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3 Issues Causing Burnout in NPs

Op-Med is a collection of original articles contributed by Doximity members.

Burnout is a surging issue among practicing NPs. The role of APPs is becoming more vital to health care every day and the demand just keeps on increasing. Along with increased utilization comes increased demands upon the profession. More is being asked of us daily, and the stress keeps increasing, with burnout rising as well.

We need, all of us, to keep NPs in active practice. As an NP for 20 years, I can tell you the profession has changed dramatically. In the beginning, my role was to work together with the physician to provide patient care. Now, 20 years later, I still work with a physician, but I see patients independently. I take charge of the patient care that I am expertly capable of providing. My practice has definitely evolved in some ways, but in other ways, it’s the same as it was 20 years ago. I feel I am still fighting for many important practice essentials.

I work in oncology with a physician partner who has supported my evolving role over the years and appreciates the complementary practice we have developed. I see my role as being the guru of symptom management, patient teaching, patient support, and listening and determining what the patient wants from their cancer care. I know when to hold treatment due to side effects and when to forge on through, with the end goal in mind. I have developed this expertise over time, like all my colleagues. Losing NP contributions to patient care due to burnout would be detrimental.

So how can we lessen burnout of NPs?

First of all, take us out of the financial crunch of health care. Frequently, physicians we work with are given bonuses when they hit and exceed minimum productivity requirements. We are compensated at a proportional level. Many institutions around the country are giving premium pay incentives to RNs. These additional incentives can place their total salary at a higher level than that of an NP. (I applaud this move for RNs as they are finally being remunerated at an appropriate rate.) Our salaries, when compared with pay incentives and retention bonuses RNs receive, have failed to keep pace with our RN counterparts. That crunch in salary structure is causing much dissension among NPs, and will, in essence, become a negative force in the years ahead. As RN salaries have increased, NP salaries have not increased at the same rate, all things considered. As NPs are called to complete higher levels of patient visits, an equitable system needs to be created to address that responsibility.

Secondly, make a DNP worth getting again. Many nurses who previously contemplated pursuing advanced degrees are no longer doing so. Why go back for a master’s degree or a DNP, incur more student loan debt, and still be paid less than an RN after all salary and incentives are totaled? According to the AACN, for the first time since 2001, enrollment in master’s programs decreased by 3.8%, which translates to 5,766 fewer students enrolled in 2021 than in the previous year. What will suffer in the end is patient care. As the shortage of NPs grows, those who remain become more dissatisfied. Without enough physicians, who will do the work? As a potential fix, NPs need to be given financial incentives commensurate with the professionals we are, as well as respect for those earned titles. I have a doctorate, yet I am called by my first name by my nursing and physician colleagues alike. Pay me the respect and refer to me by my earned degree title. When I introduce myself to patients, I always explain that my doctorate is in nursing, to ensure there is no confusion as to my clinical role. As a college professor I am referred to as Doctor — why not among clinical colleagues?

Thirdly, let us practice fully as NPs. Historically, institutions have had difficulty in utilizing NP roles appropriately. NPs have been used as scribes or worked far below the threshold of scope of practice. There needs to be greater definition of the role, based on scope of practice, to guide institutions in how best to utilize NPs. Role delineation should originate from State Boards of Nursing, responsible for our scope of practice, and not physician-dominated groups wishing to control and limit our practice due to their concerns of professional encroachment on their scope of practice. I do not believe that I am in practice to take the place of my physician colleagues. I believe NPs and MDs coexist optimally when our practice is complementary of each other, not exclusive of each other. We both provide aspects of patient care with a different level of expertise that the other does not. The role of the NP was originally created in 1965 to fill a gap left by insufficient numbers of practicing pediatricians. There is still an insufficient number of physicians today and that deficit is only expected to grow into the next few decades. Give us the ability to practice to the full extent of our license while we work actively to support our health care teams.

A recent study entitled Results of a National Survey: Ongoing Barriers to APRN Practice in the United States was published in February 2022. Participants included more than 7,000 APRNs representing all 50 states. Themes that were identified and reported by respondents included issues surrounding licensure. Additional concerns included administrative barriers, therapy restrictions, need for a physician signature, a lack of collegiality, prescribing barriers, uneven reimbursement, physician-only procedures, and telehealth issues. Barriers were identified in all states, regardless of the type of practice authority. All APRN role types identified practice barriers, some of which were more frequent for some roles than others. Restrictions for home health approval and the requirement for a physician signature for durable medical supply orders were identified by more than 40% of respondents practicing in rural areas. These are areas where the shortage of physicians is at the highest, yet restrictions on NP practice continue. Barriers to APRN practice continue to restrict aspects of patient care and patient access to care, even in states with full practice authority. 

If you want to decrease burnout among NPs, compensate us equitably, remove barriers to our practice, give us respect and grant the benefits commensurate with my knowledge, expertise, and education. Place us in roles that truly show who we are: APPs who possess additional education, knowledge, and expertise that allows us to function at the highest level of nursing.

How would you solve burnout for NPs? Share in the comments.

Dr. Karen Scanlon Henry is a nurse practitioner in medical oncology in Miami, Florida. She enjoys baking, long walks, reading, and philosophical discussions with her adult children. Writing has been a lifelong passion and hobby for her. Karen is a 2022–2023 Doximity Op-Med Fellow.

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