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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When Lawmakers and Physicians Hold Nurses Back

Editor’s Note: Toni Inglis, MSN, RN, CNS, FAAN, writes opinion for the Austin (TX) American-Statesman. She works at the Seton Healthcare Family in Austin as a neonatal ICU staff nurse and also writes a nursing blog for Seton and edits its monthly NursingNews. This article is a reprint of an April 22nd commentary in the Statesman. Toni was inspired to write the column after a particularly disappointing legislative session, in which Texas advanced practice nurses made fewer gains than in past sessions—despite Texas ranking last in access to health care and having the most restrictive laws in the country regarding APRN scope of practice and prescriptive authority. She believes the poor access and barriers to practice are related.

AJN finds the article particularly relevant as legislatures across the country deliberate on APRN barriers to practice. You can read her commentaries at ingliscommentary.com.

Here’s an idea that wouldn’t cost Texas a dime but would save millions of dollars every year: Remove all barriers restraining nurses from practicing to the full extent of their education and training.

No state needs primary care providers more than Texas, which has a severe shortage. Texas ranks last in access to health care and in the percentage of residents without health insurance. Of Texas’ 254 counties, […]

2016-11-21T13:10:43-05:00February 13th, 2012|health care policy, nursing perspective|0 Comments
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Enough with the Scare Tactics: Some Follow-Up on the IOM Report on the Future of Nursing

Shawn Kennedy, AJN’s interim editor-in-chief, already posted here about the importance of the recently released Institute of Medicine Report on the Future of Nursing. Its implications are particularly profound at a time when we have a scarcity of primary care providers—and also at a time when the Affordable Care Act (i.e., health care reform) has designated more resources to nursing education and to generally making better use of nurses’ expertise. A number of bloggers have written about the IOM report, several of them expressing chagrin about the predictably naysaying American Medical Association response. Rebutting the AMA, the Center for Health Media and Policy at Hunter College had this to say. One working NP who weighed in on this topic is Stephen Ferrara, who noted (almost two weeks ago, in fact, though we missed it until now) the real world implications of the current situation for NPs in New York State, in a succinct post on his blog, A Nurse Practitioner’s View:

The bottom line is (at least in NY where I practice), without a collaborating physician on record, the 14,000 or so NPs are unemployed and can’t legally do anything that we were trained or educated to do. It is time to remove these non-evidence based barriers and retrospective reviews and allow us to function as true partners on the health care team. Collaboration among providers would still continue to happen and I promise pigs wouldn’t start to fly. Fourteen states have already transitioned to to an […]
2016-11-21T13:15:10-05:00October 21st, 2010|career, health care policy, nursing perspective|0 Comments
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Doing the Doctoring–A Nurse Who’s Filling the Primary Care Gap for Needy Children

By Peggy McDaniel, BSN, RN

A while back, a poll on the AJN Website asked if PhD-prepared nurses should be addressed as “doctor.” My answer was an emphatic “yes!” Janie, an old friend of mine, just graduated with her doctor of nursing practice (DNP) degree this past spring. She recently opened up her own clinic, serving kids as a primary health care provider in Portland, Oregon. She is the inspiration for my vote, but her chosen path isn’t easy.

Janie is filling a void in Portland that few providers are willing to address. She’s called Dr. Janie, and she well deserves the title. I have been a foster parent here in Oregon for the past few years. The kids that enter foster care often come from neglectful and/or abusive situations. These children can be hungry, fearful, wary, dirty, sad, and often confused and angry. They also deeply crave a sense of safety.

The state requires that these children be seen within 30 days of entering foster care. Getting them seen is a huge challenge. The requirement is, in theory, a great idea—these children often have multiple medical and psychosocial needs that have been neglected. But I couldn’t find a clinic in Portland that would take a “new patient” with welfare insurance within that time frame. It was often days or longer before I would find out basic information such as allergies about the children I was asked to care for. As a nurse, I found this lack of information to be unsettling, […]

2016-11-21T13:17:28-05:00May 27th, 2010|career, nursing perspective|6 Comments
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