Petition Obama to remove restrictions on APRN practice! | allnurses

Petition Obama to remove restrictions on APRN practice!

  1. 2 https://petitions.whitehouse.gov/pet...scope/4Z8X6s7C

    Please take a few minutes to create an account and sign the petition!
  2. Visit  chudder profile page

    About chudder

    Joined Apr '06; Posts: 141; Likes: 36.

    40 Comments so far...

  3. Visit  Altra profile page
    5
    Please consider whether the President of the United States has the authority to mandate the actions of the 50 individual state boards of nursing singlehandedly -- as these are the regulatory agencies which determine the scope of individuals holding nursing licenses. Is a petition on www.whitehouse.gov the most effectively targeted vehicle for your efforts to see your views enacted?
    Last edit by Altra on Mar 18, '13
  4. Visit  chudder profile page
    0
    Of course, and good point! Lobbying the executive branch on matters that the President can't directly regulate can still make an important difference, though. e.g. if CMS doesn't pay, then it doesn't matter (as much) what any state says the APRN can or can't do...... or lobbying may have an effect on the President's overall health care message or platform.

    Plus, it's just a signature!
  5. Visit  Esme12 profile page
    0
    Just playing the devils advocate....if it's "just a signature" indicating it's not a big deal.....how effective will this petition really be???

    I think this is just a lot of fluff from the government to allow people to believe that they have a choice and a voice....when nothing is further from the truth.

    Just to note though.....I think with Obama care and the pursuit of cheap...I mean cost effective...... care that this will be the next step to even limit the public access to primary care/internal medicine MD's as they will be treated as a referral for specialty care.

    Which IMHO is not necessarily going to prove to be the best treatment for many Americans.
  6. Visit  Susie2310 profile page
    1
    Those restrictions are there for a good reason. There is a good reason doctors spend many years training to be doctors, and all those years of education and training add up to the ability to provide medical care at a level far beyond that of advanced practice nurses or physician assistants. Advanced practice nurses have their place in the delivery of health care, but not in an unrestricted, independent role. The public deserves to have access at a primary care level to primary care and internal medicine doctors who are trained in managing complex medical conditions. I want no less for my family and myself.
    Last edit by Susie2310 on Mar 20, '13
    justashooter likes this.
  7. Visit  traumaRUs profile page
    0
    A better avenue to facilitate change to APN practice is to become an active member in your state's APN organization.
  8. Visit  chudder profile page
    0
    Quote from Susie2310
    Those restrictions are there for a good reason. This petition is a poor move in my opinion, from the point of view of the quality of medical care the patient receives. There is a good reason doctors spend many years training to be doctors, and all those years of training add up to the ability to provide medical care at a level far beyond that of advanced practice nurses or physician assistants. Advanced practice nurses have their place in the delivery of health care, but not in an unrestricted, independent role. The public deserves to have access to primary care and internal medicine doctors who are trained in managing complex medical conditions. I want no less for my family and for myself.
    Do you have evidence to support your opinions?
  9. Visit  chudder profile page
    1
    Quote from traumaRUs
    A better avenue to facilitate change to APN practice is to become an active member in your state's APN organization.
    Agreed! Thankfully, there is no need to pick one over the other.
    laborer likes this.
  10. Visit  chudder profile page
    0
    Quote from Esme12
    Just playing the devils advocate....if it's "just a signature" indicating it's not a big deal.....how effective will this petition really be???

    I think this is just a lot of fluff from the government to allow people to believe that they have a choice and a voice....when nothing is further from the truth.

    Just to note though.....I think with Obama care and the pursuit of cheap...I mean cost effective...... care that this will be the next step to even limit the public access to primary care/internal medicine MD's as they will be treated as a referral for specialty care.

    Which IMHO is not necessarily going to prove to be the best treatment for many Americans.
    The "just a signature" comment was meant more to deflect criticism of the petition... as if signing the petition takes away from other advocacy efforts. It was not meant to diminish its importance. By the same token, nobody expects a whitehouse.gov petition to change to world... but a multimodal approach does work well in most advocacy efforts.

    value = quality / cost... and I can't speak to any theories about restricting access for primary care physicians.
  11. Visit  Susie2310 profile page
    1
    Please. Of course there is a great difference in the level of education and training medical doctors receive, which translates in to their ability to provide a much higher level of care than advance practice nurses or physician assistants. I am not intending to insult advanced practice nurses, or physician assistants; this is simply a fact. Please look at the number of years of college, medical school, internships, residency, fellowships, specialty training, board certifications etc. that a physician spends in acquiring training before they even begin practicing, and then compare that training to the education and training an advanced practice nurse or physician assistant receives. I will say it again; there is a good reason that advance practice nurses do not practice in an unrestricted independent role. Since advance practice nurses and physician assistants do not practice in an unrestricted role I doubt you will find data that supports their ability to provide the same quality of care as physicians who do practice independently in a primary care role. On a personal note, my family and I receive primary care from an internist and other specialists, and have done for as long as I can remember. My family members with multiple complicated medical conditions need the expertise of an internist. If you are happy to receive your primary medical care from a lesser qualified person, that is your choice, but please don't try to push that on the general public.
    Last edit by Susie2310 on Mar 20, '13
    justashooter likes this.
  12. Visit  chudder profile page
    0
    Quote from Susie2310
    Please. Of course there is a great difference in the level of education and training medical doctors receive, which translates in to their ability to provide a much higher level of care than advance practice nurses or physician assistants. I am not intending to insult advance practice nurses, or physician assistants; this is simply a fact. Please look at the number of years of college, medical school, internships, residency, fellowships, specialty training, board certifications etc. that a physician spends in acquiring training before they even begin practicing, and then compare that training to the education and training an advanced practice nurse or physician assistant receives. I will say it again; there is a good reason that advance practice nurses do not practice in an unrestricted independent role. Since advance practice nurses and physician assistants do not practice in an unrestricted role I doubt you will find data that supports their ability to provide the same quality of care as physicians who do practice independently in a primary care role. On a personal note, my family and I receive primary care from an internist and other specialists, and have done for as long as I can remember. My family members with multiple complicated medical conditions need the expertise of an internist. If you are happy to receive your primary medical care from a lesser qualified person, that is your choice, but please don't try to push that on the general public.
    I need a .gif of Cuba Gooding Jr saying "show me the evidence!"

