In Support of Independent NP Practice

Specialties NP

Published

Specializes in Anesthesia, Pain, Emergency Medicine.

Really? Why not? LOL

Are you an np?

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.
Specializes in Anesthesia, Pain, Emergency Medicine.

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.

"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

Other than that, no. I am not losing sleep over this.

Specializes in Anesthesia, Pain, Emergency Medicine.

[h=2]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 performed
better than
physicians 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 (lady partsl 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

[TABLE=width: 585]

[TR]

[TD=width: 126, align: center][/TD]

[TD=width: 72, align: center]Health Status[/TD]

[TD=width: 78, align: center]Quality

of Life[/TD]

[TD=width: 84, align: center]Quality

of Care[/TD]

[TD=width: 78, align: center]Patient Satisfaction[/TD]

[TD=width: 90, align: center]Provider Satisfaction[/TD]

[TD=width: 60, align: center]Cost[/TD]

[TD=width: 79, align: center]Length of Stay[/TD]

[/TR]

[TR]

[TD=width: 126]Improvement

[/TD]

[TD=width: 72, align: center]5[/TD]

[TD=width: 78, align: center]0[/TD]

[TD=width: 84, align: center]0[/TD]

[TD=width: 78, align: center]5[/TD]

[TD=width: 90, align: center]1[/TD]

[TD=width: 60, align: center]2[/TD]

[TD=width: 79, align: center]2[/TD]

[/TR]

[TR]

[TD=width: 126]Decline

[/TD]

[TD=width: 72, align: center]0[/TD]

[TD=width: 78, align: center]0[/TD]

[TD=width: 84, align: center]0[/TD]

[TD=width: 78, align: center]0[/TD]

[TD=width: 90, align: center]0[/TD]

[TD=width: 60, align: center]0[/TD]

[TD=width: 79, align: center]1[/TD]

[/TR]

[TR]

[TD=width: 126]No difference

[/TD]

[TD=width: 72, align: center]7[/TD]

[TD=width: 78, align: center]1[/TD]

[TD=width: 84, align: center]7[/TD]

[TD=width: 78, align: center]2[/TD]

[TD=width: 90, align: center]1[/TD]

[TD=width: 60, align: center]2[/TD]

[TD=width: 79, align: center]2[/TD]

[/TR]

[/TABLE]

PHCNPs (Primary Health Care Nurse Practitioners) (28 Randomized Control Trials)

US: 15, UK: 8; NE: 2, CA: 3

[TABLE=width: 585]

[TR]

[TD=width: 126, align: center][/TD]

[TD=width: 72, align: center]Health Status[/TD]

[TD=width: 78, align: center]Quality

of Life[/TD]

[TD=width: 84, align: center]Quality of Care[/TD]

[TD=width: 78, align: center]Patient Satisfaction[/TD]

[TD=width: 90, align: center]Provider Satisfaction[/TD]

[TD=width: 60, align: center]Cost[/TD]

[TD=width: 79, align: center]Length of Stay[/TD]

[/TR]

[TR]

[TD=width: 126]Improvement

[/TD]

[TD=width: 72, align: center]7[/TD]

[TD=width: 78, align: center]0[/TD]

[TD=width: 78, align: center]0[/TD]

[TD=width: 78, align: center]6[/TD]

[TD=width: 90, align: center]0[/TD]

[TD=width: 60, align: center]2[/TD]

[TD=width: 80, align: center]1[/TD]

[/TR]

[TR]

[TD=width: 126]Decline

[/TD]

[TD=width: 72, align: center]0[/TD]

[TD=width: 78, align: center]0[/TD]

[TD=width: 78, align: center]0[/TD]

[TD=width: 78, align: center]0[/TD]

[TD=width: 90, align: center]0[/TD]

[TD=width: 60, align: center]1[/TD]

[TD=width: 80, align: center]0[/TD]

[/TR]

[TR]

[TD=width: 126]No difference

[/TD]

[TD=width: 72, align: center]15[/TD]

[TD=width: 78, align: center]2[/TD]

[TD=width: 78, align: center]2[/TD]

[TD=width: 78, align: center]5[/TD]

[TD=width: 90, align: center]1[/TD]

[TD=width: 60, align: center]1[/TD]

[TD=width: 80, align: center]0[/TD]

[/TR]

[/TABLE]

CNSs (32 Randomized Control Trials)

US: 16, UK: 11, CA: 2, Other: 3

[TABLE=width: 585]

[TR]

