In Support of Independent NP Practice - page 9

by juan de la cruz Guide

12,966 Views | 98 Comments

Resources from Bridging the Provider Gap: From the National Governors Association: - looks like state governors are in favor of practice independence for NP's AANP Map of Practice Environments Across States, 2013 ... Read More


  1. 0
    If there were data that showed NPs were inferior MDs would have no problem keeping NPs from practicing (not that they have a hard time restricting practice now). Opposition to NP practice comes from two places: MDs wanting to protect their turf, and uneducated / irrational people (no offense and I'm not pointing fingers). Obviously MDs have "more" education in terms of credit hour and academic study and that should, in theory, equal a more competent provider. But, there is no data to show that. I think we should find out why there isn't a difference OR actually provide evidence that NPs are somehow quantitatively inferior (other than saying they have less education).

    I can understand MDs concerns, Imagine how we would feel if MAs wanted licensure and wanted to practice the same as nurses. With a little more formal education it wouldn't be out of the question. The big difference is that there isn't a nursing shortage as much as there is going to be a primary care shortage.
  2. 1
    We shouldn't give in as readily on the more education argument. Longer training yes - more education maybe. Lots of foreign MDs in the US went straight to med school from high school (yes it is true!). Like nurses, US trained docs have bachelors degrees and while prerequisites are tougher for medical school, they don't have the hands on that we did in nursing school as undergrads. The prereqs are tougher but not impossible - I know cuz I took them. Medical School is 2 years didactic, 2 years clinical. Residency varies but is hands on. In nursing we have a Bachelors in nursing specifically. NP school builds on our assumed nursing undergrad education and nursing experience with additional coursework in advanced pathophysiology, advance pharmacology, advanced assessment, etc. Unfortunately we do waste time with useless theory courses. The biggest problem I see in NP program is the lack of consistency. Some programs are very strong - others not so much. This situation is similar to that of medical education prior to the Flexner report. Changes will occur over time I'm sure as advanced practice nursing evolves.

    I think one of the great advantages of nursing education is that it prevents you from getting too cocky and thinking you know everything - which is what gets docs in trouble as we have all seen far too many times in far too many settings...NPs are far more willing to ask for help!

    In the meantime, we seem to be doing a heckuva job!
    SycamoreGuy likes this.
  3. 0
    Quote from TheOldGuy
    We shouldn't give in as readily on the more education argument. Longer training yes - more education maybe. Lots of foreign MDs in the US went straight to med school from high school (yes it is true!). Like nurses, US trained docs have bachelors degrees and while prerequisites are tougher for medical school, they don't have the hands on that we did in nursing school as undergrads. The prereqs are tougher but not impossible - I know cuz I took them. Medical School is 2 years didactic, 2 years clinical. Residency varies but is hands on. In nursing we have a Bachelors in nursing specifically. NP school builds on our assumed nursing undergrad education and nursing experience with additional coursework in advanced pathophysiology, advance pharmacology, advanced assessment, etc. Unfortunately we do waste time with useless theory courses. The biggest problem I see in NP program is the lack of consistency. Some programs are very strong - others not so much. This situation is similar to that of medical education prior to the Flexner report. Changes will occur over time I'm sure as advanced practice nursing evolves.

    I think one of the great advantages of nursing education is that it prevents you from getting too cocky and thinking you know everything - which is what gets docs in trouble as we have all seen far too many times in far too many settings...NPs are far more willing to ask for help!

    In the meantime, we seem to be doing a heckuva job!
    I agree.
  4. 0
    Samadams8,

    Are you an NP?

    Quote from samadams8
    Last first. I already addressed this. It seems silly to repeat it.

    Other pieces:

    I'd ask anyone to argue that midlevels and physicians go more into suburban and urban areas for practice, in general, than in the very rural areas. This is where the crises is, and it refects on BOTH disciplines that there is less than what is barely needed in those areas.

    Back to first reply to yours. . .

