The two million RN positions in 1998 will grow to 2.5 million by 2008. Most of the new RN positions will be in home health care, long-term care, and ambulatory care, reflecting the aging baby boomers. But other forces are driving demand as well, including technological changes that require more skilled nurses and the growth of managed care. Nursing demand has always been regional and NPs are no exception. NPs have some sort of prescriptive power in all 50 states and the District of Columbia.
Many states place no restrictions on prescriptive power or ordering lab tests.
Nurse practitioners can practice independently in 22 states, and the Department of Veterans Affairs allows nurse practitioners to practice solo. And the Balanced Budget Act of 1997 leveled the financial playing field somewhat for Medicare reimbursements for NPs. The movement toward independent practice has been exciting for nurses, but worrisome for many doctors, who complain about the competition. Detractors claim that NPs practicing independently will rely too much on specialists or that nurses' training can't compare to physicians' training. The study found no real difference between the quality of primary care and patient satisfaction.