Nurse Practitioners Flex Their Political Muscle

Posted by in Healthcare


With the new Affordable Care Act soon to kick into high gear, millions of new patients will suddenly be knocking on doctors' offices for all types of care.  That will put a huge strain on medical providers—especially on doctors who aren’t multiplying at the same rate as new patients.

 

Toni DiChiacchio, a family nurse practitioner and owner of Health Thru Care LLC in Morgantown, West Virginia noted that 40 percent of all patients admitted to a nearby hospital lack primary care providers.

 

One solution is to take the load off doctors by giving nurse practitioners (NP) more power to see patients autonomously. A state's performance evaluation review division would have to change its policy on scope of practice.

 

DiChiacchio said that more than a dozen states already allow nurse practitioners to practice entirely autonomously. She admitted that the liability issue poses a challenge, but said that 40 years of research has demonstrated that patients seen by nurse practitioners encounter no greater risk that those seen by physicians. "Patients likely will continue to see physicians, but it would be nice for them to have another choice," said DiChiacchio.

 

Dr. Hoyt Burdick, president of the West Virginia Medical Association argues that healthcare should rely more on cooperation and teamwork. "Even residencies are focused on collaboration and systems, so there's a move toward team-based care," said Burdick. "The movement for nurses to treat patients without doctors on their team comes at a time when medical care is shifting toward a team-based approach. Eliminating collaborative practice agreements promotes further isolated individuals in a fragmented system," said Burdick.

 

Some states are re-writing and re-defining nurse practitioner roles and expanding prescription rules so nurse practitioners can prescribe drugs for chronic conditions. Groups like the West Virginia Medical Association are working collaboratively with other groups to develop a list of chronic conditions.

 

While DiChiacchio noted that nurse practitioners must collaborate, she insists nurses could participate more in a patient’s health care. This would allow doctors to use more of their knowledge and experience, which is often not used to the fullest extent.

 

In California, Senate Bill 1524 advocated by California Association for Nurse Practitioners, may soon become law. If passed, it would remove the six-month delay for nurse practitioners to receive authorization to provide medication to their patients.

 

Current law stipulates that NPs have six months of supervised experience before they’re allowed to administer medications to their patients. This has prevented patient access to care, since it delays NPs from entering California’s health care workforce. The restriction also keeps experienced NPs from entering the state, since it applies to out-of-state NPs regardless of their previous length of practice. The new measure passed both houses of the legislature by overwhelming margins and now awaits action by Gov. Jerry Brown. If signed into law, the bill would take effect January 1, 2013.

 

If you’re a nurse practitioner, you should be aware that the battle is being waged to give you more power to see patients autonomously and to administer medications to your patients.

 

