Sheer Numbers: First and foremost, with over 200,000 NPs, we have definitely achieved a critical mass in our 50-years of practice.  The pipeline trajectory is depicted by a steep growth curve, due largely to the interest in pursuing the NP role by many in the nursing profession and beyond (who often enter nursing with the goal of being an NP).  Just 5-6 years ago, NP programs were preparing approximately 9,000 new NPs annually; now over 16,000 new NPs enter the workforce each year. Why are these numbers important?  For one thing, the growing number of NPs makes it more likely than not that the individuals making up the NP workforce practice in communities where they have true NP peers, unlike the early NPs who may have been fairly isolated.  The increased number of NP peers enhances our ability to network, support, and collaborate with one another.  Further, there is strength in numbers from a policy perspective, with a louder voice.  We are better able to advocate for those issues important to our profession when policy-makers realize we and the patients we serve form a mass worthy of their attention.  With our growing numbers, healthcare consumers are more likely now to have received care from an NP and serve as advocates and proponents of our ability to contribute to the healthcare needs of our communities. 

Academic Program Innovations:   Academic NP programs are adapting to the recognized future complexity of healthcare by moving to the Doctor of Nursing Practice (DNP).  However, there are several other innovations occurring in NP preparation.  The ability for practicing nurses and others to pursue NP preparation is enhanced by mixed models of training, often combining brick and mortar classroom experiences with well-designed distance learning.  These flexible programs are able to draw students from varied settings, including historically underserved communities where their care will benefit residents once they complete NP training.  NP education is further enriched through integration of innovative, simulated clinical experiences.  Combined with more traditional precepted clinical, simulated experiences ensure that all students can be exposed to and evaluated on clinical cases that are deemed essential to their training.  And while I do not believe that residencies or fellowships beyond academic programing are necessary components of NP preparation, these emerging options may offer value-added preparation for advanced knowledge, skills, and experience in more narrow clinical subspecialties.

Clinical Advancements: The clinical advancements that I think of are not unique to NPs. However, our practices do benefit from technological advancements such as point-of-care, statistically-based diagnostic decision tools, emerging diagnostic tools, remote monitoring devices, growing bodies of knowledge in genomics and bioengineering, and access to telehealth resources.  It is an exciting time for practice as we are able to learn how to integrate these advancements in our clinical practice to benefit  our patients.

Public Awareness:  Not too many years ago, most healthcare consumers would have found it difficult to articulate what an NP was.  Today, there is a definite growing understanding of and experience with NPs. A recent IOM report indicated that 25% of primary care is delivered by NPs!  Almost two years ago, I began conducting a daily search for NP-related news stories.  While my goal was to find one story daily, I regularly find many cited by search engines.  Some of these stories are local news reports about newly hired NP or the significant and innovative contributions made by NPs to their communities.   Some stories describe the legislative and regulatory actions underway to ensure that NPs are able to practice to the scope of their education and training.  All are great stories with reaching implications, as legislators, other policy-makers, and uninformed consumers are part of our public and read these stories in the news, gaining further exposure to the value NPs provide.

Broad Advocacy and Support:  Over the past few years, several evidence-based reports have been published by a number of entities which call for changes supportive of NPs and other advanced practice nurses.  There is great momentum and growing recognition of the important role of NPs in the delivery of safe, effective, efficient, and patient centered healthcare.  Maybe I’ll devote another blog to summarizing these documents.  For now, I am providing a partial but representative list to give readers a sense of the growing understanding of our role.  All NPs and NP advocates should become familiar with the content of these reports and links are provided for each source listed. These reports were prepared by non-NP organizations.  Readers also should turn to their state and/or national NP organizations for the profession's advocacy reports.

Improving Regulatory Environments:  Over the past couple of years, we have seen continued movement by state legislatures to reduce or eliminate laws placing unnecessary restrictions on NP practice.  Examples include Minnesota, Connecticut, New York, Kentucky, Nebraska, Pennsylvania, and Maryland to name a few.   The governor of New Mexico aggressively is recruiting NPs into his state from surrounding states, capitalizing on his state's the positive regulatory environment. Federally legislated programs make this a great time for NPs.  The ACA has resulted in an even greater need for primary and other care for which NPs are ideally suited.  Policy-makers are recognizing the value of health promotion and chronic disease supports, again areas in which NPs have expertise. 

High Satisfaction:  In general NPs consistently report high levels of satisfaction with their career and positions.  High levels of NP morale and satisfaction are positive for the NP role, as it helps us to serve as positive role models and to promote NP practice as a positive career opportunity for others.  This stands in contrast to others, including physicians, who frequently voice dissatisfaction with their professional role.  For instance, in August 2014, the Wall Street Journal published “Why Doctors Are Sick of Their Profession” describing a growing level of discontent and decreased morale among physicians.  By the way, I do not list physician discontent among factors promoting this as a positive moment for NPs. The existing and looming gaps in healthcare are all too great and we need “all hands on deck” to meet growing needs. 

So think about other factors you see as promoting this as a Golden Moment for NPs and reflect on what you can do to “catch the good that is within our reach”.  The final blog and third in this series will present a major call to action, identifying a number of actions we need to take now and in the future.