Nurse practitioners report several impacts on their profession during the pandemic, including the easing of practice restrictions in some states and furloughs.
A new survey shows the coronavirus pandemic has had a profound impact on nurse practitioners.
Nurse practitioners have been providing care to all coronavirus disease 2019 (COVID-19) patients from testing and triage, to emergency medicine, to inpatient medical wards, and ICUs. To address coronavirus patient surges, many states have loosened restrictions to practice for nurse practitioners.
The new survey, which was conducted online from July 28 to August 9 by the American Association of Nurse Practitioners (AANP), features data collected from 4,000 nurse practitioner respondents. This is the second survey AANP has conducted during the coronavirus pandemic.
The new survey includes several key data points.
- Treatment capacity: 82% of nurse practitioners said their facility was better prepared to address the novel coronavirus compared to the beginning of the pandemic. About one-third of survey respondents said their facility was prepared for a COVID-19 patient surge, challenges related to delayed or deferred care, and the upcoming flu season.
- Testing: Three-quarters of nurse practitioners reported that lack of timely coronavirus testing is the most daunting barrier to providing effective COVID-19 care. Limitations on testing due to eligibility criteria have improved since the first AANP survey in the spring. In the first survey, 69% of nurse practitioners reported limited testing due to eligibility criteria. In the new survey, 46% reported limited testing due to eligibility criteria.
- Safety impact: In the first AANP survey, 2% of nurse practitioners reported being infected by the coronavirus, and that figure has nearly tripled to more than 5% in the new survey. In the first survey, a quarter of survey respondents cited insufficient personal protective equipment (PPE) as a major pandemic concern, with 79% reporting they had been forced to reuse PPE. In the new survey, 18% of nurse practitioners said they had insufficient PPE.
- Workforce impact: Since the beginning of the pandemic, nearly 17% of nurse practitioners report being furloughed; but most have gotten their jobs back, with 4% remaining furloughed at the end of July. Nurse practitioners have also experienced layoffs or termination, with 3% remaining laid off or unemployed after termination at the end of July. In the new survey, about 40% report income decreases, compared to 36% in the first survey.
- Practice restrictions eased: In the new survey, more than half of nurse practitioners reported that temporary suspension of state supervisory or collaborative practice pacts was beneficial.
- Telehealth: The two surveys reflect the expansion of telehealth services during the pandemic. In the first survey, more than half of respondents reported their practice was shifting patient care to telemedicine. In the new survey, 63% of nurse practitioners reported their practices were transitioning patients to telehealth services.
Interpreting the data
While coronavirus testing has improved since the beginning of the pandemic, testing issues remain to be resolved, Sophia Thomas, DNP, APRN, president of the AANP told HealthLeaders. "More than half of NPs say there is adequate access to testing in their community. But there are many NPs who report access to testing is limited, especially for patients who need to meet eligibility criteria."
Delayed test results is a major concern, she said. "Three-quarters of NPs are reporting delays in getting test results, which is probably the most significant thing in controlling the spread of coronavirus other than wearing masks. Getting adequate test results back in a timely manner is key in preventing the spread of COVID-19. Especially for asymptomatic carriers, once they get a positive result it reaffirms to them that they need to wear a mask to prevent the spread to others and they need to socially isolate."
In several states, the temporary lifting of practice restrictions on nurse practitioners during the pandemic has been a welcomed change, Thomas said. "Five states—Wisconsin, New York, New Jersey, Kentucky, and Louisiana—have temporarily lifted all practice agreement restrictions on nurse practitioners. The actions taken by these governors are models for the nation, allowing their states to surge the number of frontline providers, treat patients with underlying health conditions, and meet vital primary care needs."
More states should ease practice restrictions on nurse practitioners, she said. "About 89% of nurse practitioners are educated in primary care roles, which is important to providing care and access to care for patients. We are calling on the remaining governors to waive the restrictive barriers that undermine access to care and limit scope of practice. We need to modernize all of these outdated barriers. Twenty-two states and the District of Columbia currently have full practice authority for nurse practitioners."
The new survey's finding that 18% of nurse practitioners lack adequate PPE is troubling, Thomas said. "It is always a concern when any provider is without the recommended PPE."
However, the availability of PPE has improved significantly since the beginning of the pandemic, she said. "The supply of PPE is much improved."
The employment market for nurse practitioners, which took a hit in the early phase of the pandemic, is relatively strong, Thomas said. "While nearly 17% of nurse practitioners have had a furlough, the majority of them have returned to work. As primary care reopens and practices are better prepared for the pandemic, we expect furloughs will end and nurse practitioners will go back to work."
The expansion of telehealth services during the pandemic is likely to continue, and telemedicine has become a crucial element of the nurse practitioner skillset, she said.
"Telehealth is now an essential skill for nearly everybody in healthcare. Nurse practitioners have a strong presence in this space, and the pandemic has exposed more nurse practitioners and patients to this form of care. … In our survey, 63% of nurse practitioners are continuing to transition patients from in-person visits to telehealth visits, and I am encouraged by this tremendous demand. This is an opportunity to improve access to care."
Photo credit: Lev Radin/Shutterstock.com
Christopher Cheney is the senior clinical care editor at HealthLeaders.
A new survey of nurse practitioners about the coronavirus pandemic found 82% of survey respondents said their facility was better prepared to address the novel coronavirus compared to the beginning of the pandemic.
Three-quarters of nurse practitioners reported that lack of timely testing is the most daunting barrier to providing effective coronavirus care.
Nearly 17% of nurse practitioners report being furloughed during the pandemic, but most have gotten their jobs back.