A report released Tuesday may give nurses with advanced degrees a potent weapon in their perennial battle to get the authority to practice without a doctor’s oversight.
The report, released by the Institute of Medicine and sponsored by the Robert Wood Johnson Foundation, says nurses should take on a larger and more independent role in providing health care in America, something many doctors have repeatedly opposed, citing potential safety concerns. It calls for states and the federal government to remove barriers that restrict what care advanced practice nurses ”” those with a master’s degree ”” provide.
The report calls for elimination of “regulatory and institutional obstacles” including limits on nurses “scope of practice” ”” which are state rules about what care people who are not physicians can provide.
So, why do we have doctors?
I am not against nurse practicioners (NPs) practicing under the supervision of doctors, but, and its a very very big “but,” NPs are NOT doctors.
Does anyone see a problem here?
I temper my above with marks with a testimonial to the fine medical treatment that I hasve received from NPs.
A good friend of mine, who is a physician’s assistant, not dissimilar to an NP, was quite emphatic in telling me that he was not a substitute for a doctor.
A Nurse Practitioner has a VERY specific scope of practice. A Medical Doctor (MD) has a VERY specific scope of practice. They are NOT the same but DO complement each other. An NP does NOT do major surgery. An MD does not make up a nursing care plan.
But NPs can provide a large range of care modalities to complement the role of the MD in the big health care picture.
Just as a civil engineer does NOT do mechanical engineering nor does a mechanical engineer do electrical engineering.
I am a nurse practitioner and I do have a problem with this.
They want independent practice, huh? Ok, let them have it. Once there are a slew of patient deaths, it will revert to the way it was.
Very sad, but when JFK Jr. spiraled his plane into Nantucket Sound, a friend of mine who is a solid, instrument-rated aviator said, “One should not be flying under conditions for which one is not qualified”.
Yup.
Whilst nurses, also, are getting too big for their britches, the real role of a physician extender will be filled by the PA’s–if I were y’all, I’d go to one of them anyway–their education is better, and they are ALWAYS overseen by a physician; it’s the definition of their role.
I’m but one opinion, but if I wanted to practice independently, I’d work to get into medical school. If you must choose other roles because you can’t GET INTO medical school, then maybe you shouldn’t be practicing independently.
‘Nuff said.
Two comments:
First, nurse practitioners are limiting supply of incoming into their field by requiring them to get a “doctorate of nursing”. All those already practicing will be conveniently grandfathered in. Should we, as a society, have a say in whether this is a good idea and helpful?
Second, the expansion of nurse practitioners scope of practice will kill primary care. Why bust your butt to get into medical school, defer your income, go into primary care and then get paid the same as a NP? Medical students see that the making NP PCPs equivalent to MD PCPs will drive down salaries. Why do it? They won’t.
I am NOT saying that NPs and PAs aren’t vital to solving today’s and tomorrow’s health care problems. They are. But it seems that unintended consequences can make the matter much worse.
What’s dumb is that a “doctorate of nursing” is not the same thing as “medical doctor”. Nursing PhD’s are taught to be profs and theorists. Frankly, primary care-wise, you might get more out of your NP with a lowly master’s, and even she/he is not taught to be independent. Drop him/her into the middle of rural Montana and see how long they last with no physician around. Plus, how many medical problems would they not be able to handle that they would have to refer? The whole thing, to me, seems imprudent and not cost-effective to begin with.
Bookworm,
How many patient deaths are attributed to nurse practitioners?
Would you care to clarify, Dr. Joan? Do you mean nurse practitioners who are working under a practice agreement with a physician, such that the latter would take the statistical(or otherwise) hits for the deaths?
You said there would likely be “a slew of patient deaths” if nurse practitioners practiced independently. There are now such NPs, right? So my question stands: How many patient deaths are attributed to (independent) nurse practitioners?
I truly don’t consider statistics like that accurate or definable. And, I’m sure you’re capable of looking them up yourself. Death can be from things chronic that may or may not result from one’s care. If a patient dies, e.g., from longstanding hypertension, is there a way to truly know whether or not more aggressive medical management by a physician, vis-a-vis a nurse practitioner, would have saved the patient or bought him/her more time? No.
My work has included medical supervision by multiple anesthesia departments–luckily even the CRNA’s are taught from a medical model. Like PAs the role of NPs was created as a “physician extender”, not an independent physician. IMHO, it should stay that way. Permission granted to disagree.
Bookworm-
I do disagree. I don’t see NPs as “substitutes” but as an adjunct to the physician. Not every patient NEEDS an MD. Some can surely be treated–WELL–by NPs and even PAs.
By the way, YOU were the one who suggested that we might see additional deaths if NPs were given “independent practice”–see #3.