    Getting the foot in the door with with regard to societal necessity in the areas no one else wanted to go to. After than, once you got the education INDUSTRY involved, they saw opportunity to make money in openning up these programs. They were all for them $$$$. But these are the same people that are OK with nurses with less than five years solid clinical experience in acute or critical care going into their NP and other advanced practice programs. If stronger clinical hour and residency requirements were in place, perhaps, it would not matter so much. But any yahoo with a BSN can go right into these programs, and the clinical hours with proper evaluation are just not there IMHO. I still think it's a good idea, regardless, to have solid physicians overseeing things. NPs and PAs are practicing medicine. There's no reason to dance around it. It is what it is. Now, as I said, for things like writing letters of medical necessity for home care, no. A NP practitioner should not have to jump through hoops with a physician for that. Come on. That's common sense, and evaluating that falls perfectly under nursing domain in any universe.

    Personally, I like the idea of NPs and physicians functioning as a team. Systems of checks and balances can be very good things. Even a non-advanced practice nurse has means of circumventing a poor medical decision from a physician many times--if she is a true advocate and has some gonads. Sure, he or she may risk getting peeved at or even losing their job for doing what's in the best interest of the patient--by getting another physician or advanced practioner involved. But that's called integrity, and doing the right thing and having integrity means in real life that you may have to pay a price. Many of us have been their and done that, and we have peace in knowing we did what was right for the patient--or in some cases, even the family. I don't care what level clinician you are. I don't have a lot of respect for those that are so fearful of their jobs or losing their careers, that they would compromise what is in the best interst of the patient or family unit. That's me. Those are the rules I live by, and after a number of decades, I never question those decisions, b/c I know they were right for the patients. I like to sleep with a clear conscience.





    Your last point. Yes, these are forms of practicing medicine that these other disiciplines have entered into. As I said. It is what it is. You can see why physicians are concerned. They should be--for themselves, their profession, and for patients. Sadly, IMHO, they have to accept responsibility for this. If they had been about the business of providing care in all areas of need, this would not have happened. Once you allow one group to move the line, other groups will follow, and have followed.
  5. 0
    Really? Why not? LOL

    Are you an np?
    Quote from reddgirl
    Oh I totally agree! I wouldn't dare think of going independent as a new NP and quite frankly not after multiple years of experience! That would totally be a bad recipe for disaster.
  6. 0
    OK, so you are not an NP. So you really have NO CLUE at all what you are talking about. You are talking from a perspective that does not have the education to make informed decisions about NP practice.

    Most of your posts are drama with no science to back them up. You have been repeatedly asked to supply proof. All you give us is your opinions. Sorry, you can repeat them over and over but that does not make them the truth.

    Quote from samadams8
    "It is plain presumptive to say that having a physician on board will strengthen nurse-managed health centers' outreach to the community. Many NMHC's serve a population that has been marginalized and could care less if a physician shows up to provide their care. Physician presence in those places serve as a token reminder of the need for a piece of paper signed as a collaborative agreement in states where it is required, nothing more nothing less."

    OK, WOW, now that is presumptive. And the comment only supports my position that you sought to contradict. That's kind of sad, and it backs up this whole "I'm the receiver making the touch down, and the other players are secondary" mentality. It's a political agenda, and there is already enough "Every discipline for himself/herself" in healthcare. People are right about one thing though; the patients pay the price.

    Absolutely getting physicians on board is vital. That you can't see this though, without somehow feeling emotionally abraised, is striking and supports another previous point I made in this thread.

    People have lost sight of the fact that it's not supposed to be all about the clinician. It's supposed to be about the patients and society as a whole.

    It doesn't matter to me if you want to downplay the importance of physicians in healthcare practice. At it doesn't matter to me if some cannot get passed the absolute reality that healthcare includes medicine, and advanced practice nurses or PAs, etc, practice on one level or another, look out, yes, medicine.

    Look, I remember that you made an intelligent response to a condition and physiological response to something a few weeks back. Dude, it was flat out excellent. And to be completely honest, my colleagues and I in critical care, at least in the units we were/are working in, were/are thinking upon the science in the very same way. We were/are experienced critical care nurses who delve/d deeper. We were not advanced practice nurses. But it doesn't matter; b/c when were thinking and approaching things in that way, we were thinking like medicine. Now, of course legally, we had to go through the proper channels for treatment purposes, but most of the physicians respected us for thinking on that level--and they even came/have come to expect it from certain of us. The point is, in thinking that way and then acting upon that thinking process and approach, with the appropriate data in hand, it moved beyond the nursing process. It involved, at its core, medicine. Now,we weren't practicing medicine, b/c we went through appropriate physician channels for the necessary orders. There can often me this fine line. When you move into advanced practice nursing, now, you are not only expected to think like this, you are expected to intervene in such a way that in actuality is medical practice.

