We’re All in This Together: Let’s Bridge the Gap, Not Widen It

May 12, 2014, 4:14 PM, Posted by Beth Toner

Kathleen Hickey

At the end of April, the New York Times published an op-ed by Sandeep Jauhar, a cardiologist who—reacting to a New York bill granting nurse practitioners the right to provide primary care without physician oversight—argued that in primary care, “there will always be subtleties and complexities that demand a doctor’s judgment.”

His conclusion? “If we want more primary care providers, let’s have them be doctors”—and, he added, “let’s find a way to increase their pay.”

His column re-ignited a firestorm of debate on the role of physicians, nurses and other health professionals. I won’t reiterate those arguments; instead, here are just a few samples of the response it generated:

  • The co-presidents of the American Association of Nurse Practitioners responded to the op-ed with a letter of their own.
  • A pediatrician from New England, writing for The Daily Beast, argued in favor of nurse practitioners caring for patients without a physician’s supervision.
  • A guest contributor to the Incidental Economist took Jauhar to task for citing only one study in support of his contention that nurse practitioners actually drive up health care costs. (In 2010, Health Affairs published a much more comprehensive review of available research on the effectiveness of nurse practitioners.)
  • Maureen Shawn Kennedy, American Journal of Nursing’s editor-in-chief, reminded Jauhar that “medical care is only one aspect of health care.”

As National Nurses Week draws to a close, I find myself reflecting on Jauhar’s op-ed, the widely varying reactions it produced, and my own experiences as a registered nurse working alongside nurse practitioners.

2014 National Nurses Week Official Logo

I volunteer at a free clinic for the uninsured in relatively wealthy Chester County, Pennsylvania. There, registered nurses and nurse practitioners work together to serve the “hidden poor” in our community. In this small, nurse-run clinic, I have seen firsthand what we can accomplish by working as a team. Together, we brainstorm ways to help our patients hurdle seemingly insurmountable obstacles to good health. Every day, we learn something from each other—and from our patients.

As I thought about those patients, I came to two conclusions:

  • We must to continue to focus on standardizing nurse practice acts across the United States and, yes, removing unnecessary restrictions on scope of practice. Doing so will not cause registered nurses or advanced practice nurses to take on care responsibilities for which they aren’t trained. As Maureen Shawn Kennedy pointed out: “To assume that nurses will venture to practice beyond their capabilities and training is akin to assuming that internists are likely to attempt heart surgery.”
  • We must focus on constructive dialogue, rather than divisiveness, as we contemplate the future of primary care in this country. Instead of defending our territories, let’s focus on how health care teams can work together to solve our overburdened primary care system, a problem that will ultimately take its toll on patients—those that we as health care professionals have vowed to serve.