Supply Of Primary Care Providers Research Articles

Understanding and addressing changing administrative workload in primary care in Canada: protocol for a mixed-method study

IntroductionMany Canadians struggle to access the primary care they need while at the same time primary care providers report record levels of stress and overwork. There is an urgent need...

Association between primary care appointment lengths and subsequent ambulatory reassessment, emergency department care, and hospitalization: a cohort study

BackgroundTo meet increasing demand, healthcare systems may leverage shorter appointment lengths to compensate for a limited supply of primary care providers (PCPs). Limiting the time spent with patients when evaluating acute health needs may adversely affect quality of care and increase subsequent healthcare utilization; however, the impact of brief duration appointments on healthcare utilization in the United States has not been examined. This study aimed to assess for potential inferiority of shorter (15-min) primary care appointments compare to longer (≥ 30-min appointments) with respect to downstream healthcare utilization within 7 days of the initial appointment.MethodsWe performed a retrospective cohort study using electronic health record (EHR), billing, and administrative scheduling data from five primary care practices in Midwest United States. Adult patients seen for acute Evaluation & Management visits between 10/1/2015 and 9/30/2017 were included. Patients scheduled for 15-min appointments were propensity score matched to those scheduled for ≥ 30-min. Multivariate regression models examined the effects of appointment length on repeat primary care visits, emergency department (ED) visits, hospitalizations, and diagnostic services within 7 days following the visit. Models were adjusted for baseline patient, visit, and provider characteristics. A non-inferiority approach was employed.ResultsWe identified 173,758 total index visits (6.5% 15-min, 93.5% ≥ 30-min). 11,222 15-min appointments were matched to a comparable ≥ 30-min visit. Longer appointments were more frequent among trainee physicians, patients with limited English proficiency, and patients with more comorbidities. There was no significant effect of scheduled appointment length on the incidence of repeat primary care visits (OR = 0.983, CI: 0.873, 1.106) or ED visits (OR = 0.856, CI: 0.700, 1.047). Shorter appointments were associated with lower rates of subsequent hospitalizations (OR = 0.689, CI: 0.504, 0.941), laboratory services (OR = 0.682, CI: 0.643, 0.724), and diagnostic imaging services (OR = 0.499, CI: 0.466, 0.534). None of the non-inferiority thresholds were exceeded.ConclusionsFor select indications and select low risk patients, shorter duration appointments may be a non-inferior option for scheduling of patient care that will not result in greater downstream healthcare utilization. These findings can help inform healthcare delivery models and triage processes as health systems and payers re-examine how to best deliver care to growing patient populations.

Variation in appropriate diabetes care and treatment targets in urban and rural areas in England: an observational study of the ‘rule of halves’

ObjectivesTo estimate the ‘rule of halves’ for diabetes care for urban and rural areas in England using several data sources covering the period 2015–2017; and to examine the extent to...

Effects of the ACA Medicaid expansions on access and health by nurse practitioner scope of practice laws

BackgroundThe Affordable Care Act (ACA) Medicaid expansions increased demand for care whereas the Scope of Practice (SOP) laws for nurse procatitioners affect the supply of primary care providers. It is important to udnerstand the interaction of the demand and supply side policies on measures of access to care and health status. PurposeTo examine whether effects of the Affordable Care Act (ACA) Medicaid expansions on access to care and health status are moderated by state scope of practice (SOP) laws for nurse practitioners. MethodsUsing data from the 2011 to 2019 Behavioral Risk Factor Surveillance System, the study used a difference-in-differences design that compared outcome changes between expansion and non-expansion states and evaluated whether these changes differed by state SOP laws. DiscussionFollowing Medicaid expansion, forgoing a needed doctor's visit due to cost declined more in expansion states with full SOP laws than states with reduced SOP laws by 3.0 percentage-points in years 1 to 3 after the expansion (p < .05). Furthermore, completing a routine checkup with a doctor increased more in expansion states with full SOP laws by 3.2 percentage-points in 4 to 6 years (p < .05). ConclusionThe ACA Medicaid expansions were associated with larger gains in certain access measures in states with full SOP laws.

Estimating the Effect of the New York State Nurse Practitioners Modernization Act on Care Received by Medicaid Patients.

