Growth of nurse practitioners in Dayton area eases doctor shortage

People who visit doctor’s offices, urgent cares and other medical offices are being examined more often by a nurse practitioner as the trend grows locally and in the U.S.

Nationally, the number of nurse practitioners soared from around 91,000 in 2010 to 190,000 in 2017, according to a recent analysis of U.S. Census data published in Health Affairs.

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Local health systems report they have seen a significant rise in nurse practitioners, who have advanced clinical training beyond their initial registered nurse education and who can prescribe medicine. Many hospitals measure the growth of nurse practitioners as part of the overall growth of advance practice providers, which also include physician assistants, clinical nurse specialists, nurse anesthetists and nurse midwifes.

These advance practice providers help increase access because they extend how many patients would have been seen if there were only physicians available.

“Endocrinology, for example, that’s an area that we have a hard time recruiting physicians, and so training nurse practitioners and physician assistants to develop that diabetic training and that specialized skill to provide that care is an extension,” said Leslee Chavez, director of advance practice providers, with Kettering Physician Network.

Nurse practitioners have played a key role in staffing some of the fastest growing areas of the health systems, such as outpatient offices with convenient care. Kettering Health’s new on-demand clinics, Premier Health’s recently built network of urgent care centers, and Dayton Children’s Kids Express are all centered around these providers.

Peggy Mark, Premier chief nursing office, said if you look historically at nurse practitioners, many were earlier found providing access to primary care in low access areas, such as rural communities. Nurse practitioners can now be found throughout Premier’s system, from the primary care office, to specialty practices, as well as around the hospital and in ambulatory settings.

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“Premier Health is what I consider a very patient centric organization. So we really focused on the needs of the patient in our decision making, and when you bring nurse practitioners into that mix, they are naturally very patient centric,” Mark said. “And so they’re a great fit for our organization.”

As of Monday, Premier Health employed 283 advance practice registered nurses, up from just 101 five years ago. APRNs is a category that includes nurse practitioners, as well as nurse midwives and clinical nurse specialists.

For Kettering Physician Network, which is Kettering Health’s network of employed providers, there were 20 advanced practice providers in 2013 and now there are 270.

“When I came here in 2013, I practiced clinically and cardiology and there were patients that had never even seen a nurse practitioner or physician assistant, so there’s been a lot of really intentional education,” Chaves said.

With the growth of advance practice providers, health systems are also facing a related challenge as more registered nurses are leaving the bedside to pursue advanced careers. The Health Affairs study said the pronounced growth in the number of nurse practitioners has reduced the size of the registered nurse workforce by up to 80,000 nationwide.

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Mark said it’s a great thing to have nursing expand as a profession, though it does mean some of their bedside nurses want to advance into those nurse practitioner roles.

“And so we will encourage that, we will assist them in doing that and at the same time then we’ll be looking for more nurses to fill those bedside nurse positions,” Mark said.

Nurse practitioners are also less expensive to employ than physicians. The Bureau of Labor Statistics reported nurse practitioners in Ohio made an average $101,710 in 2017 compared to physicians in family medicine who were listed with an average $198,230 annual salary.

Gmeiner said health systems always have to be mindful of how to give high quality care that doesn’t cost more than it needs to. One way to do that is to have a team providing health care where everyone in the team, including the nurse practitioners, are providing the highest level of care that they are trained to provide.

This extends the ability of what a health system could accomplish compared to if the only providers they had were physicians.

“What’s important for health care is we have to have fantastic safety, but do it in the most cost effective manner as possible. And these care teams can help create that synergy and hopefully promote cost effective care,” Gmeiner said.

With lots of interest in becoming a nurse practitioner, lots of schools are also competing to attract these prospective students.

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Jayne Gmeiner, Dayton Children’s vice president and chief nursing officer, said with the proliferation in training programs all trying to attract students that it’s important that future nurse practitioners attend good programs. She said good programs will be nationally accredited institutions and have strong clinical training and mentoring.

“We have to have the same rigor to make sure our graduates come from excellent nurse practitioners programs or CNRA programs,” Gmeiner said.

Melissa Holmes, Wright State University Clinical Instructor and certified nurse practitioner, said interest in all nurse practitioner programs has increased over the past several decades and more so in the past several years.

“For most of us, choosing to further our education and responsibilities to become a nurse practitioners is fueled by the desire to take on a more active role in health care and to further meet the needs of our patients,” Holmes said.

Ohio nurse practitioners: By the numbers

6,039: Professionally active nurse practitioners as of March 2019

90%: Female share of nurse practitioners

$107,840: Mean salary in Dayton metro as of March 2018

Source: Bureau of Labor Statistics, Kaiser Family Foundation

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