Are nurse practitioners disruptive innovators in healthcare?

In 2022, the Bureau of Labor Statistics released a list of 20 of the fastest-growing occupations, based on the projected percent change of employment between 2022-32. At the top? Wind turbine service technicians … and nurse practitioners (NP). 

Since the profession’s inception at the University of Colorado in 1965, the number of licensed nurse practitioners has grown by leaps and bounds. In 2010, there were 106,073 licensed NPs practicing in the United States. Today, the American Association of Nurse Practitioners (AANP) database lists more than 355,000 licensed NPs practicing in the US. 

This significant increase in nurse practitioners, particularly in primary care settings, is often regarded as a "disruptive innovation," challenging the established norms of a healthcare system ripe for reform. Harvard Business School Professor Clayton Christensen, a leading authority on disruptive innovation, defines the concept as the “process by which a product or service takes root initially in simple applications at the bottom of a market and then relentlessly moves up market, eventually displacing established competitors."

While most NPs are probably more interested in collaborating with a multidisciplinary healthcare team than “displacing established competitors,” the mere presence of nurse practitioners in the healthcare market is definitely forcing change to occur. 

To understand this change, it’s important to understand the factors driving the boom in the number of nurse practitioners. 

As the youngest baby boomers near 60, with the eldest members of Gen X right on their heels, demand across the entire healthcare sector is growing at an unprecedented rate. The Bureau of Labor Statistics projects that the US will add approximately 2.1 million healthcare jobs over the next decade and that 1 in every 6 jobs added to the economy will be in the healthcare sector. 

NPs will continue to be in particularly high demand for the following reasons.

The shortage of physicians is a critical issue in the US and a major driver in rising demand for NPs. The Association of American Medical Colleges projects a significant deficit of physicians between now and 2034. Their research suggests the United States will face:

This includes shortages of between:

Already, the Health Resources & Services Administration classifies 101 million Americans as living in designated Health Professional Shortage Areas (HPSAs) for primary care, which translates to almost 30% of the population. This shortage underscores the need for alternative advanced practice providers, such as nurse practitioners, to fill gaps in patient care. Because of the scope of experience and degree of autonomy that Registered Nurses already have, they are particularly well suited to pursue advanced training. 

The scope of practice for NPs lacks standardization across the US. Currently, 3 types of practice regulations for NPs exist:

Full: NPs can prescribe, diagnose, and treat patients without physician oversight. Nurse practitioners who operate in full-practice states are also allowed to establish and operate their own independent practices in the same way physicians do.

Reduced: NPs can diagnose and treat patients but need physician oversight to prescribe medications.

Restricted: NPs need physician oversight to prescribe, diagnose, and treat patients.

A growing number of states are expanding access to primary care by giving NPs full practice rights. In 2022, both New York and Kansas joined 24 other states, the District of Columbia, and 2 US territories that have Full Practice Authority (FPA) laws in place. 

In these states, nurse practitioners can perform many of the essential services provided by physicians, including prescribing medications. Additionally, in states where NPs do not currently have full prescriptive authority, there is a growing advocacy movement by nurse practitioners to expand their scope of practice. 

Despite considerable efforts by the AMA to limit NP scope of practice in the name of patient safety, the American Association of Nurse Practitioners cites research that consistently finds that “patients under the care of NPs have fewer unnecessary hospital readmissions, fewer potentially preventable hospitalizations, higher patient satisfaction and fewer unnecessary emergency room visits than patients under the care of physicians.”

The research demonstrates that nurse practitioners provide primary care services with no statistically significant differences in patient health outcomes compared to physicians. In fact, in some cases, patients of NPs exhibited superior outcomes. These positive results reinforce the value of nurse practitioners in delivering high-quality healthcare services.

Increasing access to and reliance on nurse practitioners to meet the healthcare needs of millions of Americans has profoundly changed healthcare delivery in the US — and will continue to do so. But the role of nurse practitioners as disruptive innovators in healthcare goes far beyond their mere participation in the healthcare system. 

Here are 3 ways that nurse practitioners are at the forefront of disruptive innovation in healthcare. 

One of the chief ways that nurse practitioners act as disruptive innovators is by emphasizing holistic patient care. Nursing and NP education is focused on health promotion and prevention, allowing NPs to provide more holistic, patient-centered care in an accessible manner. 

With a background in both nursing and advanced clinical training, NPs offer a comprehensive approach to patient well-being. They not only diagnose and treat medical conditions but also emphasize preventive care and patient education. This holistic perspective allows nurse practitioners to address not only the physical aspects of health but also the emotional, social, and psychological factors that influence a patient's overall wellness.

By bridging the gap between medical expertise and compassionate nursing care, nurse practitioners challenge traditional healthcare models to usher in a new approach to patient-centered, holistic healthcare delivery.

At the same time, The Journal for Nurse Practitioners cites research indicating that an increasing number of nurse practitioners are choosing to pursue dual specialization to increase the scope of services they can provide and conditions they are able to diagnose and treat. 

Consider the following breakdown of nurse practitioner certification from the American Association of Nurse Practitioners:

The total percentage adds up to more than 100% because of the number of NPs who choose to specialize in addition to a form of primary care certification. 

The Health Resources & Services Administration reports that 166 million Americans lack access to mental health services. Nurse practitioners function as disruptive innovators by leading the charge to address this shortage. 

According to the AANP, nursing schools across the country have added almost 100 new psychiatric mental health nurse practitioner (PMHNP) programs. Since 2012, these programs have graduated more than 13,000 new mental healthcare providers. 

Research published in 2022 indicates that the number of mental PMHNPs treating patients with Medicare coverage for psychiatric and mental health conditions grew 162% between 2011 and 2019. During this same time frame, the research found a 6% decrease in the number of Medicare patients who received care from psychiatrists. 

Furthermore, the same research also found that in 2019, psychiatric mental health nurse practitioners provided between 34% and 51% of mental health office visits for Medicare beneficiaries in urban and rural areas with full scope of practice regulations. 

The numbers don’t lie: PMHNPs are playing an integral role in expanding access to critical mental healthcare services.

A common misconception held by people outside the nursing profession is that nurses are subordinate to doctors. While nurses work collaboratively with physicians and often carry out orders for doctors, unlike physicians’ assistants and medical assistants, the role of nurses is not primarily focused on assisting doctors.  

Instead, the nursing role operates independent of, not auxiliary to, medicine and other disciplines. This means that nursing roles encompass everything from direct patient care and case management to establishing nursing practice standards, hospital administrative functions, or developing and implementing quality assurance procedures.

The independent nature of nursing, coupled with expanding practice rights, has led to a dramatic rise in nurse entrepreneurship, particularly in the form of nurse practitioner-led clinics. As nurse practitioners gain practice authority in more states, NPs are moving to establish their own businesses and further redefine the healthcare landscape.

Beyond private practices, nurse entrepreneurs are exploring various avenues such as consulting, coaching businesses, Medispas, and homecare agencies. Well-established examples, like the CVS MinuteClinic primarily managed by NPs, highlight the success of this approach. 

Nurses are consistently voted the most trusted profession and the shortage of primary care physicians means that nurse practitioner-led clinics can not only fill the gaps, but also enhance patient engagement and improve continuity of care, while keeping costs down and reducing hospital admissions. 

If you’re a nurse practitioner thinking about starting your own practice, take a few minutes to discover how Tebra simplifies practice management so you can focus on delivering exceptional, patient-centered care.