The demand for primary care services may surpass the supply of primary care providers, exacerbating challenges with access, quality, and cost in the U.S. health care system. Expanding the supply of, and access to, nurse practitioner (NP) care has been proposed as one method to alleviate these challenges. New York State (NYS) changed its regulatory environment for NPs in 2015. We estimate the impact of expanded NP scope of practice (SOP) regulations in NYS on total care days received by Medicaid beneficiaries from 2015 to 2018 using a model derived from national historical data from 1999 to 2011. We used a longitudinal data policy analysis framework and a generalized difference-in-differences model to identify the effect of changes in NP SOP regulations on total care days. The model included controls for state income and unemployment rates. Our results suggest that the policy change increased total care days provided to patients, but that this difference was not statistically significant and became negligible after computing the number of days per beneficiary. In addition, our results suggest that had NYS moved to a full practice environment, more care days could have been provided to Medicaid patients, and this difference was found to be statistically significant. Our results suggest that states should adopt full NP SOP practice environments to realize measurable benefits of expanded NP SOP.

County-level Predictors of Growth in Community-based Primary Care Use Among Veterans.

The 2014 Choice Act expanded the Veterans Health Administration's (VA) capacity to purchase services for VA enrollees from community providers, yet little is known regarding the growth of Veterans' primary care use in community settings. The aim was to measure county-level growth in VA community-based primary care (CBPC) penetration following the Choice Act and to assess whether CBPC penetration increased in rural counties with limited access to VA facilities. A total of 3132 counties from VA administrative data from 2015 to 2018, Area Health Resources Files, and County Health Rankings. We defined the county-level CBPC penetration rate as the proportion of VA-purchased primary care out of all VA-purchased primary care (ie, within and outside VA). We estimated county-level multivariate linear regression models to assess whether rurality and supply of primary care providers and health care facilities were significantly associated with CBPC growth. Nationally, CBPC penetration rates increased from 2.7% in 2015 to 7.3% in 2018. The rurality of the county was associated with a 2-3 percentage point (pp) increase in CBPC penetration growth (P<0.001). The presence of a VA facility was associated with a 1.7 pp decrease in CBPC penetration growth (P<0.001), while lower primary care provider supply was associated with a 0.6 pp increase in CBPC growth (P<0.001). CBPC as a proportion of all VA-purchased primary care was small but increased nearly 3-fold between 2015 and 2018. Greater increases in CBPC penetration were concentrated in rural counties and counties without a VA facility, suggesting that community care may enhance primary care access in rural areas with less VA presence.

Dual-eligible beneficiaries and inadequate access to primary care.

To determine whether enough primary care providers are in close proximity to where dual-eligible beneficiaries live to provide the capacity needed for integrated care models. Secondary data analysis using dual-eligible enrollment data and health care workforce data. We determined the density of dual-eligible beneficiaries per 1000 population in 2017 for each of 3142 US counties. County-level supply of primary care physicians (PCPs), primary care nurse practitioners, and physician assistants was determined. One-third of the 791 counties with the highest density of dual-eligible beneficiaries had PCP shortages. Counties with the highest density of dual-eligible beneficiaries and the fewest primary care clinicians of any type were concentrated in Southeastern states. These areas also had some of the highest coronavirus disease 2019 outbreaks within their states. States in the Southeastern region of the United States with some of the most restrictive scope-of-practice laws have an inadequate supply of primary care providers to serve a high concentration of dual-eligible beneficiaries. The fragmented care of the dually eligible population leads to extremely high costs, prompting policy makers to consider integrated delivery models that emphasize primary care. However, primary care workforce shortages will be an enduring challenge without scope-of-practice reforms.

The Impacts of the ACA Medicaid Expansions on Cancer Screening Use by Primary Care Provider Supply: Erratum.

The Impacts of the ACA Medicaid Expansions on Cancer Screening Use by Primary Care Provider Supply: Erratum.

Does Primary Care Provider Supply Influence Medicaid Acceptability?

