Family Nurse Practitioner Role: Past, Present, and Future

The nurse practitioner (NP) workforce has expanded its reach to deliver care to millions of patients nationwide, filling many roles left vacant by a shortage of primary care physicians and registered nurses (RNs). Many RNs are opting for early retirement, resigning from health care due to burnout, or pursuing careers outside of health care. This shortage has made hospitals and other health care facilities lean on nurse practitioners to fill in the gaps, as well as mentor and develop registered nurses who are new to the job.

Of the many NP specialties, the family nurse practitioner role is one of the most popular among recent graduates. Nearly 70% of NPs are certified in family care, according to the American Association of Nurse Practitioners. Because of their broad base of experience, family nurse practitioners (FNPs) are making a difference in underserved communities and providing comprehensive medical care to patients of all ages.

The demand for FNPs is not expected to slow anytime soon. There are various reasons for this, including changing health care regulations, expanded health insurance options, an increased focus on preventive care and a greater demand for health care services by an aging population. FNPs are pivotal in the delivery of high-quality health care services such as conducting patient examinations, developing treatment plans and prescribing medications.

Working as a family nurse practitioner means being the go-to resource for families for most preventive care services and the treatment of acute and chronic conditions. Historically, FNPs have always taken a holistic approach to patient care, concentrating on the patient as an individual and as part of a family.

History of Nurse Practitioners

The role of the nurse practitioner started in the 1890s when visiting nurses traveled to remote areas of the United States to provide care to underserved populations. In 1965, Loretta Ford, a nurse, and Henry Silver, a doctor, collaborated on the first training program to “bridge the gap between health care needs of children and families’ ability to access and afford primary health care.”

The original intention was for NPs to work in collaboration with physicians to deliver primary care medical services and advanced-practice nursing. Critics, however, were quick to question the professional boundaries between NPs and physicians. Despite the challenges, the NP profession grew through the 1970s and 1980s, although NPs were limited in practice and ability to prescribe medications.

By 1983, approximately 23,000 NPs worked in the U.S. Two years later, the American Academy of Nurse Practitioners (AANP) was established, offering credibility to the profession as well as a central hub for advocacy. By 1987, the federal government had spent approximately $100 million on NP education.

Other key moments in the history of nurse practitioners occurred in the 1990s. In 1993, the AANP formed the American Academy of Nurse Practitioners Certification Program. This program would prove vital in certifying the skills and knowledge of nurse practitioners with hospitals and other health care facilities. By 1999, approximately 68,300 NPs worked in the United States, meaning the number of NPs had essentially tripled over the past decade and a half, according to a historical timeline provided by the American Association of Nurse Practitioners.

As their impact on health care intensified in the 1990s, NP groups conducted scientific studies for the New England Journal of Medicine and the Journal of the American Medical Association that further legitimized the scope of practice. While working under the supervision of physicians or hospitals, NPs could treat patients on a limited basis, but not prescribe medication.

In recent years, NPs have lobbied state and federal lawmakers and launched grassroots campaigns to expand the scope of practice further.

Nurse Practitioner Role Development

At least 26 states and the District of Columbia currently allow NPs to have full authority to practice, which includes prescribing medications, ordering and interpreting clinical tests, and conducting medical studies. The remaining states and territories only allow the reduced or restricted practice, which requires NPs to work under the supervision of a physician or another health care provider. Reduced/restricted practice also means that NPs can’t provide certain health care services, such as prescribing medications to patients.

On a federal level, the U.S. Department of Veterans Affairs (VA) granted NPs full authority to practice without a doctor’s supervision in VA hospitals and clinics nationwide to shorten wait times and provide care in underserved communities. The AANP viewed this as a big step in the right direction in terms of nurse practitioner role development and making patient care more efficient for veterans.

Despite the trend toward NP autonomy, the American Medical Association (AMA), the nation’s largest association of physicians, opposed the change. In response to the VA’s decision in May 2017 to allow NP autonomy, AMA president Dr. Andrew Gurman said the final rule would “rewind the clock to an outdated model of care delivery that is not consistent with the current direction of the health care system.”

“Providing coordinated, physician-led, patient-centered, team-based patient care is the best approach to improving quality care for our country’s veterans, especially given the highly complex medical care that veterans often require,” he said.

