National Governors Association Report: Quality of Care From NPs Comparable to That of Docs
A recent report from the bipartisan National Governors Association (NGA) highlights the need to reduce state scope-of-practice barriers for nurse practitioners (NPs).
The conclusion rested on a comprehensive literature review of relevant research, spanning several years. The NGA focused its review on studies that addressed the quality of NP care and patient satisfaction with that care, as well as state regulation of NP scope of practice. Among the NGA's findings from the reviewed studies:
- "Most studies showed that NP-provided care is comparable to physician-provided care on several process and outcome measures. Moreover, the studies suggest that NPs may provide improved access to care."
- "Research suggests that NPs can perform many primary care services as well as physicians do and achieve equal or higher patient satisfaction rates among their patients."
- "NPs rate favorably in terms of achieving patients’ compliance with recommendations, reductions in blood pressure and blood sugar, patient satisfaction, longer consultations, and general quality of care."
- "[O]ne 2003 review found that NPs are more likely to serve underserved urban populations and rural areas, and a 2009-2010 American Academy of Nurse Practitioners national sample survey showed that roughly 18 percent of the respondents indicated that they practiced in rural areas."
The NGA concludes, "To better meet the nation’s current and growing need for primary care providers, states may want to consider easing their scope of practice restrictions and modifying their reimbursement policies to encourage greater NP involvement in the provision of primary care."
Poor Work Environment Reason for Mortality Rate Differences in Settings Using Agency Nurses
A new study from researchers at the University of Pennsylvania School of Nursing and elsewhere finds that higher mortality rates sometimes associated with the use of agency nurses to fill staffing gaps are principally attributable to poor work environments at the hospitals, not to the agency nurses. The study was published in December in an online edition of Health Services Research.
The research team ran statistical analyses using 2006 survey data from 40,000 registered nurses working at 665 hospitals in four states, as well as mortality data on those hospitals from state agencies. They found that hospital use of agency nurses was associated with higher mortality and failure-to-rescue rates. But when they fine-tuned their analysis to adjust for the quality of the hospital work environment as judged by the survey of nurses, they concluded that work environment, not agency nurses, was the driving force behind the differences in patient outcomes.
The authors wrote, "The seemingly negative effect of greater use of agency-employed supplemental registered nurses on patient mortality and failure to rescue may have less to do with the characteristics of the supplemental nurses than the characteristics of the work environments in the hospitals in which they are employed.” The evaluation of workplace environment focused on such issues as nurse participation in hospital affairs; nurse managers' ability, leadership, and support for nurses; adequate staffing and resource allocation; and collegial nurse-physician relations.
The study’s authors included Linda Aiken, PhD, FAAN, FRCN, RN, professor of sociology and nursing and director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania; and JingJing Shang, PhD, assistant professor at the Columbia University School of Nursing.