Introduction
The past several years have been eventful for nurse practitioners (NPs) – from the COVID-19 pandemic restructuring some of how healthcare is provided to the explosion of telehealth and the increased need for mental health providers.
Anticipating what’s ahead with projections helps us plan for the coming year and beyond. The landscape for NPs is continuing to evolve with some trends allowing us to expand our practice and impact on the patients we serve.
As we enter 2025, what lies ahead for the future of nurse practitioners? Let’s find out!
Trend of Telehealth Practice
Over the past several years, telehealth practice has greatly expanded with more opportunities for psychiatric nurse practitioners to work remotely and increase access to services for patients. Single Aim reports that 4.3% of new nurse practitioner jobs are fully remote, which is 2.5 times greater than the pre-pandemic baseline. The report noted that over half of all telemedicine clinicians are in the field of mental health; so, this rate is likely even higher for psychiatric nurse practitioners.
Psychiatric nurse practitioners are ideal for telehealth because our work relies more on conversation than physical exams, unlike annual physicals or gynecological exams. Instead, for psychiatric providers, conversation is the primary modality of information and assessment data which makes telehealth an appropriate medium for many patients with mental health needs.
Of course, there are caveats to telehealth practice. Not all patients with mental health needs are well suited for telehealth services. For example, patients with complex co-occurring medical and mental health needs may be better suited for in person visits where monitoring of vitals and weight can occur. Many psychotropic medications we prescribe can affect vital signs and contribute to metabolic abnormalities. Being able to track objective measures in person allows for better monitoring.
Additionally, for patients prescribed antipsychotic agents, monitoring for abnormal movements through the Abnormal Involuntary Movement Scale (AIMS) is much more easily conducted in person than via telehealth (although not impossible!).
Telehealth updates and extensions
Telehealth practice has greatly expanded over the past several years. This has allowed for greater access to services for patients and more flexibility for psychiatric nurse practitioners to work remotely. All great things.
But, with all the changes over the years, it can be tough to keep up with the latest updates and extensions.
Here’s a quick rundown of the timeline of events and updates you should be aware of for your practice:
- In March 2020 when the COVID-19 pandemic outbreak began, telehealth flexibilities were temporarily expanded as a part of the CARES Act; additionally, the Drug Enforcement Administration (DEA) granted exceptions for prescribing controlled substances via telehealth during the Public Health Emergency (PHE) through November 11, 2023.
- In December 2022, telehealth policy changes related to Medicare were enacted via the Consolidated Appropriations Act. What does that mean in layman’s terms that’s relevant to you? That Act permanently permitted telehealth visits for behavioral health services for Medicare patients.
- In May 2023, the DEA in partnership with the Department of Health and Human Services (HHS) issued its first post-PHE telemedicine extension for prescribing controlled substances.
- In October 2023, the DEA and HHS, issued a second temporary extension through December 2024.
- In November 2024, the DEA announced a third extension of telehealth flexibilities of prescribing controlled substances through December 31, 2025. Definitely a pattern of extensions occurring!
- Most recently, bipartisan legislation efforts are being made to further extend flexibilities in other specialties. The Telehealth Modernization Act of 2024 would have secured COVID-era telehealth flexibilities through the end of 2026, but the House and Senate haven’t been able to get it together and come to an agreement – what a surprise!
The outcome of such extensions have already—and will continue to—decrease geographic barriers to receiving care in remote and underserved areas. As stated by Delaware Representative Lisa Blunt Rochester, “One of the few positive outcomes of the COVID-19 pandemic was the rapid progress we made in utilizing telehealth services to meet patients where they are.”
Extensions of this act will allow for more patients to receive quality healthcare. Hopefully you’ve noticed the impact of these extensions in your practice over the years as well.
Scope of practice for NPs
Despite the best efforts by the lobbyists that oppose it, nurse practitioner scope of practice is continuing to expand across the United States. A significant reason why NP scope of practice continues to expand is because the need for providers remains – it’s not a coincidence that the earliest states to adopt full practice authority (FPA) are in the northwestern parts of the U.S. where there are more rural areas and a greater shortage of physicians. Rural areas face limited access to care, and the slow growth of physicians drives the increased reliance on nurse practitioners.
As of December 2024, 29 states, the District of Columbia, Guam, and the Northern Mariana Islands, have all granted full scope of practice to NPs. Six states have granted FPA since 2020, Utah being the most recent in March 2023, with several more that just fell short this past year.
