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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.

American College of Nurse Practitioners

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.  

http://www.aanp.org/...

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

Originally posted to Daily Kos on Sun Aug 02, 2009 at 06:00 AM PDT.

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Comment Preferences

  •  Thanks.... (4+ / 0-)
    Recommended by:
    Maudlin, OLinda, Mol, tardis10

    my son is planning on being an NP, he is already an RN. I will tell him about this post.

    •  Maybe the program I teach in is unusual, but (1+ / 0-)
      Recommended by:
      Caoimhin Laochdha

      our undergrad BSN program is 19% male. I think the gender balance is changing, and I welcome it. Thanks for delineating all the various NP roles and titles.  Nice work.

      Is there a plan for something similar on nurse-midwives?  CRNAs?  There is even more misunderstanding about the role of nurse-midwives.  I am no longer practicing as a CNM, but when I did, most responded to the news that I am a midwife by assuming I did home birth, and should be some sort of aging hippie.  They were very surprised to find out I had hospital privileges, could order labs, ultrasounds, epidurals and knew a lot about/ provided extensive gynecological care.

      Can someone think of a way to do a diary on the superb outcomes obtained by NPs and CNMs?

  •  You are welcome (5+ / 0-)

    I appreciated this opportunity to share the good new s about NP's.  As of 2008, only 6% of nurses were men and the percentage among NP's was about the same.  We need a more balanced profession.  

    •  this is Dr Wilson (4+ / 0-)
      Recommended by:
      Maudlin, madaprn, MissInformation, quadmom

      who can hang out for an hour or so (no more) and respond.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 02, 2009 at 06:30:39 AM PDT

      [ Parent ]

    •  Thank you Dr Wilson (3+ / 0-)
      Recommended by:
      Maudlin, Caoimhin Laochdha, tardis10

      I wince every time I hear a discussion or position paper about healthcare reform that fails to include advanced practice nurses and nurses in general. My education and training as a family nurse practitioner focused on primary care using a holistic rather than strictly medical model. Studying effective health promotion is underrated and barely reimburseable in our present fee for service healthcare delivery system which ostensibly values amputation of gangrenous limbs more than finding the health promoting interventions that would prevent the onset of type 2 diabetes 20 or 30 years prior to the amputation.  

      There are many sttudies documenting the efficacy of NP primary care starting with Mary Mundinger's outcome study in the January JAMA of 2000 ( JAMA. 2000;283:59-68.)

      I hope our professional and academic organizations do come to a consensus on healthcare reform and advocate for a single payer system.  A substantial part of our daily lives including time and resources is spent on navigating and negotiating the hurdles to care placed by insurance companies especially in regards to nutritional counseling and mental health. Where are the studies demonstrating their good health outcomes with the present systems of delay and deny?

      "And tell me how does god choose whose prayers does he refuse?" Tom Waits

      by madaprn on Sun Aug 02, 2009 at 07:24:30 AM PDT

      [ Parent ]

  •  Disappointing. (1+ / 0-)
    Recommended by:
    Caoimhin Laochdha

    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.

    "YES WE CAN" doesn't mean he is going to. ~~Daily Show

    by dkmich on Sun Aug 02, 2009 at 06:25:14 AM PDT

  •  nurses often have a lot more hands on contact (2+ / 0-)
    Recommended by:
    quadmom, Justanothernyer

    than doctors do. What I observe as a patient is that most common primary care diseases can be diagnosed, prescribed and tracked by nurses with the internist, woman's health, pediatrician, Primary Care Doctor's role reduced to that of consultant and specialist.

    Nurses handle patient care, testing, phlebotomy, mri, cat scans, vitals, and pharmeceutical prescriptions.

    Talking to them many say they would be open to more self help by patients and computer monitering of critical functions like glucose levels, blood pressure, weight and caloric intake at home with access for the nurse or physician by PDA.

    Take away the administrative paperwork required to cover one's ass against malpractice and to get approvals for care and payment by insurance companies and doctors might actually reclaim some of the practice they originally entered the profession to engage in.

    Live Free or Die --- Investigate, Incarcerate

    by rktect on Sun Aug 02, 2009 at 06:34:27 AM PDT

    •  why would you think NPs are immune to this? (3+ / 0-)
      Recommended by:
      rktect, stitchmd, quadmom

      Take away the administrative paperwork required to cover one's ass against malpractice and to get approvals for care and payment by insurance companies and doctors might actually reclaim some of the practice they originally entered the profession to engage in.

