Nurse practitioners, learning from the USA experience: a review of the literature

Abstract

This paper reviews the nurse practitioner (NP) literature to address a number of topical issues. It considers whether USA NP experiences translate to the UK, and what needs NPs might meet. The author contends that a ‘care gap’ exists, which can be linked to factors such as inner-city deprivation, technical knowledge deficits and iatrogenesis, chronic illness, failure of prevention and screening, and rising health expectations on the part of the public. NP roles might be developed to fill the care vacuum in these areas. However, progress to date has been hampered by opposition from the nursing profession itself, as well as from doctors. The paper reviews the empirical evidence on the implementation of NP roles, and considers the implications for nurse education. The NP role is highly demanding, and includes prescriptive authority in many instances. To date, the evidence from the USA studies of NPs’ safety and performance is almost unequivocally positive. To educate NPs in the UK to the high standard of their USA counterparts poses a challenge for nurse educators, particularly in pharmacology and pathophysiology. If nurse educators do not fill the ‘education gap’ in the technical areas, such as pharmacology, it is possible that the pharmaceutical industry will become involved as has happened in medicine.