- Oklahoma and Wisconsin both had FPA bills that made it all the way to their governor’s desks before being vetoed in 2024.
- Arkansas, Pennsylvania, and North Carolina introduced bills in 2024 that would have permitted FPA with a transition period.
Transition periods are common; 13 states require NPs to work under the supervision of a physician for a set period of time before practicing independently, ranging from 750 hours in Colorado up to 4,600 hours in California.
- In July 2024, Virginia reduced the nation’s lengthiest transition period of 9,000 hours (or 5 years) to 4,500 hours (or 3 years) for FPA.
- Florida is a unique case – in 2020, the state granted FPA for pediatrics, family, and internal medicine NPs that have completed a transition period of 3,000 hours, unfortunately still leaving psych NPs out of luck.
- Transition periods were at the heart of both vetoed FPA bills in 2024. Oklahoma would have had the longest transition period of 6,240 hours for NPs to prescribe Schedule III-V drugs. Wisconsin’s bill would have granted FPA without any transition period, something Governor Evers has used his veto power to request in 2022 and 2024.
NP Scope of Practice, December 2024
Source: Author, various sources, including AANP, Nurse Journal, Campaign for Action, Tegra
Continuing this growing trend, nearly all states (Alabama and West Virginia seemingly being the only holdouts), have considered expanded or FPA since 2021. Ohio also enacted a law in 2024 expanding the authority of NPs.
Also, of note is that no states have ever rescinded their increased level of practice authority to NPs. This suggests that increasing NP scope of practice is resulting in positive patient outcomes and improved access to quality care. Not something to ignore!
Multistate APRN License
The APRN Compact is a potential development on the horizon for nurse practitioners. If implemented, the Compact would create one multistate license and come into effect once seven states have enacted it, allowing Advanced Practice Registered Nurses (APRNs) to provide care across state lines, both in person and via telehealth.
In addition to saving APRNs additional time and cost of obtaining additional licenses, the APRN Compact “provides public protection by establishing uniformity in the way APRNs are regulated at the state level.” Standardization across states is something other professions could benefit from as well – how frustrating for patients and providers alike that regulations and care can vary widely from one state to another!
In February 2024, South Dakota became the fourth state to join the APRN Compact. However, the AANP and other groups oppose the Compact in its current form, as it would require 2,080 hours of practice hours as a prerequisite and does not include an APRN advisory committee. Perhaps for these reasons, Arizona, Maryland, and Utah, all existing full practice authority states, have considered but not passed legislation enacting the Compact.
How do you think your practice would change if the APRN Compact was implemented? And what drawbacks, if any, do you see from the APRN Compact?
Rise of NP entrepreneurship
Over the past several years, entrepreneurship has become an increasingly popular profession, with healthcare entrepreneurs steadily increasing. Nurse practitioners are pursuing entrepreneurship in greater numbers, many opening their own private practices.
What’s contributing to the increase of NP entrepreneurship?
Single Aim identified a strong link between entrepreneurship and specific state characteristics in the U.S., highlighting that states with lower population densities, greater legal autonomy for NPs, and fewer physicians per capita tend to foster more nurse practitioner-led businesses.
This makes sense. Less people, more NP autonomy, and fewer physicians lends itself to NPs filling a need in healthcare services. Entrepreneurship is a vessel for creativity and this sort of environment is ripe with creativity-driven solutions.
NP entrepreneurship – lay of the land
Montana leads the nation in nurse practitioner entrepreneurship, with 5.2% of NPs establishing and owning their practices. Western states dominate the rankings, with seven out of the top ten, including North Dakota (4.9%), Idaho (4.7%), Oregon (4.5%), and Wyoming (4.3%) rounding out the top 5; all five states offer full practice autonomy for NPs. Additionally, these states have a lower-than-average density of physicians per resident, resulting in unmet medical needs.
Top States for NP Entrepreneurship
Source: SingleAim. (2024). Nurse Practitioner Entrepreneurship Report 2024.
In contrast, states like New York, California, and Illinois, which have larger populations and more restrictive practice environments, report the lowest levels of NP entrepreneurship. Bismarck, North Dakota, stands out as the city with the highest NP entrepreneurship rate, with 10% of its NPs founding businesses.
Among specialties, aesthetics tops the list (20%) for entrepreneurship, followed by primary care (16%) and psychiatry (15%).