    The story can't stop there. Here's why. Regardless, it's not the same thing as going through the whole process of medical education, residency, and possibly a fellowship--not even close in terms of clinical experience and exposure--not close in terms of depth of education--not close in the many hoops and vetting processes required to become a physician and regulary practice medicine.



    I am not interested in trying to change your mind. The probability is that rather than stepping back and looking at this thing from another perspective--a bigger perspective, you have decided that you are on "Team NP." And that's fine! Go team! But it doesn't change the nature of what someone is doing at their core level, even if their profession's over approach, philosophy, and theories are different. At the end of the day, many of advanced practiced functions are,in reality, medicine, only at a more fundamental level. Sure there are differences, but such functions in most settings involve medical knowledge and practice. It's impossible to get around that core reality.


    I say, with regard to the whole situation, it will play out with the many current and forthcoming changes in healthcare, and we will see where it goes.

    I say, it depends on the patient, his/her whole history, as well as her/his current condition, which may well direct the client as to which practitioner to see. I also say that medicine needs to do a better job at filling those rural healthcare needs.

    BTW, I am not telling people who to see or who to not see. I believe in freedom, and at the end of the day, I don't really care, except as it pertains to my health and wellness and that of my loved ones, based on their/my particular needs. I say this, b/c people have choices, so let them choose.

    I'm currently not politically active on either side of this on-going debate. The biggest thing I have to say with regard to advanced practice nursing is that these programs should not allow entry of those with < five years strong, clinical experience, preferrably in acute or critical care--and preferrably in strong and diverse settings. Either that, or they need to dramatically increase praticums and residency requirements. If I had any say in how things were run on this end of nursing, that is where I would start.


    Other than that, no. I am not losing sleep over this.
  7. 6
    https://www.nursingeconomics.net/ce/2013/article3001021.pdf
    August 2011 -- A metaanalysis just released inNursing Economic$stretching over 18 years compared care provided by advanced practice registered nurses (APRNs) to care provided by physicians. Care was compared in 24 different categories.
    APRNs performed equal to physicians in 13 categories.
    APRNs performedbetter thanphysicians in 11 categories.
    Physicians performed better than APRNs in zero categories.
    The categories in which APRNs outperformed physicians:
    For Nurse Practitioners:
    lower blood sugar levels
    lower serum lipid levels
    For Certified Nurse Midwives:
    lower C-section rates
    fewer epidurals
    less analgesia
    better breastfeeding rates
    more VBACs (vaginal births after delivery)
    fewer NICU admissions
    fewer episiotomies
    fewer perineal lacerations after delivery
    lower rate of labor induction and augmentation
    Clinical Nurse Specialist (CNS) augmented care was measured in 4 categories and found it provided:
    fewer complications
    lower cost care
    shorter length of stay
    Study authors included Robin P. Newhouse, Julie Stanik-Hutt, Kathleen M. White, Meg Johantgen,
    Eric B. Bass, George Zangaro and Lily Fountain, Donald M. Steinwachs, Lou Heindel, Jonathan P. Weiner.
    See the full study...

    APRN care is better. International Meta-anlysis
    Alba DiCenso, RN, PhD, Research comparing care provided by APRNs to that of physicians. 468 papers reviewed (all Canadian papers of any type or date) and international review papers 2003-2008.
    ACNPs (Acute Care Nurse Practitioners) (18 Randomized Control Trials)
    US: 10, UK: 6; AU: 1, CA: 1

    Health Status Quality
    of Life
    Quality
    of Care
    Patient Satisfaction Provider Satisfaction Cost Length of Stay
    Improvement 5 0 0 5 1 2 2
    Decline 0 0 0 0 0 0 1
    No difference 7 1 7 2 1 2 2

    PHCNPs (Primary Health Care Nurse Practitioners) (28 Randomized Control Trials)
    US: 15, UK: 8; NE: 2, CA: 3