      Plagues everyone who treats patients

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 02, 2009 at 06:39:34 AM PDT

      [ Parent ]

      •  We aren't (5+ / 0-)

        The paper work, administrative hassles, etc. take away from patient time.  For NP's there is an added dimension in the billing nightmare - "incident to".  When we bill under our own name and number, we are reimbursed at 85% of ususal and customary, but if we bill "incident to" a physicians care, the office gets 100%.  There are some specific guidelines for this coding, though, and NO ONE wants to commit fraud.  So our care is deemed less valuable, because of a reimbursement regulation.

      •  Because with a public option (1+ / 0-)
        Recommended by:
        quadmom

        and retainer type coverage you don't need to get approvals, its covered.(period) You don't need to fill out dozens of different types of forms all asking for basically the same info, its in the computer already like with the VA. I have a VA ID card. As soon as its swiped and the practitioner enters their user ID and password my whole medical history comes up on the screen. All it takes to refill aprescription is a phone call. Take it a step further. Some of the PA's I worked with were already buying medical supplies in national group order bulk. That lowers everybodies cost.

        Lower everybodies cost enough and more things can get covered. If patients can be enabled to do their own vitals at home and it saves a checkup, whats that worth in terms of reception, check in, check out, billing, doctors time, nurses time, medical supplies?

        Live Free or Die --- Investigate, Incarcerate

        by rktect on Sun Aug 02, 2009 at 10:15:00 AM PDT

        [ Parent ]

        •  Point being that it helps everyone (3+ / 0-)
          Recommended by:
          rktect, Nina, quadmom

          NP, PA, DO, MD. ...

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Aug 02, 2009 at 10:18:49 AM PDT

          [ Parent ]

          •  Yes even those who think they like their coverage (0+ / 0-)

            I expect they would be blown away to see what could be done if medical care got back to being about what the patient needed and not what the billing would cover or require to avoid any chance of malpractice.

            I can even imagine patients being enabled to monitor themselves and adjust their diet and exercise rather than pop a pill. I can see employers being given tax breaks for helping employees get the right nutrition and exercise at work. I can imagine families getting tax breaks the way drivers get their insurance for less when they maintain a clean driving record.

            Live Free or Die --- Investigate, Incarcerate

            by rktect on Sun Aug 02, 2009 at 11:00:02 AM PDT

            [ Parent ]

  •  Another provider group c "no position" on reform. (2+ / 0-)
    Recommended by:
    Nina, Caoimhin Laochdha

    The AMA spends a lot on lobbying against health reform but many other health care provider organizations (Pediatric MD's, PA's and now NP's) "take no position".

    Disappointing since they are directly involved and many times have to negotiate with the insurance bureacracy that controls access to services.  Understandable to some degree in that taking a stand on reform could split organization whose focus is on organizing their specialty.

    Still you would think the organizations with members on the front line of health care would have some ideas on what is needed for reform vs. sitting on the sidelines. Even analyzing each proposal on what they think will work and not work.

    •  As a representative body (2+ / 0-)
      Recommended by:
      Nina, quadmom

      It is also a question of membership ...

      Your point about not splitting membership is a good one.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 02, 2009 at 08:32:12 AM PDT

      [ Parent ]

      •  AMA vs. California Nurses. (5+ / 0-)
        Recommended by:
        Maudlin, Nina, Caoimhin Laochdha, quadmom, Mol

        In many ways AMA was first and foremost a political lobbying group and has been a bad actor from day one. AMA lobbying government to kill the public health visiting nurses program is best example.

        California Nurses are the opposite side of the spectrum, politically involved and pushing for single payer.

        I wonder if it wouldn't be better to let the membership split over the delivery system, at least we would have clear voices and solutions offered by the front line practitioners.  From that would likely come some good ideas.

    •  Actually, it's a strong and important position. (6+ / 0-)

      With this argument --

      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.

      The NP community has unified around a call for the American healthcare system to recognize the primary care they provide to patients as equal in quality to that provided by physicians.