Following the Affordable Care Act's Medicaid expansions, access to care improved through elevated coverage rates among the low-income population. In Michigan, a major factor contributing to improved access among low-income patients was increased Medicaid acceptance in primary care settings. Prior evidence shows substantial geographic variation preacceptance and postacceptance of Medicaid. In this study, we determine whether physician's willingness to accept new Medicaid patients is moderated by the availability of other providers in close proximity. The study uses Michigan simulated patient (ie, "secret shopper") data collected during 2014 and 2015, and applies a difference-in-differences styled event-study regression approach comparing trends in Medicaid acceptability and appointment scheduling between areas in Michigan with higher densities of primary care providers against those with lower densities of providers that could arguably be classified a health professional shortage areas. Through one year after Michigan's Medicaid expansion, practices in low-supply areas appeared no more likely (P>0.10) to turn away a newly insured Medicaid patient than a practice in a supply-rich area. The wait times for patients in a low-supply area were about a day longer (P<0.05) than for patients in supply-rich areas through 4 months after the expansion, though this difference dissipated through 8 and 12 months after the expansion. These results indicate that newly insured Medicaid patients are gaining access to care in settings with limited health care supply.

The Economic Impact of the Expansion of Nurse Practitioner Scope of Practice for Medicaid

Introduction The demand for primary care services may surpass the supply of primary care providers, exacerbating challenges with access, quality, and cost in the U.S. healthcare system. Expanding the supply of, and access to, nurse practitioner (NP) care has been proposed as one method to alleviate these challenges. Aim To estimate the impact of expanded NP scope of practice (SOP) regulations on the costs of total outpatient visits, prescription drugs, and total care days received by Medicaid beneficiaries nationwide from 1999–2011. Methods We used a longitudinal data policy analysis framework and built a fixed-effect model, a generalized form of a difference-in-differences model, to identify the effect of changes in NP SOP regulations on the outcome variables. The models included controls for state income and unemployment rates. Results Compared to states with reduced SOP, states with full SOP had 17% lower outpatient costs (i.e., $160.45 per beneficiary per year) and 10.9% lower prescription drug costs (i.e., $145.44 per beneficiary per year). States with restricted SOP had 11.6% higher outpatient costs (i.e., $107.31 per beneficiary per year) and 5.1% higher prescription drug costs (i.e., $67.89 per beneficiary per year). Annual total care days were 8% (i.e., 819,905.9 days) higher in states with full SOP compared to states with reduced SOP (p = .05). Conclusion States that expand NP SOP may provide greater intensity of care (measured using total care days) to Medicaid patients without increasing total costs of care. The demand for primary care services may surpass the supply of primary care providers, exacerbating challenges with access, quality, and cost in the U.S. healthcare system. Expanding the supply of, and access to, nurse practitioner (NP) care has been proposed as one method to alleviate these challenges. To estimate the impact of expanded NP scope of practice (SOP) regulations on the costs of total outpatient visits, prescription drugs, and total care days received by Medicaid beneficiaries nationwide from 1999–2011. We used a longitudinal data policy analysis framework and built a fixed-effect model, a generalized form of a difference-in-differences model, to identify the effect of changes in NP SOP regulations on the outcome variables. The models included controls for state income and unemployment rates. Compared to states with reduced SOP, states with full SOP had 17% lower outpatient costs (i.e., $160.45 per beneficiary per year) and 10.9% lower prescription drug costs (i.e., $145.44 per beneficiary per year). States with restricted SOP had 11.6% higher outpatient costs (i.e., $107.31 per beneficiary per year) and 5.1% higher prescription drug costs (i.e., $67.89 per beneficiary per year). Annual total care days were 8% (i.e., 819,905.9 days) higher in states with full SOP compared to states with reduced SOP (p = .05). States that expand NP SOP may provide greater intensity of care (measured using total care days) to Medicaid patients without increasing total costs of care.

The Impacts of the ACA Medicaid Expansions on Cancer Screening Use by Primary Care Provider Supply.

Recent studies of the impacts of the Affordable Care Act (ACA) Medicaid expansions on cancer screening use have mostly found insignificant effects. We posit that these findings mask meaningful heterogeneity in impacts depending on availability of primary care providers. This study examined the impacts of the ACA Medicaid expansions on cancer screening use separately by state-level supply of primary care providers. We used data from the 2012 and 2016 Behavioral Risk Factor Surveillance System surveys to measure use of mammograms, Pap smear tests, blood stool tests, and sigmoidoscopy/colonoscopy for age groups recommended receiving these tests. The main analytical sample included 24,878-31,890 individuals with household income below 138% Federal Poverty Line. We used a difference-in-differences design comparing pre-post expansion changes in cancer screening use between expanding and nonexpanding states separately for 2 state groups defined by the median proportion of the state population residing in primary health professional shortage areas: low primary care provider supply (above median) and high supply (below median). Medicaid expansions were associated with significant increases in mammograms (11.4 percentage-points), Pap smear tests (6.9 percentage-points), and sigmoidoscopy/colonoscopy use (8.3 percentage-points) in states with high supply of primary care providers. In contrast, effects were small and insignificant in low supply states. ACA Medicaid expansions were associated with increased cancer screening use only in states with high supply of primary care providers. Improving access for Medicaid beneficiaries in provider shortage areas may require coupling coverage expansions with supply-side interventions to increase provider availability.

