Assessing the Ways the Role of the Nurse Has Expanded to Fill Gaps in Care Caused by the Pandemic

Contemporary Clinic interviewed April Kapu, RN, a professor at Vanderbilt University; acute care nurse practitioner based in Nashville, TN; and president of the American Association of Nurse Practitioners (AANP), on the future of the nurse practitioner workforce amid growth in the field and simultaneous extreme fatigue and stress among health care workers.

Alana Hippensteele: Hi, I’m Alana Hippensteele with Contemporary Clinic. Joining me is April Kapu, RN, a Vanderbilt professor; acute care nurse practitioner based in Nashville, TN; and president of the American Association of Nurse Practitioners, or AANP, which represents over 350,000 nurse practitioner, who is here to discuss the future of the nurse practitioner workforce amid simultaneous growth in the field and extreme fatigue and stress among health care workers following the COVID-19 pandemic.

So April, how has the role of the nurse expanded in recent years in terms of filling gaps in care that may have been caused by the pandemic?

April Kapu: I think that's really interesting to note. Again, it’s been 2 plus years that we've been through the pandemic and what we saw in the pandemic is—so just for the for the sake of the listeners, nurse practitioners are trained and educated through national standards, so we have national standards for accredited education training and national board certification; however, our licensure authority to practice is really state-specific, and why that's important is that there are many states that still have laws that are very outdated that need to be updated so that nurse practitioners in those states can practice to the full extent of their education and training. So this concept is this licensure authority to practice to the full extent of your education and training.

We are now at 26 states and DC that have updated their laws where nurse practitioners can practice to that full extent of education and training during the pandemic. We had 4 states move to what we know as full practice authority, and that was Massachusetts, Delaware, [and] more recently New York and Kansas. These states, like many states, had put into place executive orders which really relieved some of these outdated restrictions barriers, allowing more patients to have full and direct access to NP care—and we needed it. We had so much going on throughout the pandemic. We needed to have as much access to care as possible, and we knew that nurse practitioners were qualified and able to provide that. So in these 4 states, they actually were able to see the care that nurse practitioners provided as well as the increased access to care that the residents in their states would have, so they updated their laws to full practice authority.

So now we're at 26 and DC and hoping that now we have the momentum that all states will move to updating their laws to where we can help with the overall need to increase access to care.

Alana Hippensteele: Absolutely. So, following the pandemic, would you say trauma and burnout are continuing to impact the lives of frontline providers and health care workers, including nurse practitioners, and are these professionals still feeling the effects of the pandemic?

April Kapu: Yes, so without a question yes. The physical impact of the physical exhaustion, the mental, the emotional toll that the pandemic took on all health care workers, certainly. But nurse practitioners, as to what I’m speaking about today, still are really looking and evaluating and saying is this something that I want to continue to do. We love what we do, we find great joy in what we do, but there needs to be some infrastructure and system-wide change to really support the health and wellbeing of the caregivers, just as we want to make sure we have plenty of mental health services out there readily available for everyone.

So a lot of discussion and thought certainly on behalf of the American Association of Nurse Practitioners and on national level that we need more mental health resources for nurse practitioners, as well as all health care providers. We need to certainly address the workforce challenges because numbers-wise, you need health care workers all working, and we need plenty of them in order to take care of all of the many individuals that need care.

But on a more local level, we need policies and programs supporting healthy work environments that we really do prioritize the health and wellbeing of our workforce and in specific, our nurse practitioner workforce so that they will continue to feel supported [and] recognized for the work they do that they'll have that staffing support that they have readily accessible and available mental health services and supports there for them. So these are the things that we need to see moving forward in order to continue to show to our workforce our health care workforce that we do support them that we do support mental health as well as overall health and wellbeing.