An expanding role for nurse practitioners
The 'baby boom' generation – nearly 40,000,000 strong – is aging and many are living with a variety of chronic medical conditions such as diabetes and heart disease. The Affordable Care Act, the national health care plan designed to increase the accessibility and affordability of health insurance, will provide coverage of pre-existing medical conditions to those who were previously uninsurable. The number of U.S. medical school graduates specializing in primary care has dropped precipitously in the past two decades, resulting in a dearth of family practice physicians.
Amid all this turmoil, Ivy Alexander remains calm and focused. Alexander, clinical professor and director of advanced practice nursing in UConn's School of Nursing, is encouraged about the expanding role of nurse practitioners in an increasingly complex medical landscape.
"As medical professionals," she says, "we are recognizing that on a national level, advanced practice nurses [APNs, those with master's degrees and board certification in a specialty area] are part of the solution to the health care access crisis. The only way that patients are going to get the care they need is if all parts of the medical team, including APNs, midwives, physician's assistants, physicians, and others, come together as partners."
She continues, "It's not that nurse practitioners are going to replace any other clinicians. That's not our goal. But advanced practice nurses are extraordinarily well prepared to provide primary care. They are trained in managing multiple types of health problems and in promoting a healthy lifestyle. With the current challenges in patient care, I can only see the role of the nurse practitioner increasing."
Alexander's enthusiasm for nursing as a profession is partially what brought her to UConn from her previous position as professor of nursing and director of the adult, family, gerontological, and women's health primary care specialty at Yale.
"I looked at this position [at UConn] as an opportunity to work with a really dedicated faculty," she says. "They are superior clinicians who are devoted to their students and to the growth of our various programs – at all academic levels, from the bachelor's degree up through doctoral degrees in nursing. Our instructors, almost all of whom are also in clinical practice, reflect the commitment the School of Nursing has made to its students."
She says she was also attracted by the fact that UConn offers both master's level and doctoral level entry into its advanced practice programs. "That makes UConn different from many other nursing schools and it allows students to pick a course of study that really fits their career objectives. The growth of these programs has been steady, and this year we have 21 DNP [doctoral] students and 119 master's level students – that's quite an achievement."
In discussing the complexities of delivering quality health care, Alexander cites the findings of a 2010 Institute of Medicine report on the future of nursing that said nurses can and should play a fundamental role as the United States transforms its health care system.
"Nurse practitioners can work independently in primary care settings and in acute care settings," Alexander says. "They can really help modulate health care costs by educating patients and providing front line primary care. They are already an integral part of the Veteran's Administration (VA) system providing care to the nation's veterans, and that role is expanding."
Alexander points out that when students graduate from UConn's School of Nursing, they will be entering a profession that is in the midst of some seismic changes. She notes that nurses are playing a vital role in maximizing health care resources in this country.
"One of the things we are in danger of losing in an era of specialization is the long-term relationship that physicians in family practice have traditionally had with their patients," she says, "and nurse practitioners, who are on the front line of patient care, will help to maintain that continuity."
Alexander's research interests have focused on the areas of translation and dissemination of culturally relevant, evidence-based information and self-care strategies for midlife women, particularly in the areas of menopause and osteoporosis.
She has written two books for lay audiences that are widely read and have been translated into several languages: 100 Questions and Answers about Menopause (2005) and 100 Questions and Answers about Osteoporosis and Osteopenia (2009), both published by Jones and Bartlett. In addition, she is a Fellow in the American Academy of Nursing and has provided leadership to the National Association of Nurse Practitioners in the area of women's health, as founding chair of the organization's research committee.
Her belief in the role that nurses play in providing quality health care is highlighted by an anecdote she relates.
One of her research studies on primary care of women included conducting focus groups with middle-aged black women discussing how they perceived midlife health risks and what they were doing to modify those risks. The women said that they got most of their health-related information from Oprah, their women friends, and the Internet.
"I was really alarmed," Alexander says, "and right then and there I decided that one of the most important roles of nursing was the delivery of accurate, research-based information, as well as prompt patient care, to people who might not otherwise be getting what they need from the medical establishment."
In most cases, APNs and MDs work hand in hand, she says. "Freeing up our colleagues to do the things they are best at – while we do the things we are best at – is a win-win situation. In the end, the person who benefits the most is the patient, and that's as it should be."