States with full practice authority experience nearly double the rate of nurse practitioner entrepreneurship compared to states requiring physician supervision. In fact, in full-practice states, 2.79% of NPs are business owners, while in restricted-practice states, the rate drops to 1.45%.
This suggests that reducing legal barriers could encourage more NPs to become entrepreneurs, which might help ease healthcare shortages. However, balancing autonomy with quality oversight remains an important conversation in the healthcare community.
Impacts of expanding NP entrepreneurship
Expanding NP entrepreneurship can create both opportunities and challenges. On the positive side, nurse practitioners who start their own businesses often help address healthcare shortages, especially in rural and underserved areas.
Additionally, owning a practice allows NPs to structure their work environment, hours, and patient care approach. This flexibility can lead to better work-life balance and job satisfaction. Also, NP entrepreneurs are often providing more tailored care to patients.
NP entrepreneurship isn’t without challenges though. NPs often have significant upfront financial investment for office space, staffing, and insurance. Additionally, in addition to having clinical skills, NP entrepreneurs are required to learn business management skills and learn about marketing, billing, compliance, and human resources – the learning curve can be steep. Lastly, navigating insurance contracts (if you’re taking insurance) and ensuring timely reimbursement can be complex and take time to understand.
Navigating these challenges is do-able however, and as the data shows, more NPs are leaping over these barriers and creating practices that fill an important gap in care in the U.S.
Role of AI in healthcare
One potentially huge change over the past few years is the role artificial intelligence (AI) may have in our society. Whatever your comfort level or awareness is with the technology, AI is already rapidly shifting how we navigate the world, from mundane tasks to groundbreaking innovations.
AI powers online searches, streamlines writing emails and texts, and curates personalized feeds and advertisements through social media algorithms. Self-driving cars are redefining transportation, while AI-driven supply chains enhance global efficiency and resilience. In healthcare, AI accelerates drug development, bringing treatments to patients faster than ever before.
However, challenges loom, such as the rise of fabricated images and videos, which could disrupt political discourse and trust in media. Meanwhile, AI “friends” in customized social networks blur the lines between connection and automation.
But what are the impacts of AI for us nurse practitioners?
One primary way that AI will continue to shape healthcare is how nurse practitioners document. Documentation is one of the most time consuming aspects of our jobs. Continually finding efficiency with charting will allow for more time to engage in patient care activities and catch up on administrative tasks.
Optimizing psychiatric care through AI
While still in the early stages, AI analysis and learning from big data promises an exciting potential to transform healthcare diagnosis & treatment. Massachusetts General Hospital (MGH), a leader in the healthcare landscape, is utilizing digital technologies along with AI to uncover patterns and insights in mental health.
One application of AI is through monitoring depressive symptoms. Researchers at MGH are working on developing new technologies to assess symptoms of depression through wearable devices such as wristbands and smartphone sensors.
The ultimate goal of this work is to create models that can more objectively detect and monitor patient symptoms. Objective data is welcome in psychiatry, where unlike other fields, there is less concrete data to guide practice other than what our patients tell us.
Additional uses of AI in psychiatry involve investing in tools for better psychiatric diagnosis as well as finding ways for psychiatry to become more proactive. Much of what we do in mental health care is reactive where a patient shares a complaint, and we then treat. Predicting or anticipating when problems may occur and then intervening proactively is a much better way to provide care (and likely cheaper in the long term!).
Rise of Stimulant Prescribing
In the fall of 2024, the DEA hosted a series of webinars on ‘The Rise of Stimulant Prescribing’ with a discussion of the growing number of Americans who misuse stimulants.
A few key points highlighted during the webinar:
- Stimulant prescribing is increasing among adults; the increase in prescriptions has little to do with children and adolescents.
- Prescriptions of adult women are rising the fastest.
- Nurse practitioners are responsible for the surge of stimulant medications according to a 2023 report commissioned by the DEA.
- NPs wrote the highest percentage of stimulant prescriptions (23.4%) in 2022 compared to psychiatrists (21.8%) and family practice physicians.
- Furthermore, while the number of stimulant prescriptions dispensed from psychiatry, pediatrics, and family practice have either declined or remained stable, stimulant prescriptions from nurse practitioners have more than tripled since 2012.
Source: “The Rise of Stimulants Prescribing: U.S. trends related to prescription stimulant prescribing from 2012-2022.” DEA Virtual Diversion Awareness Training Sessions. Dec 11, 2024.
