Evidence Contradicts AAFP: NPs Ideal for Leading Patient-Centered Medical Homes

By Karen Roush MS, RN, FNP-C, AJN clinical managing editor

What will it take to end the turf war physicians are waging  against nurse practitioners? The latest foray is over who should lead patient-centered medical homes (PCMH). According to the American Academy of Family Physicians (AAFP), only physicians should. They insist that nurse practitioners do not have the knowledge or skills to do so and that expanding the NP’s role in primary care would create a “two-tiered health system,” with patients who are cared for by an NP receiving a lower level of care.

That’s not what the evidence says. Or patients for that matter. Studies consistently find that when care provided by NPs is compared to care provided by physicians, the care is similar as far as prescriptions ordered and referrals made—most important, outcomes are the same.

Well, there is one area where differences keep showing up: patient satisfaction. Patients consistently say that they are more satisfied with care provided by nurse practitioners. They say that nurse practitioners listen better, spend more time with them, and provide them with more information.

Not only are nurse practitioners capable of leading medical homes, their education and skills make them ideal for this role. Whereas physicians focus on pathology and have the depth of knowledge and skill to manage highly complex patients, NPs focus on the “human response to disease” and take a more holistic approach to patient care. Nurses coordinate care all the time, identifying […]

2016-11-21T13:09:11-05:00October 3rd, 2012|nursing perspective|4 Comments
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An NP’s Plea: Hold That Specialist

By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

Recently someone I know woke up in the middle of the night with severe foot pain. In the morning he headed to the ED, where he was diagnosed with a fracture of one of the sesamoid bones in his foot and sent to an orthopedist. Over the three days between the ED visit and the orthopedist appointment, the pain began to ease. At the orthopedist it was determined that the problem wasn’t that little sesamoid bone, but gout.

And then they sent him to a rheumatologist.

Why? The condition was already improving and he had no comorbidities. So, why the need for a specialist visit at a cost of $500 just to walk through the door as a first-time patient? A primary care provider should be competent to manage a straightforward case of gout—order and review bloodwork, prescribe medications, educate the patient about their diet, and follow up on their progress. Then if the patient doesn’t respond to treatment or anything unusual develops, call in the specialist.

This happens all the time. When I was first diagnosed with hypothyroid I was sent off to an endocrinologist (under protest). There was nothing unusual in my presentation and I had no comorbidities or […]

2018-03-28T10:35:59-04:00August 2nd, 2012|nursing perspective|5 Comments
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Nurse Practitioners Are Not ‘Physician Extenders’

By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

“Physician extender.” It’s way past time to kill that term.

A study published in the October issue of Surgery found that adding an NP to the surgical team decreased the number of unnecessary ED visits by 50% and increased the use of visiting nurse, physical therapy, and occupational therapy services. A Medscape article (registration required) on the study explained the importance of the findings in this way: “According to the researchers, physician ‘extenders,’ such as NPs, help maintain continuity of care while resident work hours are kept at a maximum of 80 per week. . . .”

Sure enough, the stated purpose of the study was to determine if “integrating this physician extender into the surgery team” would improve outcomes and resource allocation. Ouch.

Experts in our own right. Nurse practitioners are not physician extenders. We are highly skilled and educated nurses who provide evidence-based care grounded in the nursing model. We are not “extensions” of anyone. We are colleagues and collaborators, independent clinicians and experts in our own right. Our purpose is to provide comprehensive care, promote health, educate, and advocate. It is not to relieve interns, supplement physician education, or be the low-cost alternative when physicians have to “do more with less,” as Medscape quoted […]

2016-11-21T13:11:27-05:00November 11th, 2011|career, nursing perspective, nursing research|6 Comments
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Nurses Under the Influence of Pharma—Not Just an NP Problem

The danger of an NP succumbing to influence is obvious—she or he may prescribe for reasons (which may be on an unconscious level) other than clinical ones. The issues for nurses who do not prescribe medications are subtle and different. AJN's ethics columnist Doug Olsen did a two-part series exploring this last year—in January and February 2009. And AJN's editor-in-chief emeritus Diana Mason wrote on this even earlier, in an editorial in December 2000, noting, among other concerns, that "it's not unusual to see drug company underwriting of speakers at nursing conferences; of course, the topic addressed is almost always related to one of the company's top drugs."

2017-02-02T12:17:38-05:00July 1st, 2010|career, Ethics, Public health|1 Comment
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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