The 4 things keeping your NPs from practicing at top-of-license

By Allyson Paiewonsky

Amid the workforce shortages we face, now—more than ever before—it is essential to ensure top-of-license practice across the entire care team. Given present market pressures, a majority of provider organizations will be forced to maintain current staffing ratios while caring for increasingly complex patients. Providers can no longer afford to underleverage NPs' skills if they plan to survive in the current environment.

NPs want—and aren't afraid to leave if they can't—practice at top of license. And based on this report, almost a third of NPs are considering leaving health care, particularly as more of them struggle with burnout and other work difficulties. When asked about what contributes to their burnout, many NPs reported too many bureaucratic tasks (49%) and a lack of respect from their employees, colleagues, and other staff (43%). Leaders must create a platform for NPs to focus on high-value tasks and practice to the full extent of their training and licensure.

One of the major barriers that prevents NPs from focusing on their core responsibilities are pervasive misperceptions about their scope of practice. This barrier is highlighted in Medscape's recently published Evolving Scope of Practice Report, which found nearly 80% of physicians occasionally or regularly question an NPs' treatment decisions. Many health care leaders, physicians, and other care team members don't fully understand NPs' roles, which can hamper interprofessional collaboration and prevent NPs from providing the care they're qualified to deliver. There are four root causes of these misperceptions:

1. Professional culture: Clinicians learn and practice their profession within a distinct professional culture that may not emphasize the roles of other care team members. Professional culture can also reinforce staff perceptions of hierarchy among different disciplines.
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3. Siloed goals and reporting relationships: Staff in each discipline generally report to leaders in the same discipline, which can prevent members of one discipline from understanding the priorities and goals of other disciplines.
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5. Profession-specific education: Staff in different professions earn their degrees separately and are not always educated on other disciplines' roles and perspectives. Additionally, students are not always given the opportunity to practice working as members of an interprofessional team.
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7. Misperceptions about legal scope of practice: Staff may incorrectly assume that caregivers in other disciplines have more legal restrictions on their scope of practice than they actually do.

To overcome these barriers and build trust in NPs' treatment decisions, it's essential to expand perceptions of the type of work NPs can and should perform. Enhancing physicians' and other peer professionals' understanding of the NP role will help ensure NPs have both the time and interprofessional support they need to practice to the full extent of their training and skills.