She completed her Master of Science in Nursing degree at the University of Texas at Tyler in August, and is a certified Family Nurse Practitioner (FNP).
Nurse Practitioners or FNPs join physicians and physician assistants (PA) as healthcare providers.
Another term is APRN, or Advanced Practice Registered Nurse.
NPs are allowed to practice medicine with limited physician supervision, and have “prescriptive authority,” meaning they can write many types of prescriptions.
Mrs. Harber explained that a Nurse Practitioner is a registered nurse who had received advanced educational and clinical training.
They also must have a Bachelor of Science in Nursing (BSN) degree and be licensed as an RN.
They must then have either a dual Master’s of Science in Nursing / Family Nurse Practitioner, or an MSN with post-master’s work in a specialty, such as family or pediatric services.
They must also have 500 supervised clinical hours in Texas, and pass a national certification exam. Soon, they may have to possess a Doctorate in Nursing Practice to become licensed as a NP.
Mrs. Harber said she is “grandfathered,” and will not have to get the doctorate to practice.
She explained that the Nurse Practitioner profession was founded by Dr. Loretta Ford in 1965. Dr. Ford started the first NP training program, partnering with a pediatrician at the University of Colorado Medical Center.
The NP profession began because of a shortage of primary-care providers (physicians).
There are more than 140,000 NPs practicing in the U.S. today, and 9,000 new NPs enter the healthcare field each year. There are about 8,000 currently licensed in Texas.
There are 325 colleges and universities across the U.S. with training programs for new NPs.
What are Family Nurse Practitioners (Mrs. Harber’s specialty) trained to do?
They can treat patients of all ages.
They have advanced training in assessing, diagnosing, treating and prescribing for acute (such as an ear infection or a wound needing stitches) or chronic medical conditions, such as high blood pressure or diabetes.
Mrs. Harber said they also have completed advanced pharmacology courses to help in prescribing medications.
They can order and interpret a wide array of diagnostic studies, as well as provide many preventive and wellness services.
They also are more cost-effective than primary care, and take into account whether a patient is insured or not, considering this in whether to order tests or what medications to proscribe.
FNPs differ from RNs in the scope of assessments they can offer and services they can perform.
RNs do basic assessments, and carry out doctors’ orders and administer medications.
FNPs may perform advanced assessments, make diagnosis, order tests and prescribe medications.
An RN is required to have a minimum of an associate’s degree for licensure.
FNPs do about 80 to 90 percent of what physicians do.
She said a physician’s training focuses more on diagnosing and treating diseases, and that physicians have fewer regulatory restrictions.
“A physician’s education is significantly more costly than an NPs, and generally takes at least three to four years longer.
“The physician’s basis for treating patients also differs from the NPs at times,” she said. “Medical schools focus on the medical model of treating patients (studying diseases and how to cure them), while the NP’s training focuses on the nursing model of treating patients (studying people and how to heal them) by treating the patient’s body, mind and soul.”
She added that physicians have full autonomy in their practice, while NPs are heavily regulated in Texas.
“It is important to recognize that each group of providers has their own expertise that is distinct and unique,” she said. “One is not better than the other—they are just different. And they are equally valuable.”
She also explained the difference in a Family Nurse Practitioner and a Physician Assistant.
“The clinical skills FNPs and PAs learn in their respective programs are similar,” Mrs. Harber said. “Both providers learn assessment, diagnosis, treatment and prescribing techniques, and prescribing regulations in Texas are similar for both.”
She said, however, that PAs are generally trained using a medical model of care, similar to that of a physician.
The educational backgrounds of the two groups can differ a lot.
She said that to become an NP, experience as an RN and a bachelor’s in nursing is required, following by a master’s in nursing. PAs must have a bachelor’s degree, then attend a Physician Assistant school, where they may earn a Master’s degree, and eligibility to take the Physician Assistant National Certifying Exam is granted.
“There is no specific requirement as to what bachelor’s degree is required, although most complete it in Biology or something similar,” she said.
She said that many state and federal agencies regulate NP practice.
The Centers for Medicare and Medicaid Services (CMS) regulates many different aspects of healthcare for all providers, including NPs, and most insurance companies follow the CMS guidelines.
Mrs. Harber gave as an example that CMS sets the payment schedule at 85 percent of what physicians would receive, and most insurance companies follow this guideline.
CMS also sets quality standards for care.
The Drug Enforcement Administration enforces federal regulations about controlled substances, such as narcotic pain medication.
The Food and Drug Administration and Center for Disease Control also are involved in NP practice, through disseminating information and guidelines. She gave as an example CDC-issued immunization schedules for people of all ages.
State agencies also make and enforce laws relating to NPs. One of the “hottest topics” state legislators govern is what type of prescriptive authority NPs have, and how much their work must be supervised by a doctor.
The state Board of Nursing exists to protect the public by enforcing state laws and ensuring nurses provide the safest practice possible.
She cited statistics to show the need for more healthcare professionals in Texas.
The state ranks 47th in the nation in access to healthcare. It also has the highest percentage of uninsured residents, and that number has probably gone up recently.
Medicaid enrollment in Texas is expected to dramatically increase, and there is a severe shortage of primary-care providers.
“However, 80 percent of graduating Nurse Practitioners in 2009 went into primary care, many of them working with medically underserved patients in rural areas where some physicians are choosing not to work,” she said.
Mrs. Harber said that FNPs provide competent, safe, cost-effective care to patients, and can reduce healthcare costs in many ways. These include lower reimbursements, fewer emergency room visits for medical care, and decreasing sick visits to primary care offices.
She said that if the state expands the autonomy, or freedom to practice, for FNPs, “it can help Texas save millions of dollars in healthcare costs every year.”
She said they can also help the public save on healthcare costs by teaching patients how to get healthy and stay healthy.
“FNPs are also trained to keep healthcare costs lower by prescribing lower-cost medications when possible, and only ordering expensive diagnostic tests, such as MRIs, when they are absolutely necessary,” she added.
She said that Senate Bill 406, passed by the Legislature, went into effect Nov. 1, giving NPs more prescriptive authority, superseding an outdated prescriptive authority law written in 1989.
The new law does not tie their prescriptive authority to one employer or location, so that NPs can now, for example, volunteer to go into natural disaster sites and prescribe medications and treatment.
Mrs. Harber is the wife of Zack Harber and daughter of Steve and Polly Waller of Gilmer.