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Nurses and Doctors Equally Competent for Simple Ailments

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Specializes in Vents, Telemetry, Home Care, Home infusion. Has 44 years experience.

Nurses and Doctors Equally Competent for Simple Ailments

Trained nurses and general practitioners (GPs) are equally competent in providing primary care for common health issues, according to a Spanish study published online March 21 in the Journal of Advanced Nursing.

In a trial involving 1461 adult patients seen for same-day appointments at 38 practices, Mireia Fàbregas, MD, from the Institut Català de la Salut, in Barcelona, Spain, and colleagues found that nurses successfully resolved 86.3% (95% confidence interval [CI], 83.6% - 88.7%) of cases randomly assigned to their care. The rate was similar to that achieved by GPs (odds ratio [OR], 1.10; 95% CI, 0.84 - 1.46) after adjustment for individual patient variables.

Altra, BSN, RN

Specializes in Emergency & Trauma/Adult ICU.

An internal med I know has told me repeatedly, "an ER nurse can assess a patient and come up with differential diagnosis as well as I can."

Edited by Altra
typo

SycamoreGuy

Has 1 years experience.

This study was obviously funded by the evil nursing lobby who is only interested in making nurses the new Doctors. JK ;)

This is why there is a movement to allow Nurse Practitioners to practice autonomously. The care needed for general medical issues, family practices or obstetrics are absolutely on par with both a general practitioner's education and a NP's education. GP's refer out more complex problems to specialists when the medical problem is out of their scope of expertise, NP's can and should do just the same.

seanynjboy

Specializes in Medical-Surgical, Supervisory, HEDIS, IT.

This is why there is a movement to allow Nurse Practitioners to practice autonomously. The care needed for general medical issues, family practices or obstetrics are absolutely on par with both a general practitioner's education and a NP's education. GP's refer out more complex problems to specialists when the medical problem is out of their scope of expertise, NP's can and should do just the same.

In certain states like Arizona, an NP can practice by themselves. I used to work for one as an office assistant before I became a nurse. HOWEVER, Medicare/Medicaid (CMS) required a physician signature for a few things so she has a "collaboration agreement" with a physician that he signs off on the few things that require a signature of a physician. She does NOT work under him or have to report to him. She owns her own practice. I do not know about other states how NPs can practice. I believe NJ and PA you have to practice under a physician, but I am not sure.

BostonFNP, APRN

Specializes in Adult Internal Medicine. Has 10 years experience.

NPs can practice autonomously in 17 states with at least 5 others in current legislation.

BrandonLPN, LPN

Has 5 years experience.

So were the Spanish nurses in the study the equivalent of our NP or regular RN?

NRSKarenRN, BSN, RN

Specializes in Vents, Telemetry, Home Care, Home infusion. Has 44 years experience.

PA requires a collaborative agreement.

SummitRN, BSN, RN

Specializes in ICU + Infection Prevention. Has 9 years experience.

Given the Spanish medical education and nursing education models are not equivalent to US nursing and medical schools, how is this relevant to the US? All I took away from that abstract was that patients really like it if you spend more time with them.

BostonFNP, APRN

Specializes in Adult Internal Medicine. Has 10 years experience.

Given the Spanish medical education and nursing education models are not equivalent to US nursing and medical schools' date=' how is this relevant to the US? All I took away from that abstract was that patients really like it if you spend more time with them.[/quote']

This one is a much better study.

Mundinger, M. O., Kane, R. L., Lenz, E. R., Totten, A. M., Tsai, W. Y., Cleary, P. D., ... & Shelanski, M. L. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians. JAMA: the journal of the American Medical Association, 283(1), 59-68.

Lenz, E. R., Mundinger, M. O. N., Kane, R. L., Hopkins, S. C., & Lin, S. X. (2004). Primary care outcomes in patients treated by nurse practitioners or physicians: two-year follow-up. Medical Care Research and Review, 61(3), 332-351.

