Pharmacist, Nurse Practitioner Collaboration Delivers Optimal Care

Pharmacy CareersSpring 2023
Volume 17
Issue 1

For decades, pharmacy schools, residents, and fellows have been training to work alongside physicians, but that has not prepared us for what is coming.

Growth of Nurse Practitioners Prompts Shortage of Registered Nurses

There are more than 350,000 nurse practitioners (NPs) in the United States, with nearly 90% of them being certified in primary care.1 Thanks to a long-term, unwavering march toward independent practice and bolstered by COVID-19, at least 11 states have approved or are in the process of approving independent practices of NPs. The arguments for independence should sound familiar to pharmacists. Namely, a primary care shortage, especially in rural and underserved areas, justifies increasing the number of access points in the health care system.

Pharmacist and nurse practitioner | Image credit: Chinnapong -

Pharmacist and nurse practitioner | Image credit: Chinnapong -

Ironically, the explosion in new NPs will amplify the shortage of registered nurses (RNs), as more RNs choose an NP pathway. During the next decade, NP graduation rates are expected to exceed the number of nursing graduates who do not choose to become practitioners.2

Pharmacists Need to Help Shape Relationship with NPs In Ambulatory Care

Much like pharmacists, family physicians and NPs had a physician-as-supervisor relationship, wherein the physician countersigned orders or mentored proximally.

However, as NPs gain more independence, it raises the question: What is the nature of the working relationship between pharmacists and NPs? Are NPs supervisors of ambulatory care pharmacists? Are they partners? Equals? Are collaborative practice agreements in order? These are all questions that the early-career pharmacist will have to find out—or, better yet, help shape.

Pharmacy Students, Recent Graduates Can Establish Best Practices With NPs

Pharmacy leaders have always said, “Do what’s best for the patient, and eventually it will be best for pharmacists.” Our collective goals as pharmacists are to assist in screening and filling gaps to our superior access and touchpoints with the patient and to optimize the use of patients’ medications. Regardless of the teammate, we are in the service of the patient. No doubt many new models of care and modalities of process will ensue in the next few years. We need visionary pharmacists and primary care providers to help us figure out the most optimal way forward.

Pharmacists and primary care providers deliver most of the care at a fraction of the cost, making both essential to the effectiveness and sustainability of our health care system.

About the Author

Troy Trygstad, PharmD, PhD, MBA, is the executive director of CPESN USA, a clinically integrated network of more than 3500 participating pharmacies. He received his PharmD and MBA degrees from Drake University in Des Moines, Iowa, and a PhD in pharmaceutical outcomes and policy from the University of North Carolina at Chapel Hill. He has recently served on the board of directors for the Pharmacy Quality Alliance and the American Pharmacists Association Foundation.


1. NP fact sheet. American Association of Nurse Practitioners. Updated November 2022. Accessed February 15, 2023.

2. Finnegan J. In just 7 years, the number of nurse practitioners more than doubled. here’s why that’s a problem for hospitals. Fierce Healthcare. February 4, 2020. Accessed February 15, 2023.

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