Rural - urban differences in determinants of patient satisfaction with primary care

In light of the rising regional inequalities in primary care provider supply, to ensure equitable access is a pressing issue in health policy. Most policy approaches fall short in considering the patient perspective when defining shortage areas. As a consequence, implementations of new service delivery models might fail to be responsive to patients' expectations. To explore regional differences in the relative importance of structure and process attributes as drivers of patient satisfaction with local primary care, we collected data from residents of three objectively well-supplied urban and six objectively worse-supplied rural areas in Germany and tested a multi-group structural equation model. The results suggest that the relative importance of care attributes is different among the regional conditions rural and urban. Regardless of regional constraints, the strongest determinants of satisfaction are not related to structural aspects but are concerned with the quality of the doctor-patient relationship. A lack of available choices and a higher tolerance in terms of distances provide possible explanations for the results. The high importance rural residents attribute to the interpersonal relation should not be neglected in the re-organization of traditional service delivery in rural areas.

Measuring Relationships between Doctor Densities and Patient Visits: A Dog’s Breakfast of Small Area Health Geographies

A number of small area geographies are used in Australia to investigate primary care relevant outcomes/behaviours and to manage the supply of Primary Care Providers (PCP) that influence these outcomes. However, very little research exists on the choice of a small area geography suitable for these purposes. We evaluated a large basket of Australian small area geographies to determine which geography is optimal for investigating relationships between PCP supply and the use of PCP services. We used linked data to evaluate the relationship between PCP supply and the likelihood of a patient visiting a PCP, after adjusting for individual level covariates. PCP supply was measured at different geographies including Local Government Areas (LGAs), Primary Health Networks (PHNs), Statistical Areas-1/2/3 and Remoteness Areas. Overall, the strongest relationships between PCP density and PCP use were found when LGAs were used to measure PCP density. Large geographies such as PHNs also detected strong relationships while custom built geographies such as Primary Care Service Areas were not significantly better than the rest. Existing geographies such as LGAs may be suitable for investigating the effect of PCP supply at state or national scales.

Federally qualified health centers reduce the primary care provider gap in health professional shortage counties

BackgroundFederally qualified health centers (FQHCs) were designed to provide care in medically underserved areas. Substantial and sustained federal funding has accelerated FQHC growth. PurposeTo examine temporal trends in primary care provider supply and whether FQHCs have been successful in reducing the gap in provider supply in primary care health professional shortage areas (HPSAs). MethodsRetrospective cohort study design using national county-level data from 2009 to 2013. Primary care providers included physicians, nurse practitioners, and physician assistants. FindingsPartial-county HPSAs had the highest average provider supply and the greatest increase, followed by non-HPSA counties and whole-county HPSAs. The provider gap was larger in whole-county HPSAs compared with partial-county HPSAs. Counties with one or more FQHC sites had a smaller provider gap than those without FQHC sites. An increase of one FQHC site was statistically significantly associated with a reduction in the annual provider gap. DiscussionFQHCs reduced the gap in primary care provider supply in shortage counties and mitigated uneven distribution of the primary care workforce.

Healthcare resource availability and cardiovascular health in the USA

ObjectivesCardiovascular disease (CVD) remains the leading cause of death in the USA. Reducing the population-level burden of CVD disease will require a better understanding and support of cardiovascular health (CVH)...

