15 Biggest Limitations of a Nurse Practitioner
Written By: Donna Reese MSN, RN, CSN
I remember the excitement of graduating with my NP degree. Although the classes and clinical were rigorous, I was happy to put them behind me and begin my practice at last as a family nurse practitioner. As most jobs tend to do, once I was actually working as an NP, my high hopes became more realistic as I began to see cracks in the system and pitfalls to navigate as an NP.
As you begin your career, you may be less starry-eyed than I was and wisely be asking what are the limitations of a nurse practitioner? Suppose you are willing to look beyond the unusual candy-coated NP job descriptions. In that case, this article, “15 biggest limitations of a nurse practitioner”, will help to prepare you for the real-world career of an NP.
WHAT ARE THE LIMITATIONS OF A NURSE PRACTITIONER?
(The following are the 15 biggest limitations of a nurse practitioner.)
LIMITATION #1: Physician resistance
Unfortunately, some doctors still feel that NPs are “medicine light” or “physician extenders” and do not give our profession the respect it deserves. I would hope that by now, we still would not be seeing headlines like the one in the Los Angeles Times
, “Nurse practitioners aren’t like physicians, doctors warn”. However, physician resistance is still a critical issue and negative influence when it comes to NP independence and respect in the medical world. This negative attitude is a significant contributor to the ongoing limitations of a nurse practitioner.
RECOMMENDED ONLINE NURSE PRACTITIONER PROGRAMS
LIMITATION #2: Patient hesitation
Recently, I felt ashamed of my own behavior when visiting my local urgent care center. My family and I love one of the facility's long-time docs, so I asked for him to be my provider for this visit. When it was my turn to be seen, I was surprised to have a perky young NP step into my room instead of my beloved doc. Her face fell when I expressed my desire to see my preferred physician. She explained that this scenario frequently happens as many patients prefer not to be seen by an NP. I explained that I had no hesitation in seeing an NP but that, instead, I was familiar with the physician on duty.
I have heard this issue from other NPs whose patients did not trust them since they were not physicians. Many will not even try the services provided by a nurse practitioner.
LIMITATION #3: Staff disrespect
At times, certain staff may not respect the knowledge and authority of a nurse practitioner. I still cringe at the memory of one nurse who apparently disagreed with my treatment of a patient. In this instance, she loudly declared in a room full of staff that she was going to talk to the doctor about MY patient. I meekly followed her so I could hear her complaining about me to the physician. Luckily, the doctor backed me up, and his respect for my practice temporarily shut down this interfering nurse.
However, similar scenarios have occurred with other NP friends, making this issue one that can create stress and limitations for a nurse practitioner.
LIMITATION #4: Pharmacology restraints
Depending on the state where you practice, your hands may be tied when prescribing certain medications. Although nurse practitioners can write scripts for medicine in all 50 states, there are often limitations placed on a nurse practitioner for prescribing certain classes of drugs and conditions for treatment. For example, states with restrictive and reduced practice authority
may require an NP to have their supervising physician sign for specific medication or oversee what the NP prescribes.
The most significant prescribing limitations of a nurse practitioner are in the category of controlled substances, with many states still curtailing NPs from freely writing scripts for these medications.
LIMITATION #5: Employer disrespect
In addition to disrespect from the physicians you work with, NPs may have to deal with a general disregard from their employers. In a recent report from Medscape, called the Nurse Practitioner Burnout and Depression Report, 40% of NPs indicated that their burnout and depression would be better if they had more respect from administration and other sources. Having a say and voice in matters such as lighter patient loads, more support staff, and a more manageable schedule would go a long way in keeping nurse practitioners happy on the job.
LIMITATION #6: Public ignorance
Hopefully, the public is getting accustomed to the nurse practitioners’ role in the healthcare system. However, many still have no idea what NPs really do and how they play an integral role in our medical world.
For instance, I was talking with a woman the other day about her husband’s ear problem. She indicated that “some new lady” at the ENT initially saw her husband and pinpointed an issue that the doctor will continue to treat. After more discussion, it turns out that “the lady” was an NP who worked in this office and, I am sure, is highly trained in the ENT specialty. In fact, this gentleman had suffered from hearing loss, pain, and infection for years, and this NP seemed to be the one to hit the nail on the head as far as the correct diagnosis and initial treatment!
However, as impressed as I was with her diagnostic abilities, I fear she did not get any kudos from this couple as they waited for the “real” provider to continue care.
LIMITATION #7: Physician oversight
Some states, such as Pennsylvania and North Carolina
, require physician supervision for an NP to practice via a collaborative agreement. Limitations of a nurse practitioner due to the scope of practice laws can be one of the most frustrating reasons why an NP regrets becoming a nurse practitioner
. With buckets of time, money, and sacrifice dumped into obtaining your advanced practice degree, nurse practitioners in a limited or reduced practice state may often wonder if their efforts were worth the payoff.
LIMITATION #8: Additional training requirements
Often, once you land a job, your employer will require that you take specialized courses to add to your repertoire of medical skills. For NPs who are tired of schooling, this extra demand may add to your already over-booked schedule and stress level.
In addition, state scope of practice requirements may also dictate that you take additional training if you want to prescribe certain medications or treatments or order specific patient equipment. For example, although Nebraska NPs enjoy full practice authority
, they must complete 30 hours of pharmacology before they can begin to prescribe drugs.
