The president of the American Association of Nurse Practitioners discusses challenges nurse practitioners face during the pandemic and advocates for modernized practice guidelines.
As the U.S. healthcare system continues to grapple with COVID-19, nurse practitioners (NP) who have traditionally practiced in a variety of healthcare settings continue to serve a vital role in the response to the pandemic.
"When COVID-19 first hit back in the spring, we had thousands of nurse practitioners answer calls to serve and volunteer on the frontline, especially in New York, which was very hard hit," says Sophia L. Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP, president of the American Association of Nurse Practitioners (AANP). Since then, NPs have continued to serve across the country, including leaving their own practices to go work surge staffing, staying in their own practices to diagnose and treat COVID-19 in the outpatient setting, and serving as acute care NPs in the hospital setting managing acutely ill patients on ventilators, Thomas says.
Early on, NPs faced many of the same challenges as other healthcare providers: personal protective equipment (PPE) shortages, ever-changing Centers for Disease Control and Prevention care guidelines, and limited access to COVID-19 testing, Thomas says. With improved supplies of PPE and more readily available testing as more private labs have come on board, these barriers are lessened for NPs.
While a recent survey conducted by the AANP finds that a majority of NPs (82%) reported that their practices are better prepared to manage COVID-19 patients than at the beginning of the pandemic, some of the challenges from the early days of the pandemic persist.
"In some areas, testing is still limited to a certain set of eligibility criteria. I think that those are pockets of the country that still don’t have ample supplies, or it might be institutional restrictions that say that patients have to meet a certain set of criteria for testing," Thomas says.
According to the survey, 36% of respondents reported having patients turned away from testing sites for not meeting specific criteria. Even when patients are tested, 78% of NPs reported significant delays receiving the test results.
Perhaps the biggest challenge facing NPs is outdated practice guidelines that exist in many states regarding NPs, Thomas says. In many states, NPs are required to have a collaborative practice agreement with a physician that includes a number of provisions, but she says there's no evidence to support that having such an agreement improves quality of care or access to care.
During the pandemic, some states have issued emergency waivers suspending collaborative practice agreement requirements for NPs to increase capacity and improve access to care. "We'd really like for those governors to make those waivers permanent, and then have other governors get on board with modernizing their outdated licensure requirements so we can really do everything that we can to improve the overall health of this country," Thomas says.
COVID-19's Lasting Effect
While the pandemic has highlighted ongoing issues with the U.S. healthcare system, it has resulted in some beneficial consequences. For example, Thomas points to a whole new appreciation for infection prevention and control among the healthcare community and the general public, adding now more than ever there's an awareness of the importance of hand washing as it relates to the spread of disease.
COVID-19 has also shone a light on the health disparities and access to care issues that still exist in this country, Thomas says, "And we really need all healthcare providers practicing to the top of their license to be able to provide access to patients who so desperately need it. … There are millions of patients that live in health professional shortage areas, and we know that NPs will go and practice in these underserved areas."
Thomas says she also believes telehealth will be the wave of the future for NPs and will play an important part in their role as they look at ways to improve access to care. During the pandemic, federal waivers have gone a long way with popularizing teleheath's use. Before COVID-19, telehealth was restricted to Medicare patients living in rural communities. The temporary waivers remove certain Medicare limitations on telehealth, opening it up to a larger patient population.
Thomas says telehealth is a way to provide access to healthcare for people who may otherwise go without it or who may be inconvenienced when they seek it out. For example, working parents or patients who must work all day may otherwise be unable to get away for a medical appointment. With telehealth, patients can access medical services from their home or office without having to worry about driving to an appointment and waiting to be seen.
"It's definitely something that's here to stay and I'm very pleased about that," Thomas says.
Many of the challenges nurse practitioners faced early in the COVID-19 pandemic (e.g., testing shortages) persist for pockets of the country.
The American Association of Nurse Practitioners is pushing for federal telehealth waivers and state policy waivers to be permanent to end what it believes are outdated practice guidelines.