The Role and Development of the Nurse Practitioner Profession in Israel: A Scoping Review
This scoping review synthesizes evidence from 26 studies to demonstrate that while Nurse Practitioners in Israel have shown positive impacts on patient outcomes and high professional commitment, their full integration is currently hindered by organizational, regulatory, and interprofessional barriers rather than clinical competence.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In healthcare systems around the world, a growing challenge is how to care for an aging population and manage chronic illnesses when there are not enough doctors to go around. To meet this need, many countries have developed a specific type of highly trained nurse called a nurse practitioner. These are not ordinary nurses; they have completed advanced graduate education that allows them to assess patients, diagnose conditions, and prescribe medications, tasks that were once reserved almost exclusively for physicians. The idea is that these professionals can provide care that is just as effective as a doctor's, while expanding access to treatment for more people. However, simply creating a new job title does not guarantee success. Introducing such a role into a complex medical system requires navigating laws, hospital cultures, and the relationships between different types of medical staff.
A recent study from Israel offers a clear look at how this transition happens in the real world. Israel introduced the nurse practitioner role formally in 2013, and since then, the number of these professionals has grown rapidly. Researchers at the University of Haifa and the Ministry of Health decided to take a step back and map out everything that had been learned about this profession over the last decade. They gathered and reviewed twenty-six different scientific studies published between 2013 and 2026. These studies covered various medical fields, including care for the elderly, end-of-life support, surgery, and diabetes management. By bringing all this information together, the team wanted to understand not just if nurse practitioners work, but how they are actually functioning within the Israeli healthcare system, what obstacles they face, and what the results are for the patients they treat.
The review found that the profession has expanded significantly. By 2026, there were 1,139 certified nurse practitioners in Israel, working across sixteen different specialties. This represents a fourfold increase from just a few years prior. Despite this growth, the research shows that the profession is still finding its footing. The studies revealed that while the general public, patients, and even many doctors hold favorable views toward nurse practitioners, there is a significant gap in understanding. Many people, including patients and other nurses, do not fully know what qualifications these practitioners have or exactly what they are allowed to do. This lack of clarity creates confusion, even though the people involved generally support the idea of the role.
One of the most striking findings concerns the daily reality of the nurse practitioners themselves. The researchers discovered that these professionals are highly committed to their work and feel a strong sense of autonomy. However, in practice, they are often unable to use the full range of skills and authority that the law allows them to have. They are not held back by a lack of clinical ability, but rather by organizational and regulatory hurdles. Common barriers include resistance from some physicians who are hesitant to share authority, a lack of clear job descriptions, and a shortage of designated positions within hospitals and clinics. In many cases, the system simply has not caught up to the regulations, leaving these skilled professionals working in a limited capacity.
The emotional toll of this situation is also evident. The studies reported that while nurse practitioners find deep meaning and satisfaction in their work, they also carry a heavy emotional burden. Nearly half of the practitioners surveyed showed signs of elevated depressive symptoms. This distress appears linked to the high-stress nature of their jobs, particularly in fields like palliative care where they are constantly exposed to death and suffering, as well as the frustration of navigating a system that does not fully support their role. Despite these challenges, the practitioners remain optimistic, with the vast majority recommending the career path to other nurses and expecting the profession to continue growing.
When the researchers looked at the actual impact on patients, the results were encouraging. In surgical settings, patients treated by nurse practitioners reported lower levels of anxiety compared to those in units without them. In geriatric care, specifically for patients who had suffered a hip fracture, the introduction of nurse practitioners was associated with better outcomes. These patients were more likely to have surgery quickly, stayed in the hospital for fewer days, and had lower rates of death while in the hospital. They also had fewer readmissions to the emergency room after being discharged. These findings suggest that when nurse practitioners are integrated effectively, they can improve the quality of care and the efficiency of the system.
However, the review also highlighted what is missing from the current knowledge base. Most of the existing studies are snapshots in time or look back at past data; there are very few long-term studies that follow patients or workers over many years. The research is also dominated by descriptions of how the role is being set up, rather than rigorous tests of its long-term economic or health effects. The authors conclude that the main challenges to fully integrating nurse practitioners are not about whether the professionals are competent, but rather about how the healthcare system is organized and regulated. To move forward, the field needs more comprehensive studies that track outcomes over time and examine how these roles affect costs and fairness in healthcare. The experience in Israel serves as a valuable lesson for other countries trying to build similar roles, showing that success depends as much on policy and culture as it does on clinical training.
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