As part of our health series, we have spoken with the American Public Health Association, the American Academy of Pediatrics, and the American Academy of Physician Assistants. To no one's surprise, the nurses and nurse practitioners who read and commented were most interested in a nursing perspective on health reform.
I received several suggestions for nurse practitioner spokespeople, and one of them, Thad Wilson, PhD, RN, FNP-BC, kindly agreed to an interview today (we have more in the works, as well as something from the American Academy of Family Practice.)
Dr. Wilson, president of the American College of Nurse Practitioners, has been a certified family nurse practitioner since 1985. He has served on faculty at the University of Missouri-Kansas City since 1995, first teaching in the FNP program and currently serving as Associate Dean. He practices in an inner city, nurse-managed clinic sponsored by the university. Dr. Wilson has been funded by the CDC, American Nurses Foundation and other organizations to conduct research on immunizations and school-based immunization programs. He was co-founder and is currently chair of the multidisciplinary Mid America Immunization Coalition, and has been involved with the ACNP since 1999.
Daily Kos: Can you tell us a little about nomenclature... We've heard physician extenders, non-physician providers, mid-level practitioners, and specifically for nursing, APRN, RN, NP, Doctor of Nursing Practice... Who are nurse practitioners and what do they mean for consumers and patients?
Sorry, this will have to be a long answer. Let me walk you through the alphabet soup.
The best thing to call us is what we call ourselves-- "nurse practitioner"! "Non-physician" is a curious term. If apples have been around longer than oranges, should oranges be called "non-apples"? Should physicians be called non-nurses? The DEA has added to the confusion by creating a prescriber category called "mid-level provider", a term considered pejorative by most nurse practitioners. If there are "mid-levels" then who are the low-level providers or the high level providers? It does not make sense to "rank order" different disciplines. "Physician extender" is an abominable term that completely discounts the discipline of nursing.
The title Advanced Practice Registered Nurse (APRN) is a more inclusive term and includes other roles held by nurses with advanced education – certified nurse midwife, certified registered nurse anesthetist, certified nurse specialist.
As our role has emerged, we have found ourselves drowning in regulation, and also acronyms- APRN, CRNP, ARNP. APRN-BC "Advanced Practice Registered Nurse, Board Certified" is currently a certification title. CRNP (Certified Registered Nurse Practitioner) and ARNP (Advanced Registered Nurse Practitioner) are legal titles for nurse practitioners given by various state governments.
"NP" is not a legal title but simply a way to save ink when writing about nurse practitioners (NPs).
The Doctor of Nursing Practice (DNP) has created a stir recently. The DNP is an academic degree, like a PhD, but is clinically focused. Nurses who wish to become NP’s may choose either a Master’s education or may continue on with doctoral education, including the DNP. Historically, the title "doctor" was an academic title indicating a person had completed the highest level of education. Over the years the term has become synonymous with physician. But, in academic settings those who have completed doctoral degrees are still called doctors. The DNP has caused some to worry that patients won’t know if their provider is a physician or a NP or some other doctoral prepared provider (and there are many), if the title of doctor is used. While I and many of my colleagues have doctoral degrees and use the term doctor, I assure you that we all want our patients to be very clear that we are NP’s.
Daily Kos: Does the American College of Nurse Practitioners have specific policy stances on health reform?
At this time the ACNP does not have a specific stance on health care reform, except that NP’s must be included in reform proposals. Four of the leading NP organizations (American Academy of Nurse Practitioners, American College of Nurse Practitioners, National Association of Pediatric Nurse Practitioners and the National Organization of Nurse Practitioner Faculty) have developed a document outlining our stance.
Over the last 5 – 10 years the number of physicians choosing primary care residencies has dropped dramatically. In 2009 about 7% of medical school graduates chose primary care. The United States is in the middle of a primary care crisis. If NP’s are left out of health care reform, the crisis will only worsen.
Daily Kos: Different states have different policies for NPs. Down the road, are you looking for federal policy, or are you looking for state by state policy changes?
Recognizing the many divergent titles and regulatory inconsistencies across the 50 states, the nursing profession recently published a consensus document that should be used to standardize future regulation of the four types of advanced practice nursing. This document, "Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education", has been endorsed by all of the major nursing entities, include those who educate, certify, and license us. The document has been widely distributed and may be found on the websites of most nursing organizations. Information can be found at: https://www.ncsbn.org/...
Daily Kos: Are nurse practitioners a growth area? How many are there? Are they part of medical staffs in hospitals? Why not?
Like all health care professions, nurse practitioners have been growing in numbers, though they represent only 5 % of all RNs. Approximately 7500 new NPs enter practice annually with more than half prepared as Family Nurse Practitioners (for practice in family primary care practices). Nurse practitioners are also prepare for primary care practice with adults (ANP), children (PNP), women (WHNP), elders (GNP), and for specialty practice in psychiatric mental health (PMHNP). Many NPs have admitting privileges and some specialize in care of acutely, chronically and critically ill individuals in hospitals and inpatient settings of all types. The acute care NPs also focus on a population including adults (acute care NPs), pediatrics (PNP-acute care) and neonates (NNP). The Joint Commission recognizes NPs, like physical therapists, pharmacists and others, as licensed independent practitioners, though medical staffs at some institutions have attempted to bar NPs (and PAs for that matter) from obtaining admitting and other inpatient care privileges.
Daily Kos: Do NPs and the ACNP have policy about pandemic preparedness and all hazard natural disasters?
At this time, the ACNP does not have a policy on pandemic preparedness.
Daily Kos: What are we not discussing that we should be?
The majority of discussion around health care reform has been about financing. While this is critical, I am concerned that the end product of reform may be a poorly financed version of the system we already have. More discussion is needed about how to change the system and make it more efficient. There is a lot of "lip service" about a patient centered system. If this is to happen we should be focusing on what problems patients encounter, and what their needs are and then talking about how we can best meet those needs and fix those problems, using available workforce and resources, and creating new solutions.
We need to use all the qualified providers that are available rather than engaging in turf battles over numbers of years of education and degree titles.
Creation of an integrated team approach to care that allows all providers to practice to the fullest extent of their education and qualifications and to match patient needs to provider skills rather than requiring the highest priced provider to see all patients (MD).
Daily Kos: Thank you, Dr. Wilson.
The web site for the American College of Nurse Practitioners can be found at http://www.acnpweb.org