    Health Status Quality
    of Life
    Quality of Care Patient Satisfaction Provider Satisfaction Cost Length of Stay
    Improvement 7 0 0 6 0 2 1
    Decline 0 0 0 0 0 1 0
    No difference 15 2 2 5 1 1 0

    CNSs (32 Randomized Control Trials)
    US: 16, UK: 11, CA: 2, Other: 3

    Health Status Quality
    of Life
    Quality of Care Patient Satisfaction Provider Satisfaction Cost Length of Stay
    Improvement 15 5 2 4 0 9 5
    Decline 0 0 0 0 0 0 0
    No difference 8 4 0 3 1 4 1
    Data courtesy of author. Research presente by Dr. DiCenso at theXV International Nursing Research Conference.

    "Study: No Problems if Nurse Anesthetists Work Unsupervised By Docs"
    August 3, 2010 --The Wall Street Journalreports "the new study confirms that certified registered nurse anesthetists (CRNAs), who receive high-level training, are able to provide the same level of services as anesthesiologists at potentially lower cost." The study authors Brian Dulisse and Jerry Cromwell write "we recommend [the Centers for Medicare & Medicaid Services] return to its original intention of allowing nurse anesthetists to work independently of surgeon or anesthesiologist supervision without requiring state governments to formally petition for an exemption..."see the full articleor see the abstract of the study inHealth Affairs29, no. 8 (2010): 1469-1475.

    NPs better at screening, assessment, and counseling and have higher patient satisfaction
    June 29, 2010 -- In her article"The Nurse Practitioner Will See You Now,"Laura Stokowski atMedscapesummarizes the study"The Role Of Nurse Practitioners In Reinventing Primary Care"by Mary Naylor & Ellen Kurtzman inHealth Affairs(2010;29:893-899):
    They found evidence of the equivalence of care provided by NPs and physicians, beginning with the first randomized trial conducted in 1974. This and numerous subsequent studies confirm that care provided by NPs is as effective as, and no different from, that of physicians in terms of health status, treatment practices, and prescribing behavior. Moreover, NPs achieved consistently better results than their physician colleagues on measures of patient follow-up, consultation time, satisfaction, and the provision of screening, assessment, and counseling.

    Patients at nurse-lead atopic eczema clinic had greater improvement of symptoms than those at physician-lead clinic

    October 5, 2007 -- A nurse-lead dermatology clinic for children with atopic eczema had a "significantly greater improvement in severity of eczema" than children who attended a physician-lead dermatology clinic. In one measure of treatment adherence, the children's use of wet dressings was 76% in the nurse-lead clinic compared with only 12% for the children in the dermatologist-lead clinic. However, it does not appear as though the study controlled for the length of time spent. Nurses spent 90 minutes in individual and group sessions with patients, and physicians spent 40 minutes with patients, though it is unclear if this was all individual or some group time.See the article...

    Cochrane Database reports on benefits of nurse vs. physician care

    April 28, 2005 -- In an article entitled "Substituting Nurses For Doctors Results In High Quality Care, Few Savings" researchers report that "[m]any primary care responsibilities can be safely transferred from doctors to appropriately trained nurses...[y]et there is little proof that such a shift reduces physician workload or health-care costs.see the article...

    Nurse Midwives credited for second lowest hospital C-section rate in New Jersey, despite serving high-risk community

    March 28, 2005 -- Today theCourier News(New Jersey) ran a generally very good piece by Stefanie Matteson about the nurse midwifery program credited with helping the Muhlenberg Regional Medical Center achieve the state's second lowest rate of Caesarian sections, despite serving a low-income urban patient population that is more likely to have high-risk pregnancies. The article highlights the nurse midwives' care model, presents key data and includes good comments from relevant persons, though it could have focused a bit more on the midwives' clinical skill, as opposed to the admirable "cultural climate" they create.more...

    Multiple studies find no differences between care delivered by Nurse Anesthetists and Anesthesiologists

    2006 -- See the American Association of Nurse Anesthetists' web pages comparing the care of Certified Registered Nurse Anesthetists to that of Anesthesiologists. A number of studies have found no significant differences in patient outcomes based on professional background.See the AANA web pages.

