Thirty-five years of progress: Nurse practitioner presence and practice in United States hospitals

Background: Acute care comprises a significant amount of health care delivery, and demand for hospital care is forecasted to grow. Nurse practitioner (NP) roles evolved from primary care to meet patients' acute care needs. Nurse practitioners increasingly assume inpatient roles. Yet, growth of the acute care NP workforce is not widely described, and this knowledge can inform future workforce growth. Purpose: To describe the growth in the inpatient, acute care NP workforce. Methods: This study used a repeated cross-sectional design to analyze data from the US National Sample Survey of Registered Nurses (1988–2022) and the National Sample Survey of NPs (2012) to describe acute care NP workforce size, demographic, education, and practice characteristics. Descriptive statistical analyses accounted for the complex survey design and weighting and generated national workforce estimates. Results: The acute care NP workforce increased 836% (3,243–30,368 NPs) from 1988 to 2022. Yet, a growing proportion of inpatient NPs are not acute care certified. The workforce became more demographically diverse with advanced education. They also provide care in more wide-ranging clinical practice areas. Conclusion: Over the past 3 decades, a novel acute care NP role evolved into an essential role in inpatient settings. However, there are opportunities to increase the utilization of acute care NPs. Implications: This research highlights growth in the acute care NP workforce and opportunities for acute care NPs to improve access to care in inpatient settings. Educators, employers, and policymakers can support the ongoing integration of acute care NPs in inpatient care.