    Does educational level correlate well with patient outcomes?

    You present "evidence by proclamation" only.

    AFAIK, NPs can practice in independent, unrestricted roles in 18 states. Are their citizens suffering?

    I'm not trying to push NP care on you or your family. Increasing APRN utilization by removing practice restrictions promises to increase access to primary care for all.

    Check out http://www.healthaffairs.org/healthp...hp?brief_id=79

    An excerpt:

    There is a growing body of research demonstrating that patients perceive that receiving primary care and having a usual source of care is more important than who it was that provided these services. Studies comparing the quality of care provided by physicians and nurse practitioners have found that clinical outcomes are similar. For example, a systematic review of 26 studies published since 2000 found that health status, treatment practices, and prescribing behavior were consistent between nurse practitioners and physicians.

    What's more, patients seeing nurse practitioners were also found to have higher levels of satisfaction with their care. Studies found that nurse practitioners do better than physicians on measures related to patient follow up; time spent in consultations; and provision of screening, assessment, and counseling services. The patient-centered nature of nurse practitioner training, which often includes care coordination and sensitivity to the impact on health of social and cultural factors, such as environment and family situation, makes nurse practitioners particularly well prepared for and interested in providing primary care.
  13. Visit  Susie2310 profile page
    0
    Please provide the links to those 26 studies and to the evidence that supports your assertions about clinical outcomes, or reference the source of your information.
  14. Visit  chudder profile page
    0
    I did include the link to the HealthAffairs Health Policy Brief from which I took the quote....

    Here are some more articles to whet your appetite:

    Hatem, M., Sandall, J., Devane, D., et al. “Midwife-led Versus Other Models of Care for Childbearing Women,” Cochrane Database of Systematic Reviews, October 2008, Issue 4. Available at: http://apps.who.int/rhl/reviews/CD004667.pdf.

    Horrocks, S., Anderson, E., and Salisbury, C. “Systematic Review of Whether Nurse Practitioners Working in Primary Care Can Provide Equivalent Care to Doctors,” BMJ, April 6, 2002, Vol. 324, No. 7341, pp. 819-23.

    Jackson, D.J., Lang, J.M., Swartz, W.H., et al. “Outcomes, Safety, and Resource Utilization in a Collaborative Care Birth Center Program Compared with Traditional Physician-Based Perinatal Care,” American Journal of Public Health, June 2003, Vol. 93, No. 6, pp. 999-1006.

    Laurant, M.G., Hermens, R.P., Braspenning, J.C., et al. “An Overview of Patients’ Preference for, and Satisfaction with, Care Provided by General Practitioners and Nurse Practitioners,” Journal of Clinical Nursing, October 2008, Vol. 17, Issue 20, pp. 2690-698.

    Lenz, E.R., Mundinger, M.O., Kane, R.L., et al. “Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians: Two-Year Follow-Up,” Medical Care Research and Review, September 2004, Vol. 61, No. 3, pp. 332-51.

    MacDorman, M.F. and Singh, G.K. “Midwifery Care, Social and Medical Risk Factors, and Birth Outcomes in the USA,” Journal of Epidemiology and Community Health, May 1998, Vol. 52, No. 5, pp. 310-17.

    Mundinger, M.O., Kane, R.L., Lenz, E.R., et al. “Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians,” Journal of the American Medical Association, January 5, 2000, Vol. 283, No. 1, pp. 59-68.

    Naylor, M.D. and Kurtzman, E.T. “The Role of Nurse Practitioners in Reinventing Primary Care,” Health Affairs, May 2010, Vol. 29, No. 5, pp. 893-99.

    Needleman, J. and Minnick, A.F. “Anesthesia Provider Model, Hospital Resources, and Maternal Outcomes,” Health Services Research, April 2009, Vol. 44, No. 2, pp. 464-82.

    Pine, M., Holt, K.D., and Lou, Y. “Surgical mortality and Type of Anesthesia Provider,” American Association of Nurse Anesthetists Journal, Vol. 71, No. 2, pp. 109-16.

    Silber, J.H. “Anesthesiologist Direction and Patient Oucomes,” Leonard Davis Institute of Health Economics Issue Brief, October 2000, Vol. 6, No. 2.

    Wilson, I.B., Landon, B.E., Hirschhorn, L.R., et al. “Quality of HIV Care Provided by Nurse Practitioners, Physician Assistants, and Physicians,” Annals of Internal Medicine, November 15, 2005, Vol. 143, No. 10, pp. 729-36.


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