Understanding the Roles of Nurse Practitioners and Registered Nurses

Nurse Practitioners and Registered Nurses are pivotal in meeting older adults' health and long-term care needs, offering essential services like daily living assistance. Their expertise helps the aging population access personalized and comprehensive support for well-being in the years ahead.

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Understanding the Roles of Nurse Practitioners and Registered Nurses
7 Min Read February 27th, 2024

Understanding the various medical professionals available becomes increasingly important as the population ages. Two key figures playing significant roles in health care, especially for those over 50, are nurse practitioners (NPs) and registered nurses (RNs). While both are integral to the health system, they hold distinct roles, training, and scopes of practice.

The American Association of Nurse Practitioners (AANP) reports that, as of January 2023, the United States is home to over 355,000 licensed Nurse Practitioners (NPs). Furthermore, the American Association of Colleges of Nursing (AACN) highlights that nursing stands as the country's largest health profession, boasting nearly 5.2 million Registered Nurses (RNs) nationwide. Among these licensed RNs, 89% actively work in the nursing field.

Training Differences

  • Registered Nurses: RNs complete a Bachelor of Science in Nursing (BSN) degree and pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN). Their education equips them with a strong foundation in patient assessment, care planning, and basic medical procedures.
  • Nurse Practitioners: To become an NP, individuals must first be RNs and then complete a master's degree in nursing, specializing in a specific area like family practice, gerontology, or adult-gerontology primary care. This advanced education allows them to diagnose and treat a wider range of medical conditions, order and interpret diagnostic tests, prescribe medications, and manage chronic health conditions.

Educational Requirements

For Nurse Practitioners to establish their careers, they must first commit to choosing a nursing program, either a Master of Science in Nursing (MSN) or a Doctor of Nursing Practice. Following this, they must sit for and successfully pass a certification examination within their chosen specialty. 

Respected bodies such as the American Association of Nurse Practitioners Certification Program, the American Nurses Credentialing Center, the Pediatric Nursing Certification Board, and the National Certification Corporation provide these certifications.

Upon specialty certification, NPs can apply for a state license. In certain states, if NPs desire prescriptive authority, a separate application is necessary. To continue operating as an NP, upholding the state license and certification is mandatory. The prerequisites for maintaining these credentials may differ across states and certifications but usually encompass clinical practice and a specific number of continuing education hours.

The AANP identifies 27 states and the District of Columbia as full practice authority (FPA) states for NPs, meaning they can practice independently, without requiring direct supervision or collaboration with a physician, for the following tasks:

  • Diagnose and treat medical conditions
  • Order and interpret diagnostic tests
  • Prescribe medications
  • Manage chronic health conditions
  • Perform specific procedures

Full Practice Authority States:

Arizona Colorado Connecticut Delaware District of Columbia
Florida Hawaii Idaho Iowa Kansas
Maine Maryland Massachusetts Minnesota Montana
Nebraska Nevada New Hampshire New Mexico New York
North Dakota Oregon Rhode Island South Dakota Utah
Vermont Washington Wyoming    

The remaining states and territories require NPs to practice under reduced practice authority (RPA), meaning they can only perform specific tasks under the supervision or collaboration of a physician. 

The specific requirements and scope of practice for NPs in RPA states vary significantly.

Reduced Practice Authority States:

Alabama Arkansas California Georgia Illinois
Indiana Kentucky Louisiana Mississippi Missouri
New Jersey North Carolina Ohio Oklahoma Pennsylvania
South Carolina Tennessee Texas Virginia West Virginia
Guam Northern Mariana Islands Puerto Rico U.S. Virgin Islands  

It's important to note that even in full-practice authority states, some health settings, such as hospitals, may have their own internal policies regarding NP practice. Additionally, some insurance companies might require a physician referral for certain services NPs provide.

Registered Nurses Varied Duties

The hierarchical structure for registered nurses is mainly dependent on the specific workplace. In most health care environments, registered nurses are assigned duties, delegating work and supervising licensed practical nurses and nurse assistants. 

RNs with significant experience might also oversee other nurses within a particular unit. 

Roles in Health Care

RNs:

  • Provide direct patient care, including administering medications, monitoring vital signs, educating patients, and collaborating with physicians and other health care professionals.
  • Play a crucial role in various settings, including hospitals, doctor's offices, home health, and long-term care facilities.

