Nurse practitioners have always been a valuable part of patient care. Now, Delaware legislators are allowing them open their own practices, thus improving access to health care statewide.
Nadya Julien, MS, CNE, APRN, FNP-BC, was one of the first nurse practitioners in the state to open a private primary care clinic. Many of the people she treats at Tabitha Medical Care in Laurel hail from Haiti, her native country.
“For some of my patients, they have not had access to health care at all since coming to the U.S.,” Julien says. “Many of them were not comfortable seeing someone and others could not get into other practices.”
One patient, Franck Louissaint, 67, of Salisbury, says he had a care provider in the area, but it was difficult to get his concerns across because he only speaks Creole.
An employee at Mountaire in Millsboro, Louissaint first met Julien at a church where she was speaking about her new practice in his native language.
“I felt comfortable with her right away,” he says through a translator. “She made me feel at ease and her practice is affordable. It also was important that she speaks my language because I felt before some of my concerns were not being shared or understood.”
Since going to Tabitha Medical Care, Louissaint has gotten back on track with his preventive screenings, including a colonoscopy and annual physical.
“I was able to explain to [Louissaint] why these health services are important, and he was able to tell me his thoughts and concerns,” Julien says.
She says she is proud to serve the Haitian Creole community and offer valuable primary care health services for those who previously lacked a provider. Patients travel from as far as Dover and Salisbury to see her. For those who need a higher level of care, Julien refers them to physicians or specialists.
“Delaware and many other states have a shortage of primary care providers,” Julien continues. “In my practice, I focus not only on serving their immediate needs but also providing preventive care and education, such as making sure they are getting the correct screenings to prevent future health issues.”
Gov. John Carney signed the legislation into law in August 2021. Delaware joins 23 other states and Washington, D.C., in granting full practice authority to advanced practice nurse practitioners.
According to American Association of Nurse Practitioners (AANP), states that have passed similar legislation allowing NPs to practice independently have a “proven track record for increasing accessibility and patient satisfaction,” says AANP President April N. Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN.
“The legislation shows that our state recognizes that nurse practitioners can do just as well without being directly supervised by a physician,” says University of Delaware School of Nursing professor Susan Conaty-Buck, DNP, APRN, FNP-C, FAANP. “Much of Delaware has a primary care shortage, and nurse practitioners have the training and ability to fill those gaps.”
The goal of the legislation is not to have all NPs leave health systems or other practices, she points out, but instead to allow the state to support its residents in finding primary care both within physician-led practices and in new nurse practitioner practices.
Conaty-Buck works with the state’s Primary Care Collaborative group focused on how to best deliver quality primary care to patients before they get sick and end up in an emergency room.
“Multiple studies show that care delivered by a nurse practitioner is comparable in terms of safety,” she says. “Nurse practitioners are highly trained, and many have master’s degrees or higher. The goal is a healthier population, cost savings, and providing safe and efficient care to everyone in Delaware.”
She has seen many excellent nurses and nurse practitioners leave the state for jobs that pay better or offer more autonomy in how they practice, she adds. “This law will really open up opportunities for nurse practitioners here…and hopefully will allow more Delaware-trained health providers to stay here.”
Veronica Wilbur, PhD, APRN, FNP-C, CNE, FAANP, nurse practitioner at Next Century Medical in Wilmington and an associate professor at West Chester University, explains that NP training teaches how to diagnose and manage patients with common and chronic diseases.
“Comparing the models of training with physicians is difficult—it is not apples to apples—but it’s just a different way of training,” Wilbur explains.
After medical school, physicians spend two years doing rotations in hospitals prior to their residencies or fellowships. Nurse practitioners often start out as nurses. They attend nursing school and train bedside in hospitals. “They do hands-on and bedside training very early on and they keep learning both in health care settings and in school programs,” Wilbur adds.
What it comes down to is making sure the patient sees the right provider at the right time.
“We are all here to take care of the health of the community,” Wilbur concludes. “Sure, we are all educated slightly differently, but neither way of learning is wrong. Whether you see a physician or a nurse practitioner, the most important part is that you feel comfortable with your provider so you can receive the best care.”