BostonFNP, my thoughts on the first study you referenced, which I have read, are that I am not persuaded by the study design or the methods to measure outcomes. The outcome measures rely in part on self-reported information, including a patient satisfaction survey, and the objective measurements taken do not yield enough information in my opinion to make the case that nurse practitioners deliver a similar quality of primary care to physicians. The authors of the study also refer to aspects of the study that limit the generalizability of the results.

Edited by Susie2310

BostonFNP, APRN

Specializes in Adult Internal Medicine. Has 10 years experience.

BostonFNP, my thoughts on the first study you referenced, which I have read, are that I am not persuaded by the study design or the methods to measure outcomes. The outcome measures rely in part on self-reported information, including a patient satisfaction survey, and the objective measurements taken do not yield enough information in my opinion to make the case that nurse practitioners deliver a similar quality of primary care to physicians. The authors of the study also refer to aspects of the study that limit the generalizability of the results.

I actually think the study design is fairly strong and it was strong enough to be published in JAMA, but to each their own.

If you prefer a more quantitative outcome study, how about:

Wright, W. L., Romboli, J. E., DiTulio, M. A., Wogen, J., & Belletti, D. A. (2011). Hypertension treatment and control within an independent nurse practitioner setting. American Journal of Managed Care, 17(1), 58.

For anyone interested in reading about this topic, Newhouse et al. (2011) wrote a fantastic meta-analysis that evaluates the strength and results of almost every major NP outcomes study.

Newhouse, R. P., Stanik-Hutt, J., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G., ... & Weiner, J. P. (2011). Advanced practice nurse outcomes 1990-2008: a systematic review. Nursing Economics, 29(5), 1-21.

"Patients of advanced practice registered nurses have similar or better results in many outcome measurements compared with physicians and other healthcare teams without APRNs, according to a new study.

Published in Nursing Economics, the report "reinforces that APRNs provide effective, high-quality patient care and play an important role in improving the quality of care in the United States," according to a news release.

Robin P. Newhouse, RN, PhD, NEA-BC, associate professor at the University of Maryland School of Nursing and assistant dean for the Doctor of Nursing Practice Program, and co-authors conducted a systematic review comparing APRN processes and outcomes to those of physician providers. They analyzed 69 studies published between 1990 and 2008 and summarized 28 outcomes for nurses in APRN roles.

The authors described patient outcomes for each of three patient groups-nurse practitioners, certified nurse-midwives and clinical nurse specialists. Outcomes with similar or better grades than those of physician comparison groups included:

* Nurse practitioners: glucose control, lipid control, patient satisfaction, functional status, mortality.

* Certified nurse-midwives: cesarean, low APGAR score, episiotomy, labor analgesia, perineal lacerations.

* Clinical nurse specialists: Satisfaction, length of stay, cost.

The authors wrote that the results "could help address concerns about whether care provided by APRNs can safely augment the physician supply to support reform efforts aimed at expanding access to care."

The complete article is available as a PDF at Continuing Nursing Education | Nursing Economic$.

samadams8

Specializes in Peds and Adult Critical Care. Has 20+ years experience.

OK, people try not to get mad with me. Simple issues are one thing. The situations get more complex as the patients do. Today we are looking and more and more complex care situations. For these, honestly, I prefer those that have had medical education, and those that have had much longer, and more closely supervised residency hours. Medical school is the place for those that want to practice serious medicine IMHO. I support nurses. I really do. But I am going to speak honestly about this. So now I am in duck and cover position. Let the hating begin. . .only try not to. ;)

BostonFNP, APRN

Specializes in Adult Internal Medicine. Has 10 years experience.

OK' date=' people try not to get mad with me. Simple issues are one thing. The situations get more complex as the patients do. Today we are looking and more and more complex care situations. For these, honestly, I prefer those that have had medical education, and those that have had much longer, and more closely supervised residency hours. Medical school is the place for those that want to practice serious medicine IMHO. I support nurses. I really do. But I am going to speak honestly about this. So now I am in duck and cover position. Let the hating begin. . .only try not to. ;)[/quote']

So NPs are fine with the "simple" stuff. Like BP and glucose and lipids?

