and policy making require better data collection and information infrastructure.

Nurse practitioners are a vital part of the health care team. We provide primary care in rural and urban areas, community- and school-based health centers, nursing homes, and many other settings. When I see a patient, my nursing background promotes a focus on the larger context of that patient’s life including their family. I highly value my collaboration with other team members from social work, medicine, and other disciplines, and I know that patients and families benefit from access to the comprehensive services nurse practitioners provide. As health care reform unfolds, we all need to promote and support the participation of nurse practitioners in the best interests of our patients and their health.   

Jane Tuttle, Ph.D., FNP-BC, FAANP, is a professor of clinical nursing and pediatrics at the University of Rochester and has practiced in primary care for more than 35 years. She directs the Family Nurse Practitioner Program at the University of Rochester School of Nursing and teaches in the HRSA-funded interprofessional Leadership Education in Neurodevelopmental Disabilities (LEND) Program. She co-chairs an interprofessional family research roundtable with Susan McDaniel, Ph.D.

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