When the topic turns to the shortage of primary care physicians, it soon becomes obvious that the numbers aren’t adding up. Despite the best efforts to attract more medical students to primary care, it isn’t likely to happen fast enough to deal with the double strain of an aging population needing more care and more people looking for doctors now that they have access to health coverage.

One of the most frequently proposed strategies for coping with the shortage is training more nurses to move into advanced practice. Nurse practitioners could be a tremendous asset in meeting the demand for routine care, especially among underserved populations. RNs trained as health managers could help physicians make more efficient use of their time, and nurse navigators can guide patients to the services they need without time and resource-consuming duplication.

However, the next question is, with more nurses moving into advanced practice, will we still have enough nursing shoes on the ground to take care of patients at the bedside and in clinics?

“We will always need more nurses, but we also have more pathways into nursing and accelerated routes of entry that are bringing people into the field faster,” Cynthia S. Selleck ,DSN RN FNP and Associate Dean for Clinical Affairs and Partnerships at UAB said.

“In addition to people who begin their college studies as nursing students, we offer programs for people who already have degrees in other areas and want to transition into nursing. After a year of intense study and over 50 credit hours, they will be ready to sit for a license exam. We also offer an accelerated program for a master’s degree in nursing,” Selleck said.

Strong job opportunities are attracting more people who are changing careers, including more men. The definition of nurse is also changing, with changing job descriptions that include a broader range of more advanced and more specialized work.

“We need nurses who are prepared to take on a greater leadership role and more responsibility,” Selleck said. “That’s why a priority for nursing education in Alabama is the 80 by 20 recommendation in the Institute of Medicine’s report on nursing. Our goal is to have 80 percent of our nurses with a baccalaureate degree by 2020. Right now, we’re at 40 percent. We need to double that number.

“To do that, nursing schools are working to help nurses transition from one degree program to the next—to BSN, MSN, and DNP so as they advance in nursing they can be ready for new opportunities.”

Another change in medical education is a trend toward educating students in different health disciplines together from the start so they can become more experienced in working as a team. As they get to know each other and see students from other disciplines at work, they should gain a better understanding of the value of what those in other areas of health care do and how it fits into their own work.

Helping nurses stay in nursing is another essential part of making sure there are enough nurses to care for the patients who need them. Nursing can be a demanding profession. Nurses are at risk of back injury, foot, leg and joint pain from being on their feet, and the physical and emotional effects of stress that can limit their career.

“It’s important for nurses to learn to take care of themselves,” Selleck said. “Knowing about body mechanics and how to use your body can make a difference. The average patient is getting heavier. Better equipment is available for moving patients. It’s good to have it and know how to use it.”

Another valuable strategy for nurses to stay in nursing is planning their career path so they will be ready to transition to another area of nursing if the need arises. For example, nursing education, patient education, research nursing and nursing management offer opportunities to put the experience nurses gain through the years to good use while also being less physically demanding.

Whether at the bedside in a big city hospital, or working solo as a nurse practitioner in an underserved rural neighborhood, nurses play an essential role in America’s health care system.

However, in Alabama, some laws governing advanced practice nursing put our state at a disadvantage in focusing the capabilities of nurses to help bridge the primary care gap.

“This year, nurse practitioners were legally authorized to prescribe controlled substances, which will help to streamline care,” Selleck said. “However, the largest barrier is that Alabama—unlike many other states--requires nurse practitioners to be co-located with physicians at least 10 percent of the time.

“This is a problem in getting health care where it is needed. Our nurse practitioners were asked to take over The Foundry clinic when the physician operating it left. We were able to staff it four days a week by rotating four nurse practitioners. But to meet the requirement to have a collaborating physician, we had to recruit a physician, which added significantly to our cost. We could have had the clinic open two months earlier if we hadn’t had to go through such an amazing amount of labor -intensive red tape and fees that impede the process of making care accessible.”

Another problem is that insurance in Alabama tends to reimburse nurse practitioners at a lower rate than is typical in other states.

“Florida has around 15,000 nurse practitioners,” Selleck said. “Alabama has 1800. Even though we have very active programs training nurse practitioners, a large percentage go to other states to practice because of the laws limiting practice here and the lower reimbursement.

“We need to make Alabama not only a good place for advanced practice nurses to train, but also a good place to stay. Our people need the care they can provide.”