[NRSKarenRN]

Found at www.Kaisernetwork.org June 27th, 2006

Nurse Practitioners Playing Growing Role in Health Care

The number of nurse practitioners -- registered nurses with advanced degrees and training -- in the U.S. has risen from about 30,000 in 1990 to 115,000 today, the AP/Minneapolis Star Tribune reports. Nurse-managed primary care centers have increased to 250 nationwide from a small number 15 years ago. The change is attributed in part to the number of doctors choosing more lucrative specialties rather than primary care. According to the American College of Physicians, third-year residents seeking careers in general internal medicine dropped from 54% in 1998 to 20% in 2005.

Nurse practitioners are becoming more widely accepted by insurers in many states. In all but seven states, they can practice either independently or with limited supervision from doctors. In all states except Georgia, they can prescribe medications with some level of authority, although some states do prohibit them from prescribing narcotics.

Nurse practitioners perform many of the duties of a primary care doctor, such as conducting physical exams and diagnostics; prescribing medications; ordering and interpreting X-rays; and providing family planning services. Nurse practitioners typically have lower fees for office visits than doctors, and a 2000 study in the Journal of the American Medical Association found that patients treated by nurse practitioners receive the same levels of satisfaction and care as patients treated by doctors. However, the American Medical Association's official stance is that nurse practitioners should be under the supervision of physicians at all times.

Dr. Jan Towers, director of health policy for the American Academy of Nurse Practitioners, said, "There is an element within the physician community that gets a little antsy. ... They think it's going to take away revenue and business from them." Towers added, "Really, there's more than enough for everybody" (Loviglio, AP/Minneapolis Star Tribune, 6/25).

GA NP's regs just changed allowing them to prescribe some meds.
Physician collaboration not supervision in most SBON regs. Seeing greater utilization of NP's in Philly area past three years. Many specialist practices using NP to admit patients in hospitals and mange day to day care; NP in most fast track ER's in my area; doing preadmission work-up's and several are managing freestanding clinics.