    Nurse Midwife care equal in morbidity at a lower cost, with more favorable outcomes and fewer interventions

    June 2003 -- TheAmerican Journal of Public Healthpublished a study funded by the US Agency for Health Care Research and Quality of low-risk patients receiving collaborative/birth center/midwifery care who had comparable morbidity, preterm birth, and low-birth weight rates to patients receiving physician only care. Collaborative care also resulted in more favorable outcomes and a lower cost to the health care system through spending less time as an in-patient, fewer C-sections, episiotomies, inductions, and vacuum or forceps assisted vaginal births, and more prenatal services delivered despite the lower cost.more...

    Nurse-midwives transfer embryos at least as well as gynecologists

    May 2003 -- A clinical trial of 102 patients randomly assigned to receive embryo transfers from nurse-midwives or gynecologists found that clinical pregnancy rates were similar--31% for midwives and 29% for gynecologists. The study subjects had a high acceptance rate of midwives on a questionnaire. Bjuresten, K., Hreinsson, J. G., Fridström, M., Rosenlund, B., Ek, I. & Hovatta, O. (2003).Embryo transfer by midwife or gynecologist: a prospective randomized study.Acta Obstetricia et Gynecologica Scandinavica, 82(5), 462.

    London patients rate nurse-led GYN clinics significantly higher than physician-led clinics

    April 2003 -- London scientists found that nurse-led GYN clinics had significantly higher patient satisfaction scores than physician-led GYN clinics. Patients rated nurse-led clinics higher in quality, competence, provision of information and overall satisfaction. Miles, K., Penny, N., Power, R. & Mercey, D (2003).Comparing doctor- and nurse-led care in a sexual health clinic: patient satisfaction questionnaire.Journal of Advanced Nursing, April, 42 (1), 64.

    Meta-analysis: NP patient satisfaction higher and care equal to or better than MD care

    April 2002 -- In a meta-analysis of 34 clinical studies published in theBritish Medical Journalby Horrocks, Anderson & Salisbury comparing care by NP's and physicians, researchers found that patients were more satisfied with their care if it was delivered by a Nurse Practitioner (NP) than by a physician. Compared to physicians, NP's read X-rays equally well, identified more physical abnormalities, communicated better, gave patients more information and taught patients how to provide self-care better. NPs also "undertook more investigations" and spent significantly more time with patients, 14.9 minutes vs. 11.2 minutes for physicians.See the study.

    Nurse experts interviewed on nurse practitioner and physician care differences

    January 14, 2002 -- Linda Aiken Ph.D., RN and colleagues give a compelling interview to Medscape on differences in care delivery between nurse practitioners and physicians.See the interview.

    Physicians: higher patient satisfaction; NP patients: lower blood pressure in study

    January 2000 -- M. Mundinger et al. from Columbia University School of Nursing published a randomized clinical research study of 1316 patients in theJournal of the American Medical Association(2000). The study compared care between nurse practitioners and physicians. Patients answered a satisfaction questionnaire after initial appointment and were examined 6 months and 1 year later. At six months, physicians received a significantly higher satisfaction rating (4.2 vs. 4.1 on a 5.0 scale). There were no utilization differences, and the only health status difference was that patients with high blood pressure who were cared for by nurse practitioners had significantly lower diastolic blood pressures.See the abstract.

    Advanced Practice Nurses: better compliance, higher satisfaction in meta-analysis

    November 1995 -- Brown & Grimes from the Univ. of Texas at Austin School of Nursing published a meta-analysis of 33 randomized studies comparing the outcomes of primary care patients of nurse practitioners (NPs) and nurse midwives (NMs) with those of physicians in the journal Nursing Research. Patients of NPs had significantly greater patient compliance with treatment recommendations compared to physicians. In controlled studies, patients of NPs had greater patient satisfaction and resolution of pathological conditions than patients of physicians. Most other variables were similar. NMs used less technology and analgesia during labor and delivery than did physicians, and the two groups of providers had babies with similar outcomes.Nursing Research1995 Nov-Dec;44(6):332-9.See the abstract.

    NPs--better patient education, care continuity, knowledge about disease, less waiting

    October 1995 -- Langner & Hutelmyer published the results of a patient satisfaction survey of 52 HIV-infected primary care patients at an urban medical teaching clinic in the journalHolistic Nursing Practice. Patients of nurse practitioners "fared more favorably" in clinic waiting time, provider knowledge about the disease, continuity of care, and patient education when compared to physician providers. 1995 Oct;10(1):54-60.See the abstract.

