By James X. Stobinski
The first nurse practitioner (NP) program was founded in 1965 at the University of Colorado.1 The program began, “… as a response to the shortage of primary care providers arising from the expansion of coverage by Medicare and Medicaid to include low-income women, children, the elderly, and people with disabilities.”1 The numbers of nurse practitioners has grown rapidly since then and a recent urgent care visit gave me pause to think about the plentiful opportunities now available to these advance practice nurses.
As we reflect on the circumstances that preceded the beginnings of the NP role we are now in similar times. It can be argued that the shortages of primary care providers which existed prior to the passage of the Affordable Care Act (ACA) have been exacerbated more recently by more insured patients seeking routine and preventive care. The shortfall of physician providers present an opportunity for NPs as new care models have emerged to address primary care needs.
There are now about 307,000 actively practicing nurse practitioners and growth for the profession is projected to remain so into the year 2032.2 Nurse practitioner education programs are plentiful and many offer extensive online sections. Scherer explains that the primary care providers is prominent in rural areas where, “… lower incomes, limited insurance coverage and access, insufficient public transportation, and dwindling healthcare provider numbers has translated into significant need for disparities in preventable chronic diseases, hospitalizations, and elevated mortality rates.”3 These rural areas do not offer dense populations and are not attractive for many physician practices.
Many pre-licensure students aspire to an APRN role and will quickly progress to NP programs soon after entering the profession. It could be argued that such a trajectory robs the profession of needed clinicians in areas such as med-surg wards. If the best and brightest of our new nurses work only briefly in non-APRN roles, our shortages will get worse. Many of my students do not seem to place high value on extensive clinical experience prior to their NP studies. This trend is also seen in surgical services.
At NIFA, we have seen a prominent shift in the makeup of our students taking surgical assistant training. Previously, the majority of NIFA students were experienced perioperative nurses seeking an expanded role as a registered nurse first assistant (RNFA). Currently, the majority of our students are nurse practitioners. Some of these students are recent NP graduates and many lack extensive perioperative nursing experience. Adding NPs to surgical practices can increase efficiency when done well. Nurse practitioners make a cost-efficient addition to a team of providers but to function as a surgical assistant additional education and training is needed.
Turf wars are common amongst providers as American healthcare evolves in a period of prolonged provider shortages and the ongoing transition to a value-based care environment. Disputes over supervision authority and scope of practice are common for APRNs to include nurse anesthetists and nurse midwives. Not all states have favorable practice environments for APRNs, and the opposition of other healthcare professions can be formidable. In surgical care, however, the uptake of NPs has been relatively smooth.
The future for NPs in surgery is promising as their value in an intradisciplinary practice is clear. Nurse practitioners with surgical assistant credentials seem a natural and efficient fit in a multidisciplinary team delivering surgical care. I believe the healthcare marketplace and the influential stakeholders such as payors will have a say in the outcomes but for now NPs in surgery have much in their favor. The role of NPs in surgery present a promising career option for nurses now entering the profession.
References
- OAAPN. (2021, June 7). History of NPs in the United States | The profession since 1965. Ohio Association of Advanced Practice Nurses. https://oaapn.org/2021/06/history-of-nps-in-the-united-states/
- KFF. (2025, August 9). Total number of nurse practitioners | KFF State Health Facts. https://www.kff.org/other-health/state-indicator/total-number-of-nurse-practitioners/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
- Scherer, L. (2025, August 20). As primary care gaps widen, nurse practitioners step up to the plate. Medscape. https://www.medscape.com/viewarticle/primary-care-gaps-widen-nurse-practitioners-step-plate-2025a1000lze?ecd=mkm_ret_250821_mscpmrk_np-pa_e3_etid7655393&uac=530550CG&impID=7655393