The Untapped Potential of the Nurse Practitioner Workforce in Reducing Health Disparities

The growing nurse practitioner (NP) workforce represents a significant supply of primary care providers, who if optimally utilized, are well-positioned to improve access to health care for racial and ethnic minorities. However, many barriers affect the optimal utilization of NPs in primary care delivery. These barriers may also prevent NPs from maximally contributing to efforts to reduce racial and ethnic health disparities. Our review of the empirical and health policy literature sought to elucidate factors that affect NPs' potential and ability to narrow or eliminate health disparities. We found that restrictive state scope of practice regulations, disparate reimbursement policies, lack of NP workforce diversity, and poor organizational structures in NP practices may limit NPs' contributions to current efforts to reduce disparities. Our results led to the development of the nurse practitioner health disparities model which identifies barriers to and opportunities for optimal use of NPs in reducing racial and ethnic disparities. State and federal policymakers and administrators in health-care settings should take actions to remove legislative and organizational barriers to enable NPs to deliver high-quality care to racial and ethnic minorities. Researchers can use the nurse practitioner health disparities model to produce empirical evidence to reduce health disparities and improve population health.

Physical and Occupational Therapy From the Acute to Community Setting After Stroke: Predictors of Use, Continuity of Care, and Timeliness of Care

ObjectiveTo identify predictors of therapist use (any use, continuity of care, timing of care) in the acute care hospital and community (home or outpatient) for patients discharged home after stroke. DesignRetrospective cohort analysis of Medicare claims (2010–2013) linked to hospital-level and county-level data. SettingAcute care hospital and community. ParticipantsPatients (N=23,413) who survived the first 30 days at home after being discharged from an acute care hospital after stroke. InterventionsNot applicable. Main Outcome MeasuresPhysical and occupational therapist use in acute care and community settings; continuity of care across the inpatient and home or the inpatient and outpatient settings; and early therapist use in the home or outpatient setting. Multivariate logistic and multinomial logistic regression analyses were conducted to identify hospital-level, county-level, and sociodemographic characteristics associated with therapist use, continuity, and timing, controlling for clinical characteristics. ResultsSeventy-eight percent of patients received therapy in the acute care hospital, but only 40.8% received care in the first 30 days after discharge. Hospital nurse staffing was positively associated with inpatient and outpatient therapist use and continuity of care across settings. Primary care provider supply was associated with inpatient and outpatient therapist use, continuity of care, and early therapist care in the home and outpatient setting. Therapist supply was associated with continuity of care and early therapist use in the community. There was consistent evidence of sociodemographic disparities in therapist use. ConclusionsTherapist use after stroke varies in the community and for specific sociodemographic subgroups and may be underused. Inpatient nurse staffing levels and primary care provider supply were the most consistent predictors of therapist use, continuity of care, and early therapist use.

Racial Disparities In Geographic Access To Primary Care In Philadelphia.

Primary care is often thought of as the gateway to improved health outcomes and can lead to more efficient use of health care resources. Because of primary care's cardinal importance, adequate access is an important health policy priority. In densely populated urban areas, spatial access to primary care providers across neighborhoods is poorly understood. We examined spatial variation in primary care access in Philadelphia, Pennsylvania. We calculated ratios of adults per primary care provider for each census tract and included buffer zones based on prespecified drive times around each tract. We found that the average ratio was 1,073; the supply of primary care providers varied widely across census tracts, ranging from 105 to 10,321. We identified six areas of Philadelphia that have much lower spatial accessibility to primary care relative to the rest of the city. After adjustment for sociodemographic and insurance characteristics, the odds of being in a low-access area were twenty-eight times greater for census tracts with a high proportion of African Americans than in tracts with a low proportion of African Americans.

Use of motivational and educational techniques in behavioral health patients to impact self-care and emergency department visit rates