What are the leading causes of mortality in the US?

samadams8

Specializes in Peds and Adult Critical Care. Has 20+ years experience.

Many patients have comorbidities that complicate the picture. My mother is a fine example. We are both nurses. She sees physicians only--and I vet the hell out of them. I've been down this road before with her and others. There is definitely method to it. It can be hard enough at times to get experienced physicians to understand the relationship of her comorbidies and the complexities of her history. You get to the point where, hell no. You are NOT playing, period. Practicing medicine means medical school, and that's the way it should be. What's going on now is all about politics and money--really on all sides IMHO. If you want more input from people that have worked on both sides, such as NPs and advanced practice nurses that went to medical school and through residency and perhaps fellowships as well, then you will get an honest perspective on this.

So to answer your question, yes and no. It dependends on the patient--the whole picture.

BostonFNP, APRN

Specializes in Adult Internal Medicine. Has 10 years experience.

Many patients have comorbidities that complicate the picture. My mother is a fine example. We are both nurses. She sees physicians only--and I vet the hell out of them. I've been down this road before with her and others. There is definitely method to it. It can be hard enough at times to get experienced physicians to understand the relationship of her comorbidies and the complexities of her history. You get to the point where, hell no. You are NOT playing, period. Practicing medicine means medical school, and that's the way it should be. What's going on now is all about politics and money--really on all sides IMHO. If you want more input from people that have worked on both sides, such as NPs and advanced practice nurses that went to medical school and through residency and perhaps fellowships as well, then you will get an honest perspective on this.

So to answer your question, yes and no. It dependends on the patient--the whole picture.

Everyone is entitled to their own opinion, but when you say that I am (or any of my esteemed colleagues are) "playing" I find it incredibly disrespectful.

samadams8

Specializes in Peds and Adult Critical Care. Has 20+ years experience.

Everyone is entitled to their own opinion, but when you say that I am (or any of my esteemed colleagues are) "playing" I find it incredibly disrespectful.

YOU choose how you TAKE things. That too is your perogative. I will not give all the dirty details and experiences of what I mean when I say, "I'm not playing" when it comes to my loved ones care. The experiences and reasons are compelling, and perhaps if you had found yourself in similar predicaments, you would feel the same. When the feces hits the fan, you don't waste time, and you put your loved one FIRST, period. That's what it means.

See, and I don't know a physician one in the whole collection of which I have referred that would take umbrage at my comment. Seriously. What might that say? If you are fine and secure with what you do, it shouldn't bother you.

And yes. I do have my own perspective, and it is not without sound reasoning and solid experience. I don't see what this is such a big deal. If a person wants to become a lawyer, they go to law school. If a person wants to become an educator, they take the appropriate route with that. If a person wants to become an engineer, same thing. This is simply mathematics and logic.

While I will give the appropriate respect to the original information posted, I will also note important caveats. I could go even further with my perspectives on this, but then I'd have God knows how many here hating on me.

I will finish off by saying the following, and this reflects only one loved one's experience, and not the experiences of close friends, patients through volunteering, or even regular patients I have had. My close loved one coded two out of the three times needlessly. Shoot, I could even argue against the first code, making it 3 out of 3. I know it. They know it. It's pretty much well known, and a legal no brainer. Missing vital stuff needlessly is a BIG deal when it causes harm to patients. A wise person knows her/his limits.

I can be a fierce advocate for patients and even fiercer for those that are close to me. It's the same way that smart, experienced parents do not play with certain health issues when it comes to their children. You want to talk about the word use of "play." Seriously, I will show you a ton of parents that will use the same word, regardless of whether they are dealing with physicians, nurses, NPs, PAs, RT's or the freaking janitor, and they would not at all call it disrespectful--just honest.

I am truly sorry that you choose to take offense. It's not disrespectful at all. It's core honesty from strong experience. But take it as you will.

Edited by samadams8