As a psychiatric nurse practitioner, I found the webinar interesting but also frustrating at times due to the lack of discussion around the nuances, or context, of the data presented. For example, it’s curious whether the reported increase in NP-written prescriptions (with no differentiation between psychiatric NPs and other NPs) might be linked to the fact that the number of patients seeing NPs has steadily climbed over this period. As mentioned above, this growth in NPs is due to both the lack of adequate physicians to serve the nation’s increasing healthcare needs overall and the lack of any clinicians serving populations in rural settings.
It seemed the DEA, through this webinar, was referencing raw numbers of increased stimulant prescribing by NPs and potentially drawing an incorrect correlation with a rise in stimulant abuse. For instance, it’s possible that as NPs become more frequently the providers giving care, that more patients are being diagnosed and prescribed stimulants. This wouldn’t necessarily be a problem if diagnoses are accurate and prescriptions are paired with appropriate monitoring, such as pill counts and drug screens to reduce the risk of diversion or abuse.
This is a complex issue and while there is abuse with stimulants, there are also patients with ADHD who don’t receive proper treatment, particularly among females where ADHD presents differently. This webinar highlighted that it’s tough to accurately diagnose adult ADHD without official guidelines and why it’s so important to have them. Currently, there are no official guidelines on diagnosing or treating adult ADHD – perhaps that is where energy should be focused.
What are your thoughts on the cause of stimulant abuse and who is responsible? Regardless, it’s helpful to be aware of these trends in stimulant prescribing.
Market saturation among Psychiatric Nurse Practitioners?
One question asked each year by new nurse practitioners entering the field–and seasoned providers in practice–is whether the field is becoming too saturated, for psychiatric nurse practitioners, in particular.
Data from a 2018 HRSA report suggest “the U.S. will have a sufficient supply of psychiatric NPs to meet projected growth in demand for NP services in 2030.” In fact, the report suggests a possible oversupply (between 2,500 and 5,000) of psych NPs, by 2030.
It should be noted, however, this data was collected pre-pandemic, which does not factor in the increased demand for mental health services it precipitated. A 2023 cohort study of insurance claims showed a sustained increase in demand for mental health services that was 39% higher than pre-pandemic levels.
The job market for nurse practitioners is clearly growing – NPs were the third fastest growing occupation in the entire U.S. economy and the fastest growing healthcare profession in 2023 (the latest year of data). This growth is accompanied by a clear demand for services with a reported 29,000 job openings per year for nurse practitioners through 2033; 3,000 more openings projected compared to the previous year.
Fun fact – in 2022, the year prior, NPs were the second fastest growing occupation behind wind turbine service technicians (still #1 for 2023); in 2023 solar installers jumped 15 positions to take the number two spot! This shows a clear trend – many of the fastest growing jobs continue to be related to clean energy and healthcare, with tech jobs rounding out the top ten. Furthermore, among the top ten, the median wage for NPs ($126,260) is third highest, close behind computer and information research scientists and physician assistants.
Source: Office of Occupational Statistics and Employment Projections, U.S. Bureau of Labor Statistics. Employment Projections – Fastest Growing Occupations, 2023. (2024).
Summary for Psychiatric Nurse Practitioners
In 2025, psychiatric nurse practitioners can expect:
- Telehealth flexibility to remain in place through at least December 31, 2025, with continued opportunities for remote psychiatric practice.
- Full practice authority for NPs will continue to gain popularity as more states adopt or consider this legislation as the physician shortage persists and rural populations remain under-served.
- The APRN Compact may gain traction, but its current form faces opposition due to restrictive prerequisites.
- NP entrepreneurship will continue to grow, especially in states with full practice authority and unmet healthcare needs.
- Artificial intelligence will further improve documentation efficiency and support clinical decision-making but won’t fully transform NP roles in 2025.
- Stimulant prescribing trends show NPs leading in prescription volume, emphasizing the need for improved diagnostic guidelines and monitoring protocols.
- Market demand for NPs remains strong despite concerns about potential oversaturation in certain specialties.
The future for psychiatric nurse practitioners and nurse practitioners in general is filled with promise and exciting possibilities. As we look beyond 2025, the profession stands poised to continue its trajectory of growth and innovation. The journey ahead holds countless opportunities to redefine what’s possible in healthcare delivery, and it’s exciting to envision the role NPs will play in this evolution.