      In effect, they are asking that various forms of economic and other discrimination against their profession, in favor of physicians, end under the reform legislation. That is an important issue and their decision to focus 100% on the issue makes a lot of sense.

      I've had tremendous respect for non-physician primary care providers since my experience with U.S. Navy hospital corpsmen during the Viet Nam War. I was lucky enough to avoid combat, but fell seriously ill three times, once as an enlisted man, once as an officer candidate and later as an officer. All three times an MD flubbed the dx and prescribed generic palliatives for emergent conditions. All three times a corpsman petty officer made the right call, covered the doctor (officer) and got me treated correctly.

      During those same years my brother was an enlisted man in the Army Medical Corps and the Surgeon General Corps at Walter Reed. So, for all the years since, I've paid attention to the non-physician primary care providers I've encountered and my respect for the quality of care and treatment they afford their patients remains undiminished.

      The discrimination against nurse practitioners and other non-physician primary care providers that exists in many corners of the system we have now violates the fundemental American principle of equal pay for equal work and is invidious. I applaud the nurse practitioner community for taking a stand against it and forgive them for not weighing in on public option, single payer, etc.

      "If you are going to tell people the truth, be funny or they will kill you." Billy Wilder 1906 - 2002

      by LeftOfYou on Sun Aug 02, 2009 at 08:53:30 AM PDT

      [ Parent ]

      •  I think you miss point. No position on reform (2+ / 0-)
        Recommended by:
        Nina, quadmom

        of the health care system by the organizations of front line health care providers such as nurse practioners, physicians assistants and pediatric MD's.

        These organizations, on the other hand, are very political as their status as providers is determined politically by state and Federal regulatory agencies

        They lobby strongly for their position in the system but then bail out on the systems negative effect on the patients (and themselves).

        I suppose better no position than to be like the AMA which has been a very negative influence on US health care beginning with it's successful drive to eliminate the public health visiting nurses which provided basic home care to the poor but which doctors felt infringed on their money making prospects so AMA killed it.

        •  The American Nurses Association is For (0+ / 0-)

          universal health care and -- favors single payor.   The ANA is the largest credentialling body for nurse practitioners so while the amercian College of Nurse Practitioners does not have a formal position their largest credentialling body does.  

  •  As a paramedic trainee (2+ / 0-)
    Recommended by:
    Nina, Caoimhin Laochdha

    looking to go on either to nursing or becoming a PA I have to say, I HATE the term "Physician Assistant." It sounds like a PA is there to get the Doctor's coffee and pick up his dry cleaning. (And we all know that that's what interns are for!) (Just kidding.)

    Really, we need to devise new terms for the entire field of clinical medicine practiced by non-doctors.

    Since what a typical PA or NP does today is often more technical and medically complex than an actual doctor could ever imagine even 50 years ago, it's demeaning to presume that such practitioners are just "assistants." And since doctors now have to specialize far more than they ever used to -- not because they are going for those lucrative "specialist" dollars (though there IS some of that) but simply because every field of medicine presents ten times as much information to master today than it did a generation ago...specialization is the only way to do your job, really.

    I'm thinking Physician Associate or Practitioner Associate (the second more obscure, but both maintain the PA acronym). Or possibly Associate Practitioner.

    Even NPs might consider changing to such a name since a lot of patients still presume a "nurse" (of whatever level) is something less than a doctor.

    Just a thought.... any feed back?

    •  I could go even further as there are many RN's (3+ / 0-)
      Recommended by:
      TiaRachel, Nina, Caoimhin Laochdha

      today who perform more complex proceedures then physicians did 30 years ago. Health care is changing and I am disappointed that the NP associations have neither developed a position paper on Health care reform or even pandemics. If NPs and PAs have not developed these papers soon they will be left out of the change and I know the AMA would not be to sorry to see this happen. While at it, the Mental Health NP's need to become more active in the abusive changes occuring in mental health (sponsered by the pharmacuticals) The changes being made to promote pharmacutical companies profits should be considered pure malpractice.

      I get along just fine with God. It's his fan club I have significant problems with.

      by utopia on Sun Aug 02, 2009 at 09:06:25 AM PDT

      [ Parent ]

  •  Thank you, Dr. Wilson.... (2+ / 0-)
    Recommended by:
    Maudlin, quadmom

    I've probably missed him - but wanted him to comment on stand-alone Nurse Practitioner Practices....and what it would take to expand that across the country....as a means to helping alleviate problems with access to healthcare.

