Prescriptive Authority for Nurse Practitioners - page 3

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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 access to insurance and more... Read More


  1. 0
    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.
  2. 0
    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 [COLOR=#000000]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. [/COLOR]
  3. 2
    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.
  4. 0
    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.
  5. 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.
  6. 0
    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.
  7. 2
    Quote from kalevra
    I actually see PAs taking the primary care provider role in the future. In the military my primary care provider was a PA as is are most other Units. We see him or her first for whatever issues we may have. Then if lets say they feel we need a specialist like Oncology then they refers us, and they take it form there. As for pain issues the usual pain meds, physical therapy consult, splints, low duty, sutures, medications etc are all handled by the PA. Regular routine hospital visit stuff anyway.

    I mean the MD primary care provider is based on the medical model. The PA is also based off of the same model, except that they only take 6 years to make. Makes sense to me. Its been a proven system for years. The framework is already there.
    Good morning, Kalevera. First, thank you for your service in the military. We are all in your debt. As a military person, you know that things are done very differently in the military than how they are done in the civilian world, including the way the military uses its medical personnel. I share your respect for PAs; their practice is “a proven system,” as you correctly point out. I have not had any qualms about placing myself or my children in a PA's hands. This is because years of observation have demonstrated that their education is adequate, and that they do refer to physicians when it is in the patient's best interest.

    However, you may have some factual misunderstandings about NPs. NPs also have 6 years of training, including two years of graduate education with clinical training, and many have more. NPs also “issue the usual pain meds, physical therapy consult, splints, low duty, sutures, medications, etc.” I think, from your posts, that you are familiar with the education required to become a PA. You might find answers to some of your questions about NPs by sitting down with one and asking her about her education. I think that you will come away reassured.

    Finally, the practice of NPs is also a proven system. It has been in place for more than 40 years, is recognized in every state, territory, and province of the U.S. and Canada, has matured significantly in terms of the rigor of candidate selection and licensure, and, in numerous outcome studies, NPs have also been shown to provide safe and effective care, just as PAs have.

    Again, my thanks, and my best wishes. You raise worthwhile questions that deserve answers. I hope that I have answered some of those questions, and that others will address more of them.
    Last edit by CountyRat on Jan 9, '13 : Reason: Grammar
    PCURN-BSN and kalevra like this.
  8. 1
    Quote from kalevra
    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.

    Yes, you are correct, Kalevra. Nursing is an autonomous, self-regulating profession. Our scope of practice is always expanding, just as it is for PAs, respiratory therapists, paramedics, and other providers. State and provincial regulatory boards (which consist of nurses, by the way) the facilities that hire us, and others also have a place in defining scope of practice. However, the job of expanding what a profession may provide is the responsibility of the members of that profession.

    As for treating underlying cause, of course that is within the scope of professional nursing. We are not pillow fluffers. We provide professional services that facilitate the patientís recovery of the highest level of health possible, including addressing the cause of their health problem.
    kalevra likes this.
  9. 0
    Quote from CountyRat
    Good morning, Kalevera. First, thank you for your service in the military. We are all in your debt. As a military person, you know that things are done very differently in the military than how they are done in the civilian world, including the way the military uses its medical personnel. I share your respect for PAs; their practice is “a proven system,” as you correctly point out. I have not had any qualms about placing myself or my children in a PA's hands. This is because years of observation have demonstrated that their education is adequate, and that they do refer to physicians when it is in the patient's best interest.

    However, you may have some factual misunderstandings about NPs. NPs also have 6 years of training, including two years of graduate education with clinical training, and many have more. NPs also “issue the usual pain meds, physical therapy consult, splints, low duty, sutures, medications, etc.” I think, from your posts, that you are familiar with the education required to become a PA. You might find answers to some of your questions about NPs by sitting down with one and asking her about her education. I think that you will come away reassured.

    Finally, the practice of NPs is also a proven system. It has been in place for more than 40 years, is recognized in every state, territory, and province of the U.S. and Canada, has matured significantly in terms of the rigor of candidate selection and licensure, and, in numerous outcome studies, NPs have also been shown to provide safe and effective care, just as PAs have.

    Again, my thanks, and my best wishes. You raise worthwhile questions that deserve answers. I hope that I have answered some of those questions, and that others will address more of them.

    I fully understand that both of them NP or PA can provide the required level of care for patients. Their levels of education are adequate to meet the needs of patients. With the passage of the affordable care act, there will be a shortage of PCPs. I just found having NPs and PAs fighting for the same job as redundant.

    It just makes more sense to standardize across the board. My thinking was their would less resistance from the powers that be to make PA the PCP standard. The reason being they are built upon the medical model and so have less legal issues to deal with. As compared to an NP where they tread on a fine line between practicing nursing vs medicine. It is my understanding there were legal ramifications.

    Thank your CountryRat, I hope I get some of these questions answered as well. I think I had inadvertently annoyed a few people on this thread already.
  10. 0
    Who would be the most vocal opponent regarding expanding the prescriptive authority of NPs?


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