[TD=width: 103, align: center][/TD]

[TD=width: 56, align: center]Health Status[/TD]

[TD=width: 61, align: center]Quality

of Life[/TD]

[TD=width: 48, align: center]Quality of Care[/TD]

[TD=width: 75, align: center]Patient Satisfaction[/TD]

[TD=width: 93, align: center]Provider Satisfaction[/TD]

[TD=width: 69, align: center]Cost[/TD]

[TD=width: 48, align: center]Length of Stay[/TD]

[/TR]

[TR]

[TD=width: 103]Improvement

[/TD]

[TD=width: 56, align: center]15[/TD]

[TD=width: 61, align: center]5[/TD]

[TD=width: 48, align: center]2[/TD]

[TD=width: 75, align: center]4[/TD]

[TD=width: 93, align: center]0[/TD]

[TD=width: 69, align: center]9[/TD]

[TD=width: 48, align: center]5[/TD]

[/TR]

[TR]

[TD=width: 103]Decline

[/TD]

[TD=width: 56, align: center]0[/TD]

[TD=width: 61, align: center]0[/TD]

[TD=width: 48, align: center]0[/TD]

[TD=width: 75, align: center]0[/TD]

[TD=width: 93, align: center]0[/TD]

[TD=width: 69, align: center]0[/TD]

[TD=width: 48, align: center]0[/TD]

[/TR]

[TR]

[TD=width: 103]No difference

[/TD]

[TD=width: 56, align: center]8[/TD]

[TD=width: 61, align: center]4[/TD]

[TD=width: 48, align: center]0[/TD]

[TD=width: 75, align: center]3[/TD]

[TD=width: 93, align: center]1[/TD]

[TD=width: 69, align: center]4[/TD]

[TD=width: 48, align: center]1[/TD]

[/TR]

[/TABLE]

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):

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

cochrane_thumb.gifApril 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

nj_courier_thumb.gifMarch 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

aana_thumb.gif2006 -- 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

ajph_thumb.gifJune 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 lady partsl births, and more prenatal services delivered despite the lower cost.more...

Nurse-midwives transfer embryos at least as well as gynecologists

aoeg_thumb.gifMay 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

jan_thumb.gifApril 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

bmj_thumb.gifApril 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

medscape_thumb.gifJanuary 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

jama_thumb.gifJanuary 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

nsg_rsch_thumb.gifNovember 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

hnp_thumb.gifOctober 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

jlo_thumb.gifMarch 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.

[h=3]Further studies[/h]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[/h]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.

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.......

Specializes in ACNP-BC, Adult Critical Care, Cardiology.

A well-balanced commentary on the historical timelines leading to the current debate. A fitting closing remark to this thread:

NEJM

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.

Really? Why not? LOL

Are you an np?

I did say as a new NP right?

Specializes in Anesthesia, Pain, Emergency Medicine.

This is what you said.

"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.

I did say as a new NP right?

I meant that as a NP down here in Florida. It's not a crooked shaped state for nothing. I would do it but only of I considered moving out of Florida. I would also have to trust a good mentor to guide me a little in the beginning but after I get a set if new wings anything is possible. My previous post was a misunderstanding on my part. I'm simply saying that I would want to practice independently but not as a new grad in Florida or even with experience in Florida. It's bad for us down here period.

I meant that as a NP down here in Florida. It's not a crooked shaped state for nothing. I would do it but only of I considered moving out of Florida. I would also have to trust a good mentor to guide me a little in the beginning but after I get a set if new wings anything is possible. My previous post was a misunderstanding on my part. I'm simply saying that I would want to practice independently but not as a new grad in Florida or even with experience in Florida. It's bad for us down here period.

In other words, you aren't saying that you or experienced NPs are incompetent to provide care independently, just that with the regulations in florida you wouldn't want to try to do it.

Exactly. I would have to fight like a gladiator but I am 100% all for independent practice and Florida needs to totally step up their game.

Specializes in ER; CCT.

If you are a California NP and would like to say that you actually did something to ensure of SB 491 passing, send me a PM. I have some thoughts.

I am amazed and happily admit that I was wrong! It isn't completely there yet, but the California Senate passed SB491 today! The bill will now go to the Assembly. Please contact Sen Hernandez, who sponsored the bill and thank him....ASK that he PLEASE not amend the bill as he is thinking of doing (to require the NP to be on board with an HMO, or other practice organization)! The bill is great as is! We do not want a new barrier to practice to replace an old one!

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