Indeed, NPs nationwide have responded to similar criticisms that imply NPs are trying to steal positions from doctors. In a guest column in The (Mississippi) Clarion-Ledger newspaper, NP Jennifer Easley acknowledged the hours of training for an NP are less than those for a physician. But, as an advanced practice registered nurse (APRN), “most of us have worked years and years caring for patients in hospital settings, 12 hours at a time,” she said.

“This is not an MD versus NP argument. We are not trying to take anyone’s patients or step on toes. We are a valuable addition to the medical community and want to do our part,” she said in the opinion column.

The Future of FNPs

Despite some rough moments in the history of nurse practitioners, experts see the role of the FNP expanding in the coming years. The U.S. Bureau of Labor Statistics (BLS) is projecting the number of nurse practitioner roles will grow by 52% (335,200) by the year 2030, making it one of the fastest-growing roles in health care.

FNPs also do well from a salary perspective, earning an approximate annual salary of $97,900, per the most recent reporting (March 2022) from compensational information source Payscale. The competitive pay and job security have made the family nurse practitioner role a solid career choice among aspiring health care workers, regardless of their state’s practice authority.

To become an FNP, APRNs must pursue a Master of Science in Nursing (MSN) degree with a focus on treating patients from prenatal to adult. To become eligible for FNP licensure, graduates must pass the American Academy of Nurse Practitioners Certification Board (AANPCB) exam or the American Nurses Credentialing Center (ANCC) Family Nurse Practitioner exam. Additionally, many states have their own requirements that FNPs must satisfy to be able to practice.

What’s Driving the Demand for FNPs?

While there were approximately 220,300 NPs in the workforce in 2020, the number of NPs is expected to jump significantly over the course of the decade.

The growing demand for FNPs is being driven by physician shortages, a larger focus on funding strategies for preventive care, the expanding medical needs of an aging population, and the need for more primary care providers in rural areas. Changes put in place by the Affordable Care Act (ACA) are also empowering NPs to address the national health care shortage by providing more primary care to those who need it.

It also bears mentioning that the COVID-19 pandemic is playing a part in the increased demand for FNPs as families become more mindful of preventive care and vaccinations.

How Is the Role of FNP Likely to Change in the Coming Years?

The role of FNPs is expected to shift in the near future due to a combination of changes stemming from changes in legislation, technology and demographics.

The National Academy of Medicine (formerly the Institute of Medicine) recommended over a decade ago that NPs should be able to practice more fully so they can use the full scope of their expertise and training. Many states that do not currently allow NPs to practice to their full extent are working to pass laws that will change this as well. Kansas is one of the most recent states that now allow NPs full practice authority.

As 3D printing, video conferencing, telemedicine, and telehealth, as well as other technological innovations, become integral to the health care process, nurses must learn new skills and become tech proficient to keep up with changes. Genomics is also expected to play a bigger role in nursing. This will require nurses to learn how these advances — and any ethical issues that may surround them — are relevant to their roles.

Changes in demographics are also expected to impact the nursing profession. A 2020 study conducted by the National Council of State Boards of Nursing (NCSBN) randomly polled 157,459 RNs and 172,045 Licensed Practical/Vocational Nurses (LPN/VNs). The study revealed the following:

• The demographic of male RNs continues to increase; they represented 6.6% of nurses in 2013 and were reported as 9.4% in the 2020 study
• 2% of respondents identified as a minority (selected “other” or “two or more races”)

Additionally, according to the American Association of Nurse Practitioners NP Fact Sheet, in 2022 the median age of an NP was 49, down from age 51 in 2017.

The number of nurse practitioners who come from racial and ethnic minority groups has grown during the past several decades. However, minorities are still underrepresented in the nursing profession, with close to 80% of RNs identifying as white or Caucasian.

However, statistics provided by the AACN’s report on 2018–2019 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing indicate a shift. The following are the percentages of minorities enrolled by degree type.

• Entry-level baccalaureate programs: 34.2%
• Master’s programs: 34.7%
• Research-focused doctoral programs: 33%
• Doctor of Nursing Practice (DNP) programs: 34.6%

Nursing students seeking careers as FNPs can look forward to a promising future. As the need for FNPs continues to grow, so does the demand for well-qualified practitioners of all genders and ethnic backgrounds. Additionally, nurse practitioner role development and changes in legislation will continue to affect this particular facet of the health care system.