Bold Solutions, Not Tired Turf Battles
Susan B. Hassmiller, PhD, RN, FAAN, is senior adviser for nursing at the Robert Wood Johnson Foundation, and director of the Future of Nursing: Campaign for Action.
On Thursday, New York Times blogger Pauline Chen, MD, took a fresh look at the disagreements over the services that advanced practice registered nurses should be authorized to provide, reporting on a primary care meeting at which a doctor dared to raise “the unmentionable” topic with his colleagues. The room, she reports, erupted into discord and chaos.
The same divide was documented in a survey reported by the New England Journal of Medicine in May. It is a terrible shame. What we need, now more than ever, is open and reasoned conversation within and between health care fields about the best way to provide high quality care and improve our population’s health.
These are challenging times for our health care system. Millions of Americans are about to gain insurance through the Affordable Care Act. Our population is getting older and living with more chronic illnesses. And we have an urgent need to promote prevention, improve quality, and contain costs.
There is no question that we need more physicians and more primary care physicians in particular. There is no question that physicians should treat the sickest patients and those with the most complex health problems. But there also is no question that we need nurse practitioners to be able to practice to the full extent of their education and training.
There is a large and growing body of evidence that shows nurse practitioners are as effective as physicians in a number of key areas, including patient education, consultation time, patient follow-up, and patient satisfaction. Nurses also are the only providers available in many rural and underserved communities.
Consumers are open to nurse-led care. A survey commissioned by the Association of American Colleges of Medicine, published in the June issue of Health Affairs, found that about half of the respondents preferred to have a physician as their primary care provider. However, when they were presented with a scenario that described an option to see a nurse practitioner or physician assistant sooner than a physician, most elected to do so rather than wait.
When antiquated laws prevent highly educated nurses from doing all they are trained to do, patients wait needlessly for prescriptions they need, get their test results – and thus their follow-up care – later than necessary, and many do not learn the best ways to avoid and manage their diseases.
Nobody gains when that happens. That’s why, in more and more states, lawmakers and courts are stepping in to ensure that nurse practitioners can practice to the full extent of their education and training.
But state by state advances will be painfully slow. We need bold solutions and real consensus, not tired turf battles. Let’s all agree that nurse practitioners are a vital part of the solution as we search for ways to expand access to primary and preventive care in this country.