An Uphill Battle...

            Are we as soon-to-be advanced practice nursing graduates prepared on the doctoral level going to welcomed into the healthcare community because of the increasing shortage in primary healthcare providers throughout the United States or will we be continually fighting against the stigma that we are not adequately trained to provide quality care to our patients?

 

Anyone who keeps up with an advanced practice nursing organization has heard about the continual struggle for NPs to be allowed to practice to the full extent of their training. An article recently published by the New York Times (found here) discussed the worsening shortage of physicians and the looming influx of patients that will gain insurance coverage under Obama’s healthcare law. AANP’s President Angie Golden provided this reply,

 

“Nurse practitioners can play a critical role in addressing the country’s growing physician shortage.

 

With advanced degrees, they are skilled diagnosticians and clinicians who treat acute and chronic illness and prescribe medications.

 

Four decades of research show that nurse practitioners provide high-quality, cost-effective, comprehensive, patient-centered primary health care with excellent outcomes.

 

In a growing number of states, a nurse practitioner can own and operate an autonomous, independent practice, not requiring any physician involvement. But in too many states, antiquated laws prevent us from practicing to the full extent of our advanced education and clinical training.

 

Elected officials in affected states should work to remove these unnecessary barriers. Doing so will instantly increase access to quality health care, improve outcomes and make health care more affordable for all Americans.”

 

Shortly after the publication of the New York Times article, a report was released by the AAFP (found here) stating, “Granting independent practice to nurse practitioners would be creating two classes of care: one run by a physician-led team and one run by less-qualified health professionals. Americans should not be forced into this two-tier scenario. Everyone deserves to be under the care of a doctor.”  While this seems harsh, the report later goes on to state, “The training and certification nurse practitioners receive is appropriate for dealing with patients who need basic preventive care or treatment of straightforward acute illnesses and previously diagnosed, uncomplicated chronic conditions. But patients with complex problems, multiple diagnoses, or difficult management challenges require the expertise of primary care physicians working with a team of health care professionals.”  The report also states that, “Utilizing all health professionals in a team approach will work for the patient and the practice. It is important to recognize that ‘involving nurse practitioners in a practice team and exerting their full capabilities is a promising way to expand primary care workforce.’ ”

 

Following the aforementioned AAFP report, an interesting blog post was written by one of the AAFP board members (found here) discouraging independent practice for NPs. What I found most interesting was the comments posted by other providers. Some of these comments were very anti-NP stating that NPs are trying to kick primary care providers out of practice, drive down their reimbursements, and even calling for a media campaign to “instill fear in the public” about the “reduced training” NPs have. One poster even accused NPs of making more mistakes than physicians which the writer stated caused an “increase in healthcare costs”. However, others were more reasonable noting the research that has been done supporting positive NP outcomes and proposing that NPs and physicians work together for the advancement of healthcare in our country.

 

I hold a fairly moderate view on this issue. It is my feeling that this discussion speaks to NPs knowing their scope of practice, limitations, and when to refer patients to other providers. As a new NP I certainly do not plan to go around telling anyone that I am a physician, that my education compares apples to apples with a physician, that I can provide better care than a physician, that physicians do not play an important role on a patient’s healthcare team, or that I should replace a physician. However, there are things that I feel I am adequately trained and fully capable of doing without the supervision of a physician including wellness exams and screenings, diagnosis and treatment of acute illnesses, and diagnosis and management of non-complex chronic conditions. Although I don’t know what the future will bring, I currently have no intention of practicing 100% independently, without ever getting input from or collaborating with a physician.

 

I know there are a multitude of different opinions out there, even among our fellow DNP students. What are your thoughts? Should NPs practice independently? Does independent NP practice push us beyond our scope of practice?