Prescriptive Authority for Nurse Practitioners - page 2

The passage of the Affordable Care Act (ACA) will provide many more Americans access to health care. The ACA will reduce the cost of receiving health care, while also enabling uninsured Americans... Read More

  1. Visit  harmonizer profile page
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    deleted
    Last edit by harmonizer on Jan 6, '13
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  3. Visit  kalevra profile page
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    Quote from lazer31285

    The Association of American Medical Colleges estimates a shortage of 46,000 primary care physicians by the year 2025 (Rouston, 2010). Nurse Practitioners can easily step into the role of primary care.

    There are currently 150,000 nurse practitioners in the United States, and 5,500 practitioners graduate every year (Rouston, 2010).

    Nurse practitioners are more cost-effective than physicians, while continuing to provide the same quality of care. Time and time again, patient satisfaction and respect for nurse practitioners is extraordinary. The appropriate action for state legislatures is to remove prescriptive restrictions permitting nurse practitioners to provide the care they were trained to provide.
    So because of the Affordable Care Act we will have a shortage of primary care physicians estimated at roughly 46,000. The idea is to increase the Nurse Practitioners scope of practice to better handle the massive shortage. The prescriptive authority of the Nurse Practitioner would be the primary focus as. We reorganize and reallocate the 150,000 plus 5,500 graduates yearly to better fill the need.



    It is a brilliant idea to reallocate the NPs to an area with a deficit in man power. Makes absolutely perfect sense to do so.

    However, there is an alternative route. Rather than change the scope of practice in several states in the US, society can just reallocate Physicians Assistants to fill the 46,000 expected deficit. According to the Bureau of Labor ans Statistics there are currently 83,600 PAs from the last census. There are also more graduating every year.

    From a practical stand point I do not see the need to advance the scope of practice for NPs when the alternative will work just as well without any extra work. There is no legal issues about practicing nursing vs practicing medicine. PAs work form the same medical model as MDs so prescription are easily carried out. You pay them significantly less than an MD so they are very cost effective.

    My question is why go through the state to state battle to enhance the NPs scope of practice when there is a viable alternative that also fills the 46,000 deficit?

    This is an honest question and not being sarcastic.
    Last edit by kalevra on Jan 7, '13 : Reason: addition
  4. Visit  juan de la cruz profile page
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    Quote from kalevra
    So because of the Affordable Care Act we will have a shortage of primary care physicians estimated at roughly 46,000. The idea is to increase the Nurse Practitioners scope of practice to better handle the massive shortage. The prescriptive authority of the Nurse Practitioner would be the primary focus as. We reorganize and reallocate the 150,000 plus 5,500 graduates yearly to better fill the need.



    It is a brilliant idea to reallocate the NPs to an area with a deficit in man power. Makes absolutely perfect sense to do so.

    However, there is an alternative route. Rather than change the scope of practice in several states in the US, society can just reallocate Physicians Assistants to fill the 46,000 expected deficit. According to the Bureau of Labor ans Statistics there are currently 83,600 PAs from the last census. There are also more graduating every year.

    From a practical stand point I do not see the need to advance the scope of practice for NPs when the alternative will work just as well without any extra work. There is no legal issues about practicing nursing vs practicing medicine. PAs work form the same medical model as MDs so prescription are easily carried out. You pay them significantly less than an MD so they are very cost effective.

    My question is why go through the state to state battle to enhance the NPs scope of practice when there is a viable alternative that also fills the 46,000 deficit?

    This is an honest question and not being sarcastic.
    This is exactly why I stated on my previous post about putting the article in perspective. NP's and PA's ARE practicing primary care now in all the 50 states. Scope of practice restrictions aside, federal law allows for NP's and PA's to see their own panel of patients and be reimbursed as long as provisions for collaboration or supervision is in place in states that require them. The article is about prescriptive authority. Both professions prescribe medications in all 50 states except for controlled substances in some states. The OP is in Florida where both PA's and NP's are not allowed to write prescriptions for any controlled substance. Does that make sense at all for PA's and NP's to be able to write any other medication that has just as many deleterious effect on a patient and not be able to write for controlled substances? You decide.
  5. Visit  kalevra profile page
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    Specifically, when do they begin to practice medicine and not nursing? Lets say the NPs and PAs get what they asked for. They get prescriptive authority as requested in all 50 states. Now at what point would the NPs be practicing medicine and not nursing. I am interested in how that would be handled on a court room debate level.

    I still see the PAs with an edge over the NPs regarding their practice. Only is reason being is that as nurses you can get sued for practicing medicine. Where as PAs are are built on the medical model so there is less resistance there.
  6. Visit  elkpark profile page
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    Quote from kalevra
    Specifically, when do they begin to practice medicine and not nursing?
    As long as NPs and other advanced practice nurses are practicing within their scope of practice established by the state in which they're practicing, they are practicing nursing, not medicine.
    myelin and Psychcns like this.
  7. Visit  Psychcns profile page
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    My understanding is that medicine got control of everything related to health care a long time ago in every state and made it illegal for any other professions to practice anything related to medicine or surgery. All non MD's have had to have laws enacted so they can have a profession--and the support of MD's are needed to pass any health care legislation!!
  8. Visit  BostonFNP profile page
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    Quote from kalevra

    So because of the Affordable Care Act we will have a shortage of primary care physicians estimated at roughly 46,000. The idea is to increase the Nurse Practitioners scope of practice to better handle the massive shortage. The prescriptive authority of the Nurse Practitioner would be the primary focus as. We reorganize and reallocate the 150,000 plus 5,500 graduates yearly to better fill the need.