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  • Alex Kecskes
    Alex Kecskes
    Thank you all for your passionate and considered responses. Time will tell how this issue finally works itself out.
  • Tyler C
    Tyler C
    Sure, I'm all for giving more flexibility in the health care industry. But the so-called Affordable Health Care act will prevent any kind of flexibililty. You will be wading through various paperwork and bureaucracies just to get simple things done. Plus, the bill mentioned, violates my conscience against abortion, because this bill opens the door for more unlicensed butchers to operate their baby-killing mills. Good luck
  • Marvin P
    Marvin P
    What does it take to get certified as a Nurse Practitioner.
  • Jeff R
    Jeff R
    I'm a former rural hospital administrator.  I think it's best to stick with colaboration.  Nurses NP's and PA's need to work with doctors.  We've taken too many nurses into administrative roles where they are best taking care of patients.  Don't use the Affordable Healthcare Act as a reason for stress in patient care.
  • Joyce S
    Joyce S
    As a nurse for over 30 years, I would not want a nurse diagnosing me for anything but the flu. There is a reason we have Medical Doctorates. This is malpractice waiting to happen. No nurse I ever worked with in the CCU would ever pretend to know all the answers as a doctor, they were however, excellent in the narrow scope of their practice level, only from experience.
  • Krista k
    Krista k
    I think with the doctor shortage, the NP should have more power. At least they listen when you go see them.
  • terry C
    terry C
    Finally common sense in the medical community.   Many experienced foreign physicians with desired specialties should also be allowed to practices as NPs instead of all the USMLE and residencies.  Why can't a comprehensive exam be available for experienced foreign physicians to be NP qualified?
  • Susan S
    Susan S
    I have been working in healthcare for 35 yrs. and have met and  worked with many competent,bright and compassionate NP's.I have also witnessed NP picking up on conditions that were missed by MD's. NP's listen and do far more teaching than the MD's do and today educating pts to take care of themselves is a great way to prevent health issues.Who does the Diabetic educating???The nurses and NP's.This is one of the biggest healthcare issues of our time.I have great respect for the job the NP's do and they certainly deserve to be more autonomous!
  • Luis H
    Luis H
    It a very good idea to have NP work autonomous after six months.  It takes a MD 3 year  work autonomously.
  • REBECCA L
    REBECCA L
    IF NURSES ARE  GOING TO BE GIVEN MORE RESPONSIBILITY,THEN THERE WILL BE A NEED FOR MORE MEDICAL ASSISTANTS .THERE SHOULD BE LAWS IN ALL STATES THAT DOCTORS ARE NOT ABLE TO HIRE NON MEDICAL STAFF TO PREFORM PATIENT CARE.CERTIFICATION SHOULD BE MANDATORY,
  • Marianne P
    Marianne P
    I agree. The NP needs to act autonomously. I hear too many NPs saying they are just glorified hand maidens to doctors.  If I were aware before the beginning of my NP program that we don't work autonomously, I wouldn't have chosen it as a career path.
  • Nissy R
    Nissy R
    I strongly reccommend autonomous practice for nurse practioner.
  • Sherrie M
    Sherrie M
    As a nurse who sees patients in adult family homes, long term care facilities and private homes, I have seen much more consistent and compassionate care given to patients by nurse practitioners in the patients own environments than MD's who require trips to offices and clinics. This is much better care for those who have trouble getting out. It is only fair that these very necessary practitioners are allowed to be autonomous if they chose to be.
  • Margaret D
    Margaret D
    I am a registered nurse. I get so sick of physician groups complaining about how nurses should be forced to limit their scope of practice implying we are not qualified enough to care for patients. On a daily basis, I see patients with poorly or inadequately managed health conditions who see their physicians on a regular basis. In this article, Burdick speaks of collaborative agreements but where was his support over the years when we were clamoring for these same agreements? Physicians have always perceived that their revenue base would be adversely affected if nurses entered private practice or took a more active role in primary patient care.  Now, as we are moving more toward fees based upon a patient's state of health and accountable care organizations, they recognize our expertise in helping patients understand their health and wellness and want to share in the revenue we could generate.The fact of the matter is that quality healthcare has always depended upon the collaboration among levels of care providers and various disciplines. Physicians are just beginning to accept this. And at the ripe old age of 58, I am completing my Master's in nursing and then will pursue certification as an NP so I can continue to contribute to my patients' optimal health.
  • Maria H
    Maria H
    I think this is good due to the high volume of patients waiting to see a provider . I find some of the NP are more patient friendly due to the dr's scheduling giving them just a little more time to answer questions.Maria
  • JOANNE W
    JOANNE W
    My name is Joanne and I am a LPN(licensed Practical Nurse) and I agree that Nurse Practitioners should have the power to see patients autonomously. They are just as knowledgeable and capable to provide care a physician can  provide. I think this will be a great team care approach to providing excellent care to all people.
  • Beverly H
    Beverly H
    I totally believe that NP's should get more power! I also firmly believe that we need the ACA more than anything. All people should have affordable healthcare and will do my best to make sure it does not get overturned! Also, for all our health's sake, do NOT get rid of the EPA!!!!!!
  • Linda W
    Linda W
    I haven't had good experiences with nurse practitioners supervised by doctors, and neither have my family members.  If healthcare has deteriorated to the point that NPs are working unsupervised, God help us.
  • stella a
    stella a
    I think it is a wonderful idea to extend the spectrum of reliability on nurse practitioners and allow these professionals to provide medical service in a more autonomous manner.The politics mix of insurances exerting power on the medical profession in addition to the unrealistic power of the American Medical Association has hurt the formation of new and interested medical doctors as ECFMG rules to certify a physician have become almost insurmountable and expensive by adding more steps (total of 4 exams) to pass in order to be allowed to obtain a residency in the medical area of interest for each doctor.
  • Carol G
    Carol G
    I dont see anything wrong about a 6 month preceptorship for writing Rx's.  That is a big responsibility.
  • Rhoda F
    Rhoda F
    seen first-hand the inherent dangers when APN was allowed to see "her" patients without the involvement of the M.D. She failed to recognize a massive MI just waiting to happen several hours later. Then, the doc was sued to get to her policy under a collaborative agreement with the owner-doc of the walk-in care center. Patient didn't want to sue the APN colleague/friend of his RN wife. Doc on duty who never was involved with the patient became target of choice-true injustice- no thanks. Nurses lack the training & experience to function autonomously. Go to med school & residency if you want to do your own thing!
  • Bonnie R G
    Bonnie R G
    I think this is a great opportunity for nurse practioners and will have a positive effect on adequate patient care while decreasing emergency room visits. This can also increase the nurse practitioner population.
  • Samuel Z
    Samuel Z
    I believe this change to the way Patients are treated will help the industry in much need  of caring for Patients. Especially, now that the Babyboomer Generation is retiring and the care of Capable personnel is needed. So far, one of the Best news we have heard in a Long Time.
  • Alex Kecskes
    Alex Kecskes
    Thanks, Chandra, for you personal insight into this important matter.
  • Chandra H
    Chandra H
    As an LPN I find this to be a long time overdue,  BY TAKING THE HANDCUFFS OFF THE NP'S , MAYBE  THE NP'S WOULD HAVE TIME TO ACTUALLY COMMUNICATE WITH THE HANDS ON NURSES FACE TO FACE, NOT JUST CHART TO DR. ALLOWING FOR ANOTHER SOURCE OF INFORMATION CONCERNING THE PATIENTS NEEDS AND ACTIONS THAT WE AS THE HANDS ON WORKERS WOULD LOVE TO GET THE OPPORTUNITY TO PERSONALLY DELIVER !!I

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