    I know that a couple of the NP faculty I worked with have started their own clinics.  But they don't get enough press to show the public that that is a very viable solution.

    •  I was very impressed with my NP. (0+ / 0-)

      I had a semi-urgent medical problem, but the doctor I tried to become a new patient of wasn't available, so I saw the NP instead.  If I hadn't known she was a NP, I would have thought she was a doctor, she was that good.

      "Jeers to republicans who can't even write a good love letter, no wonder all the bills they write suck" - Irish Patti

      by Maudlin on Sun Aug 02, 2009 at 12:04:38 PM PDT

      [ Parent ]

  •  What is it, exactly, that a (0+ / 0-)

    nurse practitioner can't do that a primary care physician can?

    •  Nurse Midwives don't do C-Sections (0+ / 0-)

      and will refer certain high risk patients to OB's.
      In Primary Care, there isn't much difference between physician and NP.

      Here in America, our destiny is not written for us - it's written by us. Barack Obama 9/28/08

      by quadmom on Sun Aug 02, 2009 at 10:48:43 AM PDT

      [ Parent ]

    •  As a patient who has seen nurse practitioners (1+ / 0-)
      Recommended by:
      Maudlin

      I can tell you that there are many drugs that nurse practitioners cannot prescribe.

      What's the point of seeing, for instance, a NP at a drug store, i.e., Walgreen's, if they're not allowed to prescribe what the patient needs.  It's a true waste of time and money.

      For convenience, I recently saw a NP at a local Walgreen's 1 mile away, instead of traveling to see my Board certified in internal medicine doctor.

      I was charged $66.00, and still wasn't able to be treated for my particular problem and was advised to make an appointment to see my doctor.

      Health ins. is antiquated like the typewriter & pager. People don't retire from their 1st job & more people are self-employed. No more $ to CEOs. Inves

      by gooderservice on Sun Aug 02, 2009 at 12:04:28 PM PDT

      [ Parent ]

    •  Practice varies by state (0+ / 0-)

      In many states an APRN primary care and physician primary care will be similar for many patients.  

      This is particularly the case in managing chronic conditions, for instance.

      Some states restrict prescribing privileges for APRNs while other states do not have a restricted formulary from which they may prescribe.

      In many rural areas, APRNs provide health care access that would not be otherwise available.

      sláinte,

      cl

      Religion is like sodomy: both can be harmless when practiced between consenting adults but neither should be imposed upon children.

      by Caoimhin Laochdha on Sun Aug 02, 2009 at 04:45:03 PM PDT

      [ Parent ]

  •  Oh, doctor, doctor... (0+ / 0-)

    I have to admit being a bit skeptical about the god-like qualities of physicians.  I am a physicist--with a PHD (I call it Polish Horse Doctor) who worked for a time in the 70's in a hospital environment.  Back then I read Solzhenitzin's 'Cancer Ward' where a female clinician was working on her doctorate in order to be a 'real doctor'.  I was amused then, and continue to be, as many physicians continue to believe that medical school is so much more than a professional trade school.  Sure we need them, as we surely need lawyers and accountants.  They certainly enjoy center ring status when we are sick, no argument there, but the physicians really are just another profession that needs to be under regulation.  This is why I particularly savor a doctorate in the very important fields of nursing and nursing practioning.  Physicians simply have no monopoly on medical knowledge.

  •  Well, NPs and PAs are invaluable in my state.... (1+ / 0-)
    Recommended by:
    Maudlin

    Not many physicians want to work or live in Podunk, Utah....tho they are desperately needed.

    The program I worked with also had a psych/mental health nurse practitioner program.  Talk about invaluable.

    It was the RNs from a particular county in eastern Utah that lobbied for the program.  They simply could not attract a psychiatrist to either live or have regular hours at the local clinic.

    If they needed to refer patients to see a physician - they'd have to wait until residents and interns from the School of Medicine could rotate out to the hinterlands to see them.  And it is a three hour drive each way to the big city.

    You think primary care is lacking in rural America?  Try psych/mental health care.  It's pretty much non-existent.