NPs:

Nurse Practitioners can perform all the above duties of an RN, in addition to: 

  • Ordering and interpreting diagnostic tests like X-rays and blood work.
  • Prescribing medications for a broader range of conditions.
  • Diagnosing and treating a wider variety of illnesses and injuries.
  • Managing chronic conditions like diabetes, hypertension, and heart disease.
  • Ordering certain medical procedures.

Benefits for Older Adults

For older adults navigating the health system, NPs offer several unique benefits:

  • Improved Access to Care: NPs can help address the growing demand for primary care, particularly in underserved areas where access to physicians might be limited. This can be especially beneficial for older adults living in rural communities or facing challenges with transportation.
  • Increased Continuity of Care: NPs often develop long-term relationships with their patients, allowing them to provide more personalized and comprehensive care. This continuity of care is crucial for older adults managing chronic health conditions.
  • Focus on Preventive Care: NPs are trained to emphasize preventive care, including counseling on healthy lifestyle choices, screenings for age-related conditions, and promoting overall well-being. This focus on prevention is critical for older adults looking to maintain good health and reduce the risk of future illnesses.
  • Holistic Approach to Care: NPs often take a more holistic approach to patient care, considering the physical symptoms and the emotional and social factors affecting a patient's overall health and well-being. This comprehensive approach can be especially valuable for older adults dealing with complex health concerns.

Specific Settings

  • Hospital Care: While NPs typically do not replace physicians in hospital settings, they can collaborate with them to provide various services like medication management, pre-operative and post-operative care, and patient education. In some cases, NPs might even admit and discharge patients under the supervision of a physician.
  • Regular Health Care: In primary care settings, NPs often act as the first point of contact for older adults. They can conduct physical exams, order and interpret diagnostic tests, diagnose and manage common illnesses, prescribe medications, and provide counseling and preventive care services.

NPs in Long-Term Care Settings

As the population ages, the demand for health professionals in long-term care facilities like nursing homes and assisted living will rise. Nurse Practitioners (NPs) play an increasingly pivotal role in nursing homes, assisted living facilities, and home health agencies, where they deliver essential long-term care services. 

As advanced practice nurses, NPs bring a high level of expertise and autonomy to these settings, offering comprehensive patient assessments, managing chronic conditions, and implementing personalized care plans. 

Their ability to prescribe medications and perform procedures enhances the quality of care for those requiring ongoing long-term care, both skilled and custodial services (help with daily living activities and general supervision due to memory loss), often reducing the need for hospitalizations. 

By working closely with patients, families, and other health professionals, NPs in long-term care settings ensure that residents receive the holistic care they need while promoting their independence and quality of life. 

Their presence in these facilities is crucial in meeting the growing demand for healthcare services among aging populations, making NPs indispensable in the continuum of care for seniors.

Because of their training, NPs collaborate with other medical professionals, including the physician and any specialists involved, to develop and implement care plans. Plus, they provide education and counseling to residents and their families.

Aging Society Requires More Health Professionals

As our society ages, the strain on the healthcare system intensifies, with an increasing number of older adults requiring both skilled and semi-skilled services. This demographic shift necessitates a broad spectrum of care, ranging from long-term medical management to assistance with activities of daily living and supervision for those experiencing memory loss. 

The growing senior population challenges our medical infrastructure's capacity. It underscores the critical need for comprehensive care models to support individuals across various stages of aging and health conditions.

Including NPs in the health care workforce represents a significant step towards addressing these challenges. NPs, with their advanced clinical training and ability to provide a wide range of medical services, are well-positioned to meet the complex needs of an aging population. 

Additionally, their expertise extends to supervising semi-skilled services for those providing help with daily living activities and offering cognitive support, which is essential for maintaining the dignity and independence of the care recipients.

With NPs now integral to the health team, access to quality care services in all settings, from hospitals and nursing homes to assisted living facilities and home care, has been dramatically enhanced. Their role alleviates the pressure on physicians and bridges the gap in care delivery, ensuring that older adults receive timely, personalized, and efficient care. 

The presence of NPs across various care settings ensures a holistic approach to aging, one that supports the physical, emotional, and social well-being of the senior population, facilitating a higher quality of life and better health outcomes.

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About the Author

Linda is a former journalist who now enjoys writing about topics she is interested in so she “can keep her mind active and engaged”.

LTC News Contributor Linda Maxwell

Linda Maxwell

Contributor since December 11th, 2017

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