ANA President Barbara Blakeney, MS, RN, CS, ANP, has written a letter in response to an article in the November 2002 issue of Redbook Magazine, ("Advice docs give their own families"), that contains a section warning patients not be "brushed off" onto a nurse practitioiner (NP).
October 18, 2002
Letters
Redbook
224 West 57th St.
New York, NY 10019
Dear Editor:
The American Nurses Association takes exception to the suggestion "Don't let yourself be brushed off onto a nurse practitioner" included in "Advice Docs Give Their Own Families" (November 2002, pg. 64). While we agree that patients should always be able to access their physicians, we are disappointed that the doctors Redbook interviewed chose to make that point by impugning the quality of care delivered by advanced practice registered nurses (APRNs), specifically nurse practitioners (NPs).
APRNs have been providing primary and preventive care to patients for more than 35 years. All APRNs must meet rigorous education, certification and continuing education requirements. Today, there are more than 160,000 APRNs, including 70,000 NPs, in the United States, and research dating back to the mid-1980s demonstrates that in terms of quality of care, patient satisfaction and cost-effectiveness, NPs are among the best values in health care. A 1986 federal government report (Office of Technology Assessment) concluded that APRN care is of equivalent quality to that provided by physicians and that in areas of communication and preventive care, APRNs are more adept than physicians. A 1993 study conducted for the ANA found that NPs deliver primary health care as competently as physicians and provide more health promotion activities, such as patient education, than physicians. The patients of the APRNs reported being more satisfied with their health care provider, complied with their treatment programs and were very knowledgeable about their health status.
More recent research also bears out the high quality of care provided by NPs. A study in the May 2000 issue of the Journal of the American Medical Association concluded that in an ambulatory care setting in which patients were randomly assigned to either nurse practitioners or physicians, patients' outcomes were comparable. In the July 20, 2002, edition of the British Medical Journal, a study found that patients were satisfied with NP care and that no differences in health status existed. In fact, the study indicated that NPs took more time in consultations and used that time to investigate more about the health concern or illness than did doctors, and concluded that increasing availability of NPs in primary care is likely to lead to high levels of patient satisfaction and high quality care.
Both the federal government and Congress have taken action recognizing the high quality of care provided by NPs. In 1998, the Federal Department of Veterans Affairs decided to formally accept NPs without links to physicians. And on Jan. 1 of that year, a federal law went into affect allowing Medicare to reimburse NPs directly in all geographic areas. In communities across the United States, NPs provide care in clinics and other community settings that help reduce the number of emergency room visits and keep frail elderly in their homes. Furthermore, in all 50 states and the District of Columbia, NPs have some authority to write prescriptions for their patients.
Implying that NPs provide a lesser quality of care is a disservice to your many readers who could benefit from the excellent care they provide and from the increased time that NPs spend answering their questions and reviewing their overall health.
