What Every Woman Should Know About Nurse Practitioners

Over the past few years, the U.S. has seen a dramatic increase in demand for doctors that the profession just can't keep up with. Although this primary care "crisis" hasn't really turned out to be as terrifying as it first seemed, it has brought new attention to all the options we have in choosing where to get our care — including nurse practitioners. "They’re in all settings where healthcare is delivered," explains Stephen Ferrara, RN, DNP, RNC-BC, executive director of the Nurse Practitioner Association of New York State and assistant professor at the Columbia University School of Nursing. "So it’s likely that people have come across nurse practitioners without realizing it." We talked to Dr. Ferrara about how nurse practitioners (NPs) are different from MDs, and what you need to know about seeing an NP for your primary care — yep, you don't necessarily need to see an MD.

What are nurse practitioners?
"A nurse practitioner is an advanced-practice nurse, so an RN with advanced education. They’re licensed and authorized in all states to diagnose, treat, and prescribe. Nurse practitioners deliver primary and specialty care, which encompasses all populations across the lifespan."

What kinds of specialties do NPs practice?
"The specialty of women’s health is one where nurse practitioners really excel. It’s the comprehensiveness of care, being able to listen and address concerns of female patients, and not necessarily be so quick to prescribe something, but really to work together in partnership with that patient to help them meet their healthcare goals. There’s plenty of locations that specialize in women's health, such as Planned Parenthood. They don't just do abortions — which is what people usually think of. It's family planning and it's really addressing the whole needs of women’s health.

"Family nurse practitioners (FNPs) really encompass the whole lifespan. We can take care of pediatrics to geriatrics, and that’s how we’re educated and prepared. Adult nurse practitioners (ANPs) focus on just the 18-year-old adult and up. There are also women's health, pediatric, and psychiatric nurse practitioners. "Then the other big category is acute care nurse practitioners who are usually in hospital and inpatient settings in critical care units where patients are much sicker and their needs are very different from a non-hospitalized patient. They care for those patients just as well. People assume nurse practitioners are in outpatient settings, but they can be found throughout every healthcare setting."

How does the NP approach differ from that of traditional doctors?
"We meld nursing and medicine into this hybrid of a profession. A lot of what we do as nurses, first, is patient advocacy and patient empowerment. We focus on health education and health literacy. As advanced-practice nurses, we bring that to the next level. "It’s partnering with the patient to set realistic expectations, and it’s taking a holistic approach — whole body and mind. We're not just focusing on a disease process or one particular organ; we’re looking at the person as an individual but also as part of a family and seeing what psychosocial aspects come into play. That complicates things that might otherwise seem easy. "For instance, high blood pressure is a physiological issue. Theoretically, if somebody has high blood pressure, there are medications to treat it. But if it were really that simple, nobody would have high blood pressure. Where the nurse-practitioner approach comes in is looking at that patient and understanding if there are any barriers to access medication. Can they afford it? Did they hear anything negative about a family member who took it and had a bad side effect? Or maybe they'll take the prescription but not get it filled. All these things are routine parts of how NPs approach patient care.

"The other part that nurse practitioners are known for is health promotion and disease prevention. So it’s putting an emphasis on well care, preventative health, vaccines, screenings. That’s really where the NP approach, I think, is unique in the healthcare landscape."

Do NPs have different prescribing powers?
"Generally speaking, no. NPs are licensed in all 50 states and D.C. and they're nationally certified in their specialty. But each state does have their own little differences about prescribing controlled substances. That includes things like painkillers and mental health medications. "All nurse practitioners attend similar types of programs, they take the same certification exams, yet [in this way] their practice is really dictated by the state that they’re licensed in. That creates arbitrary barriers for patients to access nurse practitioners, and that’s why a lot of state and national NP organizations are trying to get these laws and regulations updated."

How do NPs feel about traditional physicians?
"When it comes to nurse practitioners and physicians, we don’t practice 'us vs. them.' Some of the media will make it seem like we have this contentious relationship, but we really don’t. We do our best to [take] care of the needs of every patient. And [if that means] referring them to a physician, or physical therapist, or any other specialist, that’s what we’ll do and what we want any provider to do at the end of the day. We have a unique set of skills and education, and all we want to do is be able to care for the patient the way in which we were prepared to do so." Whether you're having trouble finding a primary care MD or you're unhappy with your OB-GYN, Dr. Ferrara says you can check out npfinder.com to look for NPs in your area.