LIMITATION #9: Medicare/Medicare limitations
For vague reasons, some states reimburse NP services at an inequitable percentage compared to a physician's payment. For example, Illinois NPs received roughly the same amount for their services as a physician. In contrast, Kentucky’s Medicaid program pays only 75% of what a doctor gets for the same service. This unfair system makes NPs a less-than-desirable choice when it comes to hiring, as practices lose out on profits when they hire NPs.
LIMITATION #10: Your specialty
Another one of the limitations of a nurse practitioner is by virtue of your specialty itself. Some NPs have a very narrow niche and may find limited jobs due to the lack of availability in their field. While family nurse practitioners can find work in urgent care, hospitals, and ambulatory settings caring for adults and children alike, in contrast a neonatal NP
may have a very narrow choice of opportunities.
Even though my heart was in pediatrics, I chose a family nurse practitioner program for my MSN to broaden the scope of my career possibilities. I was able to find work in pediatrics, but my degree also opened other doors for me later in my career in a wide variety of environments other than children’s health.
LIMITATION #11: Limited job offerings
Similarly, some NPs generally report difficulty finding work once they obtain their advanced degree. Nurses in the South report increased challenges finding a job compared to their Northern and California peers. In fact, the best states to work
for an NP in 2022 are New York, Arizona, and Maryland. Some new NPs report that in their community, either there are not many nurse practitioner jobs offered or the area is saturated due to numerous local schools graduating NPs from their programs. NPs willing to move for work are more successful than those unwilling or unable to go where the work is more abundant.
LIMITATION #12: Flexibility
As with many health-related jobs, the lack of flexibility can be one of the limitations of a nurse practitioner. Compared to those in the business or entrepreneurial world, many NP jobs simply have a rigid structure. Working in a hospital requires a time clock and an expectation to be available on the floor while at work. While your business friends skip out for a Starbucks latte at any hour, you are controlled by your 8- or 12-hour shift inside the hospital. In addition, taking off work at the last minute to go to a concert or out to dinner with friends on scheduled days is no easy task.
Recently, I had asked for one day off a month in advance to go to a relative's wedding, only to be turned down by my supervisor. Being boxed in by the confines of our practice and administration minimizes flexibility in our careers. Professionals outside of the hospital system take this type of freedom for granted.
LIMITATION #13: Less-than desirable work placement
When I became a nurse practitioner in Pennsylvania, I worked as a school nurse. I envisioned setting up an inner-city school clinic and performing physicals for the sports teams and children who did not have their own physicians, similar to the practices where I had some clinical rotations.
In my state, I was required to have physician oversight as an NP. When I approached my supervising school physician about my plans, I was shocked at his answer. He said he disapproved of nurse practitioners and that their only place should be in areas where they can’t find enough doctors, such as Indian reservations and war zones! Granted, this was a long time ago, but that doctor is still practicing and has the same ideology he expressed to me in that eye-opening meeting.
Although this is an extreme example, NPs still are utilized most in environments that may not be optimal and where physicians have no interest in working.
LIMITATION #14: Compensation
Although nurse practitioners often make a healthy wage, compensation is still listed as one of the top reasons NPs are dissatisfied with their careers. Some may point out that the financial limitations of a nurse practitioner may be due to disparity in gender compensation. Research has shown that a gender pay gap
does exist between male and female NPs. With most nurses and NPs being female, this equates to lower pay for NPs in general compared to male providers. Having to fight for fair compensation may leave NPs feeling underappreciated and devalued.
LIMITATION #15: Time constraints
When I first started working as an FNP
, I had great aspirations of sitting down with my patients and teaching them all about their conditions and the measures to achieve optimum health. Preventative care was high on my list as a topic for all patients. In reality, I rarely had time for a quick interview and exam before rattling off my diagnosis and treatment.
Today, medical practice time constraints cut short many vital periods necessary to treat patients effectively. Recently, at my own appointment with my nurse practitioner PCP, my problem and diagnosis were simple, and we whipped through the necessities to cover my immediate needs. I remember sitting and looking at my provider, and he began to chat about my work and the weather. I recall thinking, “Why are we just chatting? My visit is over. This type of chit-chat is odd”!
It is a sad commentary that we rarely have time to have a relaxed conversation with our patients because administrative demands schedule every second of our time. And in my instance, such a discourse felt out of place due to the rarity of this occurrence. For me, one of the more disappointing limitations of a nurse practitioner is the feeling that I am not giving enough time to my patients to delve into their needs fully.
My Final Thoughts
Hopefully, the “15 biggest limitations of a nurse practitioner” has not scared you away from a promising career as an NP. Instead, perhaps by answering the question of what are the limitations of a nurse practitioner?, you can go into a job with your eyes wide open and avoid some of the pitfalls that have caused NPs before you to fail. A famous author
once said, “There were two ways to be happy: improve your reality, or lower your expectations”. I hope that knowing what to expect as an NP allows you to experience a happy career—wishing you the best!
Donna Reese MSN, RN, CSN
Donna Reese is a freelance nurse health content writer with 37 years nursing experience. She has worked as a Family Nurse Practitioner in her local community clinic and as an RN in home health, rehabilitation, hospital, and school nursing.