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Back Letter to the Editor Nurse practitioner responds to column

Nurse practitioner responds to column

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RECENTLY, an MD wrote a column (Doctor’s Notes, “Finding Dr. Right” by Dr. Chen Huang, 3.13.2012) that listed several qualities to be possessed by a good healthcare provider. The advice on this subject was noteworthy, thoughtful, and beneficial. However, the article contained some incorrect information regarding the role of advanced practice registered nurses. Specifically, the author wrote that a nurse, a nurse practitioner and a physician assistant are all to be considered as "physician-extenders." The term ‘physician extender,’ when applied to an advanced practice registered nurse (APRN), is demeaning, derogatory and wrong. We are not physician extenders any more than a doctor is a ‘nurse extender!’

Advanced practice registered nurses have their own theoretical foundation which is holistically developed for the purpose of treating an entire person; Medicine’s approach is generally to treat the ailing or inadequately-functioning part of a person. Unfortunately, most MDs/DOs are ill-informed about the philosophy and goals of APRNs. As an aside, some medical schools have recently recognized a weakness in medical education and require that a medical student spend some time performing nursing functions and absorbing nursing constructs.

APRNs are acutely aware of the scope of their practice and will not treat conditions for which they are not trained. Like other peer professionals in primary care, an APRN will refer to experts when an issue is outside of their area of expertise.

Primary care, the kind of care sought initially for many complaints, is provided both by APRNs and by physicians. Interestingly, multiple studies have shown that patients rate their level of satisfaction with an APRN higher than for a physician, reportedly due to the longer amount of time spent taking a history; the slower more seemingly detailed, physical examination; and the patient-centered treatment planning. The cost of APRNs is also lower than for physicians; in the physician’s defense, HMOs and other budget-conscious entities have severely impacted the manner in which a physician may interact with a patient.

Finally, the article goes on to say, “While nurses and nurse practitioners are great working under the direct supervision of a doctor, they are not qualified to give independent opinions and advise you regarding your diagnosis, your care, the appropriateness of it, or the directions your care should take.” This statement is inaccurate and, unfortunately, shared by many in the organized medical community.

Below is the description of the scope of practice from the American College of Nurse Practitioners:

Nurse practitioners (NPs) are registered nurses who are prepared, through advanced education and clinical training, to provide a wide range of preventive and acute healthcare services to individuals of all ages. Today, NPs hold a master’s degree. NPs take health histories and provide complete physical examinations; diagnose and treat many common acute and chronic problems; interpret laboratory results and X-rays; prescribe and manage medications and other therapies; provide health teaching and supportive counseling with an emphasis on prevention of illness and health maintenance; and refer patients to other health professionals as needed.

NPs are authorized to practice across the nation and have prescriptive privileges, of varying degrees, in 49 states and on Guam. Nurse practitioners perform services as authorized by a state's nurse practice act. These nurse practice acts vary state to state, with some states having independent practice for NPs (not requiring any physician involvement), some with collaborative agreement required with a physician.

There is a shortage of professionals in primary care. This drives up the cost of medical care and delays patients receiving needed treatment. NPs are uniquely qualified to provide this care and are not in competition with MDs. Those states that require that a nurse collaborate with a physician experienced tremendous pressure from the medical lobby to disallow APRNs to practice independently. Doctors feared that the quality of health care would decrease and also that NPs would compete for the money. This has proven to not be the case and it is time for all to embrace the independent practice of APRNs.

As an APRN, I welcome dialoguing productively with physicians toward the provision of the best possible care for all who seek it.

Judith Avery,
APRN-BC,PhD
Tamuning

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