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?
Wow, this was an excellent post, Becky, and I'm so glad you brought up such a relevant conversation for us to hold. I am in a little bit of a different position for 2 reasons:
ReplyDelete1) I'm in psych, where many NPs work independently and don't seem to have much push-back from psychiatrists (at least that has been my experience).
2) I plan on returning to California after graduation, where I will be required to work under a physician's supervision (very loosely).
I personally am okay working alongside a psychiatrist, mainly because I have always known that is what I would be in for. That being said, I hope to develop a trusting and collaborative relationship with a psychiatrist who will offer me the autonomy I deserve. But I also agree with what you shared above, in that NPs are completely qualified to care for uncomplicated cases. The same is true in psychiatry. And when we receive a case that we believe is too complicated, we refer out to a psychiatrist. I believe as NPs, we should be trusted to know when to refer out to an MD, just as primary care providers are entrusted with the ability to refer out to specialists as needed.