Struggle continues over expanded role for nurses

Despite policy analysts calling for more liberal scope-of-practice regulations for nurse practitioners to meet growing demand, new research reveals a nurse-doctor disconnect over giving NPs more professional leeway.

Physicians and nurses not only perceive their primary care roles and skills differently, but also the effects of expanded NP roles on cost and care quality, according to a survey of 972 clinicians published yesterday in New England Journal of Medicine.

Researchers from Massachusetts General Hospital found more than 66 percent of surveyed physicians agreed that doctors provide a "higher quality of examination and consultation" than NPs, while more than three-quarters of the surveyed NPs disagreed.

Moreover, 77 percent of NPs reported their expanded role would reduce costs while only 31.1 percent of doctors expect costs savings from expanded NP roles, Medscape Medical News reported.

Organized medicine has been encouraging nurses to obtain higher degrees in order to expand their clinical reach, according to an NEJM health policy report published today. With that in mind, the American Association of Colleges of Nursing (AACN) has seen enrollment in master's programs balloon to 67 percent over a five-year period and admission to practice-focused doctorates soar a whopping 955 percent.

The NEJM survey also found NPs were more likely than physicians to agree that NPs should lead medical homes and receive equal payment for the same clinical services.

The latter issue remains a point of contention for caregivers. In fact, a recent Medicare Payment Advisory Commission (MedPAC) recommendation to erase inequities between physician and advanced nurse practitioner pay for performing higher-level services generated heated debate among readers.

Amid the controversy surrounding scope of practice, the industry will likely see an expanded supply of NPs: Nurse practitioner jobs are expected to grow 94 percent from 128,000 in 2008 to 244,000 in 2025, according to a study published in the July 2012 issue of Medical Care.

For more:
- here's the NEJM study
- check out the health policy report
- read the Medscape article

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