    Nurses in ENT clinics provide more cost-effective care than physicians

    March 2004 -- The article does not appear to have specifically studied patient outcomes beyond cost-effectiveness of care. However, cost-effectiveness can in any case encompass positive health outcomes. See the abstract: Uppal, S., Jose, J., Banks, P., Mackay, E., & Coatesworth, A. P. (2004).Cost-effective analysis of conventional and nurse-led clinics for common otological procedures. Journal of Laryngology & Otology, 118(3), 189-192.

    Further studies

    Bryant, R; Graham, M.C. Advanced practice Nurses: A Study of Client Satisfaction.Journal of the American Academy of Nurse Practitioners, 14(2) 89-92, Feb 2002.
    Mary D. Naylor, Dorothy A. Brooten, Roberta L. Campbell, Greg Maislin, Kathleen M. McCauley, J. Sanford Schwartz. Transitional Care of Older Adults Hospitalized with Heart Failure: A Randomized, Controlled Trial.Journal of the American Geriatrics Society, May 2004.
    Burl, JB; Bonner, A; Rao, M; Khan, A. Geriatric Nurse Practitioners in Long Term Care: Demonstration of Effectiveness in Managed Care.Journal of The American Geriatrics Society, 46:506-510, 1998
    Lin SX, Hooker RS, Lenz ER, Hopkins S. Nurse practitioners and physician assistants in hospital outpatient departments, 1997-1999.Nursing Economics. 2002; 20(4): 174-179.
    Grumbach K, Hart LG, Mertz E, et al. Who is caring for the underserved? A comparison of primary care physicians and nonphysician clinicians in California and Washington.Ann Fam Med. 2003; 1:97-104.
    Stange KC. In this issue: health care inequalities [editorial].Ann Fam Med. 2003; 1:66-67.
    Jackson DL, Lang JM, Swartz WH, et al. Outcomes, safety, and resource utilization in a collaborative care birth center program compared with traditional physician-based perinatal care.Am J Public Health. 2003; 93:999-1006.
    Restrepo, A; Davitt, C.; Thompson, S. House Calls: Is there an APN in the House?Journal of the American Academy of Nurse Practitioners. 13 (12) 560-564, Dec 2001
    Lambing, A.Y.; Adams, D.L.C.; Fox, D.H.; Divine, G. Nurse Practitioners' and Physicians' Care Activities and Clinical Outcomes with an Inpatient Geriatric Population.Journal of the American Academy of Nurse Practitioners. 16 (8) 343-352, Aug 2004.
    Hoffman, L.A.; Tasota, F.J.; Scharfenberg, C. Zullo, T.G.; Donahoe, M.P. Management of Patients in the Intensive Care Unit: Comparison Via Work Sampling Analysis of an Acute Care Nurse Practitioner and Physicians In Training.American Journal of Critical Care. 12 (5) 436-443. Sept 2003.
    Hoffman, L.A.; Tasota, F.J.; Scharfenberg, C. Zullo, T.G.; Donahoe, M.P. Outcomes of Care Managed by an Acute Care Nurse Practitioner/Attending Physician Team in a Subacute Medical Intensive Care Unit.American Journal of Critical Care. 2005;14:121-132.
    Russell, D. ; VordeBruegge, M.; Burns, S.M. Effects of an Outcomes-Managed Approach to Care of Neuroscience Patients by Acute Care Nurse Practitioners.American Journal of Critical Care. 11 (4) 353-362. July 2002.
    Kleinpell, R.M. Acute Care Nurse Practitioner Practice: Results of a 5-Year Longitudinal Study.American Journal of Critical Care. 14 (3) 211-221. May 2005.
    Adams KF, Baughman KL, Dec WG, et al (1999). HFSA (Heart Failure Society of America) guidelines for management of patients with heart failure caused by left ventricular systolic dysfunction-pharmacological approaches.Journal of Cardiac Failure, 5(4), 357-382.
    Albert, N & Young, J. (2001) Heart failure disease management: a team approach.Cleveland clinic journal of medicine, 68(1), 53-64.
    Bargardi AM. Impact of nurse practitioner-implemented evidence-based clinical pathways on "best practice" in an interventional cardiology program. 72nd Scientific Sessions of the American Heart Association.www.medscape.com/medscape/CNO/1999/AHA/day2/08-bargardi.html
    Brass-Mynderse NJ. (1996). Disease management for chronic congestive heart failure.Journal of Cardiovascular Nursing, 11(1), 54-62.
    Dahl J & Penque S. The effects of an advanced practice nurse-directed heart failure program.The Nurse Practitioner, 25(3), 61-77.
    Evangelista, L & Dracup, K ( summer 2000) A closer look at compliance research in heart failure patients in the last decade.Progress in cardiovascular nursing, 97-103.
    Fonarow, G, Stevenson L, Walden N, et al. (1997). Impact of a comprehensive heart failure management program on hospital readmission and functional status of patients with advanced heart failure.J Am Coll Cardiol, 30(3), 725-732.
    Hershberger, R E, Hanyu, Ni, Nauman, D. J, et al. (2001) Prospective Evaluation of an outpatient heart failure management program.Journal of Cardiac Failure, 7(1), 64-74.
    Martens KH & Melor SD. (1997). A study of the relationship between home care services and hospital readmission of patients with CHF.Home Healthcare Nurse, 15(2), 123-129.
    Paul, S. (1997). Implementing an outpatient CHF clinic: The nurse practitioner role.Heart and Lung, 26(6), 486-491.
    Rich MW, Beckham V, Wittenberg C, Leven CL, Freedland KE & Carney ME. (1995). A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure.The New England Journal of Medicine, 333(18), 1190-1195.
    Ramahi, T, Longo, M, Rohlfs, K, Sheynberg, N. (2000). Effect of heart failure program on cardiovascular drug utilization and dosage in patients with chronic heart failure.Clinical cardiology, 23, 909-914.