  •  Why do NP organizations feel the need to lie? (0+ / 0-)

    A cursory glance at 2009 match data here:

    http://www.nrmp.org/...

    shows that 46% of medical school graduates chose family medicine, internal medicine or pediatrics. There is absolutely no way to go from that fact to the 7% figure claimed by the gentleman above. This isn't the first time I have seen NP lobbying organizations mislead or exaggerate evidence in order to further their cause.

    I find it disconcerting that they would use our current crisis to push for 100% autonomy, but I am not surprised at all. Mary Mundinger has been hell bent on equating nurse practitioners with physicians for quite some time now.

    This is just another naked power grab. The solution to our healthcare woes is not to create entirely new professions out of mid-air and simply pay them less, that doesn't help anyone. Nurse practitioners need to push for a more cohesive regulatory and legal regime, and are in dire need of more uniformity among the different schools. 100% online DNP courses currently exist; this is utterly unacceptable.

    Until we can guarantee patient safety they should not be awarded full practice autonomy, it is simply irresponsible.

    •  Differing statistics (1+ / 0-)
      Recommended by:
      Mol

      I didn't realize I would be called a liar, but I guess that is the world blogging.  I think we may have two different set of statistics.  Yes, 42% of the family practice residencies were filled in 2009 - the lowest percentage of resident slots.  On the other hand, a study released this last year indicated that less than 2% of medical school graduates ACTUALLY plan on practicing family medicine.  While it is only a news story, the data is there to support it and it wasn't hyped by an NP group.  Truth is, if it weren't for foreign medical school graduates many of the residencies would go unfilled.

      http://www.msnbc.msn.com/...

      A naked power grab?  Spoken from one who has the power and will fight to the death to keep it?

      As to the last comment, PLEASE produce your data proving NP's are unsafe.  I have yet to see one single piece of evidence.  

      •  Here is the study NEJM (0+ / 0-)

        Found the study in the New England Journal of Medicine.  Seems like a reliable source. Check Chart B on page 1 - about 7% of the matches were for primary care.  

        •  I don't see a link to the NEJM article... (0+ / 0-)

          So I can't really comment on what you're saying. I am simply looking at the data from the 2009 match, which clearly shows 46% going into a primary care field: pediatrics, internal medicine or family practice. And that MSNBC article only mentions internal medicine, apparently ignoring family practice entirely (which is the true descendant of the old GP anyway). Regardless, it's patently ridiculous to take the 7% figure seriously, let alone this 2% number you are mentioning now. I still don't see a link to back up that figure.

          I am not disputing that nurse practitioners have a role in our system. I am not even disputing that most of them are probably qualified to be primary care providers for many patients. My main concerns are:

          1. uniformity and adequacy of education
          1. uniformity in licensing standards

          As it stands right now, there are several 100% online only DNP curricula. There is little standardization in curricula across the country. Do you dispute that these facts render many programs inadequate to provide the necessary knowledge-base upon which to build a career being the primary caregiver for a patient?

          Lastly, we should not rush to grant new authority to practitioners solely because a certain area may have a greater need for medical care. Before legislating that new authority comparative studies should be done to determine the safety of NPs as primary caregivers for patients. One study published ten years ago by the person with the biggest conflict of interest is not adequate research. I cannot give you studies showing NPs are unsafe because we really don't know yet, and that's the whole point. Their full autonomy in certain states is still a very new thing.

          Respectfully,
          meisterMD

  •  I would rather go to a Nurse Practicioner (0+ / 0-)

    than a GP for my basic health care.  They take their time and they are very experienced.

  •  Proud of my mom (3+ / 0-)
    Recommended by:
    DemFromCT, Maudlin, Mol

    My mom went to work for the NYC Dep't of Health in 1968 after the death of my father.  A few years later, she was chosen for the first NP program in NYC (at least for NYC-employed nurses) at Cornell-New York Hospital Medical Center.  The City sent her and a number of her colleagues to the one-year, full-time program in Pediatrics. Upon their graduation, their title was Pediatric Nurse Associate. The City, long well known and respected as a leader in public health, invested in this training, paying all expenses and keeping all participants on the payroll.  She retired in the mid-1990s, after many years at Jamaica Health Center, the NYC Public Schools and finally Worth Street HQ as an administrator.  She taught me that the best hospitals are those with the best nursing staffs.

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