Thursday, September 24, 2009
A larger role for nurse practitioners
From the RoundTable blog
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Kristin H. Conrad
Conrad, of Radford, is an instructor at the Radford University School of Nursing.
I am writing in response to the Sept. 14 article "Primary doctor shortage foreseen," by Associated Press writer Steve LeBlanc. This article discusses the anticipated demand for primary care doctors. The writer states that as many as 40,000 doctors will be needed over the next decade to keep up with anticipated shortfalls due to health care reform.
LeBlanc writes "a raft of ideas has been proposed," including increasing primary care physician salaries and finding more money to repay medical school debt incurred by primary care physicians in training. No mention is made of utilizing advanced practice nurses to help meet the anticipated shortfall.
Advance practice registered nurses are ready, willing and well-qualified to fill gaps in patient care in the United States right now. These highly trained nurses are registered nurses with advanced education and clinical experience beyond the basic bachelor's degree in nursing. They generally complete a Master's degree, but many have additional degrees, such as a PhD in or a Doctor of Nursing Practice degree. APRNs work with patients across the lifespan, and may specialize in caring for different ages and different groups of people. For instance, there are family nurse practitioners, certified nurse-midwives and pediatric nurse practitioners, as well as geriatric, adult, acute care, psychiatric, neonatal and women's health nurse practitioners, certified registered nurse anesthetists and clinical nurse specialists.
As you can see, there is an APRN for almost everyone. In fact, there are almost 6,000 nurse practitioners providing care to the people of Virginia, in a multitude of sites across the state. Advanced practice registered nurses are dedicated, qualified and highly trained nurses who are ready to meet the nation's health care needs in their respective areas of expertise, including in primary care.
APRNs have a long history of providing excellent patient care in the United States. Many research studies have shown that APRNs provide safe and very effective health care to a variety of patients in a variety of settings. In one large review, "Substitution of doctors by nurses in primary care" (Laurant, et al., 2005), researchers looked at 16 studies, comparing nurse practitioner care to physician care outcomes. The authors concluded that, "appropriately trained nurses can produce as high quality care as primary care doctors and achieve as good health outcomes for patients."
Another study (Lenz, Mundinger, Kane, Hopkins, & Lin, 2004) looked at patients who two years previously were assigned randomly to either a physician practice or to a nurse practitioner care model. At the end of the two years, patients had no differences in their health status, their use of specialists, number of visits to the emergency room or numbers of admissions to the hospital. The patients also showed no difference, between the two groups, in satisfaction rates for their care. In other words, patients in one group had the same health status as patients in the other group, and both groups were just as happy about the care they received. There are many more studies supporting the safety and excellent care provided by advanced practice nurses.
Advance practice registered nurses, working in collaboration with physicians and other members of the health care team, can help meet our nation's health care needs. I encourage the people of the Roanoke area and New River Valley to speak to an APRN about his or her training, concern for helping others work toward a healthy future and about the gaps in health care that APRNs are ready to fill. It is of particular importance in rural areas, such as Southwest Virginia, to have enough care providers available. In this time of uncertainty, and in light of the upcoming primary care provider shortages, we need to consider using all our available resources, including advanced practice nurses, to meet health care gaps.
