Emphasizing the research that supports the cost-effective, quality care that nurse practitioners (NPs) provide, this author discuss practical pointers to increase one’s own visibility in a practice as well as the visibility of the NP profession as a whole.

There are several professional and political barriers facing nurse practitioners (NPs) today. Nurse practitioners struggle for recognition among physicians and insurance providers. There is also a general lack of knowledge among the public about NPs and their roles. Often reported barriers to practice for NPs include legal restrictions, reimbursement restrictions, low salary and resistance from other providers.

These barriers are certainly not insurmountable. Accordingly, let us take a closer look at key tips and strategies that NPs can utilize to overcome some of these barriers.



Each and every NP needs to take a proactive approach to his or her job and profession. The key is focusing your attention on things you can control as opposed to focusing on circumstances (such as the efforts of another profession) that you have no control over. Knowing the difference between the two often requires a balance of courage and diplomatic grace.

What Studies And Surveys Reveal About NP-Provided Care
Providing outstanding patient care is what we do best and we must continue to keep our focus on the patient. Multiple studies support the quality of care we provide and there has yet to be a study showing the opposite.1-11 In a recent study published by JAMA, 1,316 patients were randomly assigned to either nurse practitioners or physicians. The study proved that patient outcomes were comparable.1

Researchers have also examined the cost effectiveness of NP-provided care. They found that NPs are not only paid less but the study also found that NPs deliver primary care in a more cost-effective manner than physicians.12 After a review of several studies, the Congressional Office of Technology Assessment concluded that NPs can perform as much as 80 percent of the primary care health services and up to 90 percent of the pediatric primary care provided by primary care physicians. The office also found that NPs provide a level of care that is equal or better than the care provided by physicians, and do so at a lower cost.13

Retail Health Clinics: Will They Have A Positive Impact For NPs?

- Nurse practitioners have recently gained greater public attention with the emergence of retail health clinics, such as Healthspot, Minuteclinic and Take Care Health, which are expanding throughout the nation. Retail clinics, or quick clinics as they are sometimes called, offer treatment of the most basic and frequent illnesses in convenient settings. The convenient locations near supermarkets and pharmacies are not the only unique thing about these clinics. Retail clinics are staffed mainly by NPs. This enables the owners of retail clinics to control costs yet provide a high standard of care. While retail clinics give NPs significant autonomy, they limit the number of conditions that can be treated in these clinics. While the publicity of retail health clinics has brought a bit of a spotlight to the NP role, it may also put NPs on the radar for physician groups working to limit NP practice. In 2005, the chairman of the American Medical Association (AMA) Board of Trustees announced the creation of the Scope of Practice Partnership, a group of state and national physician organizations monitoring other heath care professions’ attempts to expand their practice.20 While we may disagree with some physicians, we should not forget to build the good relationships we have with physician supporters of our role. Working collaboratively with other health professionals is the optimal solution in providing high quality and cost-conscious medical care. Reference: 20. AAFP New Now. Scope of Practice Partnership to Address ‘Doctor-Nurse’ Trend. 4.3.2006. http://www. aafp.org/online/en/home/publications/news/news-now/ professional-issues/20060403scope.html

For the last several years, Gallup Polls have discovered that nurses are consistently ranked high among America’s most honest and ethical professionals.12 Lastly, study after study documents the high satisfaction rating with NP-provided care.13-16

The empathetic care nurses provide is likely the root of the strong respect from the public. Health consumers know they can find a listening ear and helpful hand from a nurse.

Given that studies and surveys continue to reveal that the quality of care remains the same or actually improves when the care is provided by NPs, having this information can only improve our position when negotiating with those who place barriers to our practice. We need to do a better job making this valuable information known to the public, politicians, insurance carriers and other health care providers.

However, it is imperative that we continue to demonstrate our outstanding care via research. We need to conduct studies to provide further data to support our claims. Future studies should not only measure the quality of the care we provide but the cost effectiveness as well.

Practical And Subtle Ways To Increase NP Visibility
Tell everyone you have a conversation with that you are a NP. I realize this is a daunting task because it leads to the inevitable question of what it is we do. However, we need to realize that this is the single best thing we can do to promote the NP profession. Each person you tell will likely tell several others what you told them (or close to it) about our profession. Keep your explanation short and simple, and try to refrain from making comparisons to other professions such as physicians.