    It is a brilliant idea to reallocate the NPs to an area with a deficit in man power. Makes absolutely perfect sense to do so.

    However, there is an alternative route. Rather than change the scope of practice in several states in the US, society can just reallocate Physicians Assistants to fill the 46,000 expected deficit. According to the Bureau of Labor ans Statistics there are currently 83,600 PAs from the last census. There are also more graduating every year.

    From a practical stand point I do not see the need to advance the scope of practice for NPs when the alternative will work just as well without any extra work. There is no legal issues about practicing nursing vs practicing medicine. PAs work form the same medical model as MDs so prescription are easily carried out. You pay them significantly less than an MD so they are very cost effective.

    My question is why go through the state to state battle to enhance the NPs scope of practice when there is a viable alternative that also fills the 46,000 deficit?

    This is an honest question and not being sarcastic.
    PAs require a MD supervisor and are not individually licensed, so how does moving them address the shortage of PCPs in rural areas if a MD must move with them, and there is an increasing deficit of PCP physicians.
  9. Visit  kalevra profile page
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    Quote from elkpark
    As long as NPs and other advanced practice nurses are practicing within their scope of practice established by the state in which they're practicing, they are practicing nursing, not medicine.
    OK so if you advance the prescriptive authority of an NP so that it in their scope of practice, then they will still be practicing nursing. Even though they are treating the underlying cause and not the symptom.
  10. Visit  kalevra profile page
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    Quote from BostonFNP
    PAs require a MD supervisor and are not individually licensed, so how does moving them address the shortage of PCPs in rural areas if a MD must move with them, and there is an increasing deficit of PCP physicians.
    The reason I bring them up is two fold.

    First is that there are legal issues regarding practiced medicine vs practicing nursing. I thought there was a fine line that an NP was treading.

    Second is that PAs were designed from the round up as PCPs during the 1960s by [FONT=verdana, arial, helvetica, sans-serif]Dr. Eugene Stead at Duke University in NC. Their very existence was due to a need of primary care physicians. The idea wad to use them as "combat multipliers". In essence thought they do practice with physician supervision, they have enough autonomy to treat the run of the mill complaints on their level. In other words the Physicians is not looking over your shoulder as you practice, you work as their agent. In essance as long as you have a direct line of communication with them such as a phone, your good to go. PAs are licensed with extensive education.
  11. Visit  BostonFNP profile page
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    Quote from kalevra

    The reason I bring them up is two fold.

    First is that there are legal issues regarding practiced medicine vs practicing nursing. I thought there was a fine line that an NP was treading.

    Second is that PAs were designed from the round up as PCPs during the 1960s by Dr. Eugene Stead at Duke University in NC. Their very existence was due to a need of primary care physicians. The idea wad to use them as "combat multipliers". In essence thought they do practice with physician supervision, they have enough autonomy to treat the run of the mill complaints on their level. In other words the Physicians is not looking over your shoulder as you practice, you work as their agent. In essance as long as you have a direct line of communication with them such as a phone, your good to go. PAs are licensed with extensive education.
    I don't argue that many PAs can/do/could function autonomously with minimal supervision from a physician; this is no different for NPs that function in the same capacity (my practice employs a physician to review charts once per month because our state requires that - even the physician jokes about how it's the easiest money he could imagine making).

    You mention that PAs were designed to be PCPs. Have PAs ever been educated and licensed to be independent practitioners? I don't doubt that they could be, but to my knowledge, they never have been.

    It's not my argument that PAs can't function as independent PCPs, I believe they can, simply that they are at no advantage over NPs. NPs have been educated as independent practitioners. And NPs have functioned in this capacity in many states with good outcomes.
    elkpark and kalevra like this.
  12. Visit  kalevra profile page
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    Why is it so important that the PCP (in this case NP or PA), be an independent practitioner?

    As a PCP you deal with run of the mill problems that the patient comes to you with in your office. Then if their problem requires a specialist, you are going to refer them to someone else anyway. Your not running an ER with GSW coming in at 3 am. My PCP keeps regular hours.

    I'm not trying to be offensive to anyone , I am actually curios about this topic.
  13. Visit  BostonFNP profile page
    3
    Quote from kalevra
    Why is it so important that the PCP (in this case NP or PA), be an independent practitioner?

    As a PCP you deal with run of the mill problems that the patient comes to you with in your office. Then if their problem requires a specialist, you are going to refer them to someone else anyway. Your not running an ER with GSW coming in at 3 am. My PCP keeps regular hours.

    I'm not trying to be offensive to anyone , I am actually curios about this topic.
    Do you work as a PCP? If you don't, it is very difficult to truly appreciate the workflow in primary care, especially rural primary care. In rural practice (and even non-rural) there is limited (timely) access to specialists (and even diagnostics); you must be prepared to handle every situation, you are very much an independent practitioner.
    coast2coast, BCgradnurse, and kalevra like this.
  14. Visit  kalevra profile page
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    Quote from BostonFNP
    Do you work as a PCP? If you don't, it is very difficult to truly appreciate the workflow in primary care, especially rural primary care. In rural practice (and even non-rural) there is limited (timely) access to specialists (and even diagnostics); you must be prepared to handle every situation, you are very much an independent practitioner.
    Of course I am not a PCP. If I were, I would not be asking question so that I could better understand the situation.

    So what happens in rural areas when an NP decides a specialist or specific diagnostic test is required?

    What do you mean by handle any situation?

    What would you do in a rural setting for a patient that has had a traumatic amputation on a farm? I am assuming they would be sent to a specialist at this point. Please correct me if I am wrong.

    Im just interested on how things work in real world practice.


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