The Doctor Can't See You Now – But the Nurse Can

When Douglas Peterson called to make a doctor's appointment recently, he was given a choice. He could see the doctor in three weeks, or a nurse practitioner the next day. 

"I had a couple of questions about a medication I was taking," says Peterson, 61, a business consultant in northern California. "I made an appointment with the nurse."

He's not alone. In doctor's offices, walk-in clinics, emergency rooms and long-term care facilities throughout the country, nurses are increasingly the front line of primary care — the healthcare professionals we're most likely to see first when something ails us.

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Nurse practitioners, who have advanced degrees and specialized training, examine patients, diagnose diseases, order tests and, in some areas, even write prescriptions. Some 250 clinics around the country are staffed entirely by nurse practitioners. Even where nurses work closely with doctors, they are taking on a growing range of roles and responsibilities.

That's how it should be, many experts say. "Nurse practitioners can deal with about 80 percent of the problems that show up in primary care settings," says Marla Salmon, ScD, RN, FAAN, dean of nursing at the University of Washington. "Allowing advanced practice nurses to do what they do well improves efficiency and increases access to health care. And when nurse practitioners encounter a problem they can't deal with, they can refer patients to the appropriate doctor."

In a report released today called "Leading Change, Advancing Health," the Institute of Medicine and the Robert Wood Johnson Foundation outline the many ways in which nurses are key to solving many of the challenges facing health care. "Given their education, experience, and unique perspectives and the centrality of their role in providing care, nurses will play a significant role in the transformation of the health care system," the report states.

For many years nurse practitioners have helped make up for a growing shortage of primary care and geriatric physicians. They'll continue to play that role as health care reform brings coverage and access to more Americans.

But the contribution of nurses goes beyond filling in when doctors aren't available. Nurse practitioners can play a key role in improving the quality of health care for older patients with chronic illnesses. "Nurses are positioned across the health care system to provide high quality health care, increase access to health care services, and keep costs down," notes the Center to Champion Nursing in America, an initiative of AARP, the AARP Foundation and Robert Wood Johnson Foundation.

The rise of advanced practice nursing

Nurse practitioners are part of a larger category called advanced practice registered nurses, which also include nurse anesthetists, nurse midwives and clinical nurse specialists, who often work in acute care. Advanced practice nurses have education and training beyond that of standard registered nurses. (Unlike RNs, all of whom have college degrees, licensed practical nurses, or LPNs, graduate from accredited nurse training programs that are not part of college or university degrees. Physician assistants, commonly referred to as PAs, perform some of the functions of a nurse practitioner, such as examining patients and diagnosing illness, but they typically work directly under a doctor's supervision.)