Background and objective: People with mental health and substance use disorders present with multiple medical comorbidities, social and legal issues. Due to these care complexities, this patient population has high rates of hospital readmissions and emergency department (ED) visits. Patients with mental health disorders require integrated care, which is the coordination of physical and behavioral health care. These patients may benefit from various educational techniques and counseling including the Teach Back Method (TBM) and motivational interviewing (MI). Houston Methodist Hospital (HMH) Behavioral Health Transition of Care Program, a quality improvement program, utilizes educational tools and counseling techniques during inpatient and post-discharge phases to improve care coordination in patients with behavioral health conditions. One of the goals of the program is to contribute to a reduction in the behavioral health/substance abuse diagnosis ED visit rate at the participating HMH system hospitals. For the first year (April 2014 through March 2015), the goal was to reduce the behavioral health ED visit rate by 5% from baseline (October 2013 through April 2014). This paper aims to 1) provide evidence to enhance motivation and establish partnership with patients, 2) report on the Behavioral Health Transition of Care Program’s use of motivational and educational techniques, 3) describe the program’s patient demographics from June 2014 through March 2015, 4) report program performance data, and 5) report ED visit data of patients with a primary or secondary behavioral health or substance abuse diagnosis. Methods: Data for two of three HMH hospitals participating in the Behavioral Health Transition of Care Program are reported. Staff members carrying out interventions include social workers, educators, nurse practitioners, and a clinical pharmacist. Patients are eligible for inclusion in program interventions if they have a current or previous mental health or substance abuse disorder and are at high risk for readmission (determined by the Discharge Decision Support System [D2S2] conducted by the floor nurse). Social workers are consulted on high risk patients to conduct a Personal Health Record (PHR) and Morisky Medication Adherence Scale (MMAS-8) and enroll patients in the post-discharge interventions (telephone calls, home visits, or both). The clinical pharmacist is consulted on inpatients with a low MMAS-8 for coaching and medication education. After discharge, enrolled patients receive follow-up automated telephone calls. Educators call patients with post-discharge issues reported via these calls. Nurse practitioners conduct one to two home visits over the 30-day post-discharge period. Aggregate data was obtained using reports obtained for quality-improvement purposes. Descriptive statistics are reported. Results: Of the 2,330 high risk encounters at HMH and San Jacinto Methodist (SJ) over June 2014 through March 2015, the average age was 55.8 years old, 4.68% encounters were insured by Medicaid, and the average D2S2 score (range: 0-11) was 4.4. Social workers completed PHR on 73.61% of the encounters and 13.48% of the discharged encounters had home visits within 30 days after discharge. There was a 4.6% reduction in the behavioral health ED visit rate from baseline to first year. Conclusions: HMH implemented a Behavioral Health Transition of Care Program that uses MI and the TBM to facilitate in reduction of ED utilization by behavioral health patients. Although the goal of 5% ED visit rate reduction was not achieved, various contributing factors such as a high demand but limited supply of primary care providers may impact the rate.

DNP’s: What Can We Expect?

The United States’ health care system is evolving, with the introduction of the Patient Protection and Affordable Care Act, a growing population of elderly, an increasing demand and dwindling supply of primary care providers, and a shift to health information technology. The nursing profession, 3 million strong, prepares to meet these challenges and improve healthcare through leading change in patient care delivery and health care policy. The American Association of College of Nurses (AACN) recognizes the growing demands on practicing nurses, educators, and nurse leaders, and endorses the advancement of the doctor of nursing practice (DNP) degree to prepare advanced practice registered nurses (APRN) as practicing scholars and influential leaders in health care. 1 American Association of Colleges of Nursing AACN Position Statement on the Practice Doctorate in Nursing. http://www.aacn.nche.edu/publications/position-statementsDate: 2004 Google Scholar Although the DNP is not to replace the research-focused PhD degree, questions arise as to what roles the DNP can fill. The proposed roles of the DNP include practitioner, leader, and educator. This article will review the development of the DNP education, the possible roles of the DNP, and whether the DNP prepared nurse can help the nursing profession meet the demands of a growing population, educate future nurses, and promote positive change through leadership and contributions to the health care system. The United States’ health care system is evolving, with the introduction of the Patient Protection and Affordable Care Act, a growing population of elderly, an increasing demand and dwindling supply of primary care providers, and a shift to health information technology. The nursing profession, 3 million strong, prepares to meet these challenges and improve healthcare through leading change in patient care delivery and health care policy. The American Association of College of Nurses (AACN) recognizes the growing demands on practicing nurses, educators, and nurse leaders, and endorses the advancement of the doctor of nursing practice (DNP) degree to prepare advanced practice registered nurses (APRN) as practicing scholars and influential leaders in health care. 1 American Association of Colleges of Nursing AACN Position Statement on the Practice Doctorate in Nursing. http://www.aacn.nche.edu/publications/position-statementsDate: 2004 Google Scholar Although the DNP is not to replace the research-focused PhD degree, questions arise as to what roles the DNP can fill. The proposed roles of the DNP include practitioner, leader, and educator. This article will review the development of the DNP education, the possible roles of the DNP, and whether the DNP prepared nurse can help the nursing profession meet the demands of a growing population, educate future nurses, and promote positive change through leadership and contributions to the health care system.