    Read more:Do physicians deliver better care than Advanced Practice Nurses?

    Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors | BMJ
    Abstract


    Objective: To determine whether nurse practitioners can provide care at first point of contact equivalent to doctors in a primary care setting.
    Design: Systematic review of randomised controlled trials and prospective observational studies.
    Data sources: Cochrane controlled trials register, specialist register of trials maintained by Cochrane Effective Practice and Organisation of Care Group, Medline, Embase, CINAHL, science citation index, database of abstracts of reviews of effectiveness, national research register, hand searches, and published bibliographies.
    Included studies: Randomised controlled trials and prospective observational studies comparing nurse practitioners and doctors providing care at first point of contact for patients with undifferentiated health problems in a primary care setting and providing data on one or more of the following outcomes: patient satisfaction, health status, costs, and process of care.
    Results: 11 trials and 23 observational studies met all the inclusion criteria. Patients were more satisfied with care by a nurse practitioner (standardised mean difference 0.27, 95% confidence interval 0.07 to 0.47). No differences in health status were found. Nurse practitioners had longer consultations (weighted mean difference 3.67 minutes, 2.05 to 5.29) and made more investigations (odds ratio 1.22, 1.02 to 1.46) than did doctors. No differences were found in prescriptions, return consultations, or referrals. Quality of care was in some ways better for nurse practitioner consultations.

    Quote from TheOldGuy
    LOL - Ok....back to the ranch.....again....

    Does anybody know of any DATA, any STUDIES, ANYTHING EVIDENCE BASED, that shows NP directed/provided care to be less than excellent (or at least equivalent to physician provided/directed care)? If so, could you provide a link?

    So far, it seems like the answer is no.......
  8. 0
    A well-balanced commentary on the historical timelines leading to the current debate. A fitting closing remark to this thread:

    NEJM
  9. 0
    Quote from nomadcrna
    Really? Why not? LOL

    Are you an np?
    Yes I am. I speaking to myself simply because I'm a new grad. Not to experienced NPs. I think with time we should be able to independently practice without a MD breathing down our necks. I live in Florida where the NP role is not well received so we are scrutinized to the fullest and we are expected to fail in most cases. That's all I'm saying.
  10. 0
    Quote from nomadcrna
    Really? Why not? LOL

    Are you an np?
    I did say as a new NP right?


Top