Expanding the Scope of APRN's Does Not Endanger Patients

[JeanettePNP, MSN, RN, NP]

http://www.sciencebasedmedicine.org/expanding-the-scope-of-practice-of-advanced-practice-nurses-does-not-endanger-patients/#more-29797

Excellent article (by a physician) on the Science Based Medicine blog pointing out the fallacies of restricting APRN scope of practice and supporting the ability of APRN's to provide quality patient care.

[msn10]

That is a great article. I wish more of these were in peer reviewed journals as well. Although reading the commentary on the bottom is always entertaining.

I especially appreciated his comparison of the practice of an APN to an MD with regards to the following argument made by physicians in Michigan:

The statement:

"Consider this: if nurses were given this broad expansion of scope, what would happen if something went very wrong in the course of treatment–something that a nurse doesn’t have the education or training to handle? Are you willing to put patients in this precarious situation?

His response:

"This is a transparently weak argument. To illustrate what I mean, let me ask: What happens when a physician encounters something in the course of diagnosis or treatment that goes very wrong and he doesn’t have the training to handle? He calls in other physicians who can handle it! Seriously, by this reasoning, no gastroenterologist should ever be allowed to do colonoscopies because he can’t repair a colon if he perforates one, and no cardiologist should be allowed to do angioplasties because he has to call in a heart surgeon to fix the problem with an emergency bypass if he messes up a coronary artery during a balloon angioplasty, a known risk of the procedure. The key is not being able to handle everything, as every physician specialist knows. The key is to be able to recognize when you’re in over your head and can’t handle a problem and not to be too proud or stubborn to call for help from someone who can handle it. You know who taught me that? Pretty much every surgeon I ever trained under. To

, “A man’s got to know his limitations.” This is true whether that person is a physician or an APRN, and APRN training pounds a knowledge of those limitations home."

I think he has made the argument for many APN's who are trying to elevate their practice in resistant states.

[JeanettePNP, MSN, RN, NP]

I liked the article because SBM is not know for suffering fools gladly, and sometimes I think comes down TOO hard on CAM and anything he considers "woo." So I was expecting an article bashing APRN's... I was pleasantly surprised.

But there you have it... science-based medicine supports APRN practice. :)

[Pachinko]

This underscores the fact that MD objections to expanded scope for APRNs stems (IMO) from unfounded bias at best and territoriality at worst. You have to look at the research, period.

[futureeastcoastNP]

I think most educated people realize that NPs do not harm patients. This whole campaign by physicians to destroy their reputation is primarily a turf war. It makes no sense at all that having MORE qualified healthcare providers would mean poor healthcare outcomes. It's sad that an organization like the AMA, which should be composed of some of the brightest minds in this country, would push an argument with no factual or scientific proof just to further an agenda.

[nomadcrna, DNP, CRNA, NP]

There are many peer reviewed studies out there already. This is nothing new. His comments are based on those peer reviewed studies.

That is a great article. I wish more of these were in peer reviewed journals as well. Although reading the commentary on the bottom is always entertaining.

I especially appreciated his comparison of the practice of an APN to an MD with regards to the following argument made by physicians in Michigan:

The statement:

"Consider this: if nurses were given this broad expansion of scope, what would happen if something went very wrong in the course of treatment–something that a nurse doesn’t have the education or training to handle? Are you willing to put patients in this precarious situation?

His response:

"This is a transparently weak argument. To illustrate what I mean, let me ask: What happens when a physician encounters something in the course of diagnosis or treatment that goes very wrong and he doesn’t have the training to handle? He calls in other physicians who can handle it! Seriously, by this reasoning, no gastroenterologist should ever be allowed to do colonoscopies because he can’t repair a colon if he perforates one, and no cardiologist should be allowed to do angioplasties because he has to call in a heart surgeon to fix the problem with an emergency bypass if he messes up a coronary artery during a balloon angioplasty, a known risk of the procedure. The key is not being able to handle everything, as every physician specialist knows. The key is to be able to recognize when you’re in over your head and can’t handle a problem and not to be too proud or stubborn to call for help from someone who can handle it. You know who taught me that? Pretty much every surgeon I ever trained under. To

, “A man’s got to know his limitations.” This is true whether that person is a physician or an APRN, and APRN training pounds a knowledge of those limitations home."

I think he has made the argument for many APN's who are trying to elevate their practice in resistant states.

[msn10]

There are many peer reviewed studies out there already.

I did't say this was a new idea. My post said more of these and many of the articles are in nursing journals. Although JAMA and other have done some it would be nice if more editorials were also done in physician magazines with this type of focus.

[PatMac10,RN, RN]

Loved it. Very concise and thorough. Solid arguments and great, real life, comparisons. Very logical reasoning as well.

[PwettyPrincess]

You girls are crazy!!! MDs know more than NPs!!!

[BostonFNP, APRN]

I say with my collaborating physician last week and this was the topic of our conversation. He has 30+ years of experience more than I.

I tend to refer patients much earlier in the process than he does, as one might expect based on our experience level. As it turns out my outcomes are slightly better, and while we initially thought this came at an increased cost to the system, turns out he also order more unnecessary/expensive tests than I do, and this balances out that cost. We were both surprised by this, and he has vowed to refer a bit earlier now.

My collaborating doc always supports the decisions I make, and part of the reason he feels confident in doing that is that I have demonstrated that I competently handle things is feel comfortable and call for support promptly when I don't feel comfortable. I also practice much closer to guidelines than he does. It is an interesting dynamic.

[nomadcrna, DNP, CRNA, NP]

You have any evidence of this? I think this was probably a troll post.

You girls are crazy!!! MDs know more than NPs!!!

[PwettyPrincess]

^4 years of medical school +3-5 years of residency +1-2 years if they do a fellowship. Is that good enough for you?