Instead, explain that the NP has a separate role. At the same time, do not be afraid to use the word “nurse.” The word nurse should not impair our professional image but enhance it. Surveys have shown that the nurse is the most trusted health professional and this can be a great quality for someone in the provider role.17

For the last several years, Gallup Polls have discovered that nurses are consistently ranked high among America’s most honest and ethical professionals.

Many NPs remain “invisible” in their practice in the sense that they are not promoted in any way outside of the office and barely inside the office. We are just now beginning to see the names of NPs on the letterhead and business cards of medical practices. I think this is essential as remaining “invisible” decreases the likelihood that patients know about us and what we do, and in turn want to see us as providers. Never leave home without your business card. If you do not have a business card, pay to get some printed.

Another way NPs often remain invisible is through “incident to” billing when NPs bill under the physician’s name. Again this reduces our recognition as professionals and the likelihood that managed care organizations and insurance companies will credential NPs.

Support Your Peers And Profession
Choose NPs for your needs as well as the health care needs of your family. We need to make a statement that we prefer to seek the care of NPs for our family. Make your decision known to your family, friends and anyone else you have an opportunity to tell.

Refer to other NPs. Do not be afraid to send a referral to another NP that may practice in a setting or specialty other than your own.

Joining organizations such as the American Academy of Nurse Practitioners and American College of Nurse Practitioners allow the expansion of the NP profession on a national level. The political action committees of these organizations remain active in supporting NP growth and utilization. I encourage all NPs to join at least one if not two professional NP organizations. Doing so will reveal our strength in numbers. Recent publications estimate there are more than 116,000 NPs in the United States.18

In order for the profession to move forward with greater autonomy and less impediments to practice, NPs must work with representatives to support legislation to remove such impediments. The American College of Nurse Practitioners offers a list of members of the U.S. Senate and House of Representatives.19

We have made great strides through the years but key issues remain. On that note, congratulations to Georgia NPs who now have prescription authority after the passing of bill SB 480. Although it was a long and hard fight, advanced practice nurses in this state remained proactive and dedicated to being recognized as prescribers of medication.

Increase Your Business Acumen
The healthcare field is undergoing drastic changes. Whether we like it or not, business professionals are now driving how we as providers deliver health care services. We all know how important it is to maintain clinical skills and knowledge. I believe it is also important to learn the business of being a clinician.

Having a knowledge of general business practice is becoming a necessity in medical practice rather than a helpful adjunct. Nurse practitioners have proven that they provide quality care and are cost effective. However, what we have lacked as a profession is the business savvy to sell ourselves and effectively communicate our worth. Unfortunately, with the little, if any, business education in our training programs, it is up to us individually to gain this knowledge. Unfortunately, those clinicians who do not understand basic business principles are in danger of becoming ineffective healers.

Having a better knowledge of billing processes is essential. Ultimately, it is the provider who is responsible for the accuracy of any patient bill submitted. Often, it is the provider who is least knowledgeable regarding the billing process.

Joining organizations such as the American Academy of Nurse Practitioners and the American College of Nurse Practitioners allow the expansion of the NP profession on a national level. The author adds that joining these organizations helps bolster the clout of these organizations and reveals the strength in numbers of the NP profession.

Nurse practitioners should be familiar with the entire billing process of their practice environment from collecting co-payments and coding the visit to accounts receivable. I believe the task of coding should not be left to the office staff. Only the provider knows what procedures were performed and what level of evaluation and management codes are warranted based on the complexity of the visit.

Nurse practitioners should also be familiar with the documentation necessary to bill a certain level of service. Learning the amount of income you bring to your practice and the overhead of having you on board is important to understand your financial worth to the practice as well as your clinical worth.

A good start to increasing your business acumen is to read one of several business books geared toward NPs. You could also consider attending business-focused continuing education courses offered at national NP conventions or even attending business courses at a local university.

Final Notes
Challenges to the NP practice will always remain in this ever-changing practice environment. At the same time, change will bring opportunity. The high demand for nurses will continue to increase the need for NPs. Clearly, the current research and recent surveys reinforce the high level of quality care that NPs provide. Armed with this knowledge and doing all the practical things that NPs can do to initiate change, these clinicians can have a greater impact when it comes to increasing their own visibility as well as the broader recognition of the NP profession.