Nurse Practitioners Fight for More Independence

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Physicians are resisting legislation that is geared towards allowing advance practice registered nurses (APRNs) like nurse practitioners to practice independently. This has been proposed as a solution to the problem of increasing health care costs.

The main objection stated by physicians has been that while they understand that NPs have an important role, NPs simply don’t have enough medical training to practice and prescribe medication independently of a supervising physician.

In this article on the Healthcare Finance News site, the president of the American Academy of Family Physicians, Glen Stream, states that family physicians complete between 7 and 20 times more clinical training than nurse practitioners, and that substituting NPs for physicians is a “disservice to patients.”

Nurse practitioners will be the first ones to say that they are not doctors nor are they doctor replacements, however, they say, they offer high-quality care and high patient satisfaction at lower costs.

“NPs are nurses first and foremost,” said Deonne Benedict, a nurse practitioner who owns Charis Family Clinic in Edmonds, Wash., one of a handful of states that allow NPs to practice and prescribe independently.

“Physicians seem to be making the same arguments they made historically against osteopaths, optometrists, chiropractors and others,” said Benedict. “The fact is that we have a strong body of evidence with hundreds of studies showing that NPs provide excellent care, with high patient satisfaction and quality care outcomes.

We are educated differently, from a nursing perspective, but we are highly educated.” And like their physician colleagues, Benedict noted, NPs know when it’s appropriate to refer.

“What are the issues around allowing APNs to practice independently?” said Janet Selway, DNSc, ANP-BC, director of the adult gerontology nurse practitioner program and assistant professor at the Catholic University of America’s nursing school. “Two words: fear and misunderstanding.

“Some of our colleagues in medicine fear that NPs are trying to be physician replacements. Rather, we highly value our nursing background and believe that our unique nursing perspective benefits the patient.

Both disciplines should focus on the patient and avoid getting bogged down in fighting over an outdated captain of the ship view.”

While the medical training argument won out in Texas last year, physician groups like the AAFP may find themselves fighting an uphill battle that ultimately comes down to money. As state governments continue to feel the pressure to rein in healthcare costs, the argument that NPs can offer high quality care at lower costs is bound to get attention.

Also adding weight to the arguments of NPs is a report issued in the fall of 2010 by the widely-regarded Institute of Medicine. In “The Future of Nursing: Leading Change, Advancing Health” the IOM recommends eliminating scope of practice barriers and the expansion of the Medicare program to include coverage of advanced practice nursing services.

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