Expanding roles of nurse practitioners stir controversy

As the reality of the nation's shortage of primary-care physicians sinks in, a growing number of states are looking beyond the daunting task of finding more physicians and considering the roles of other types of caregivers.

To be exact, 28 states are considering expanding the role of nurse practitioners to fill the void left by physician shortages, reports the Associated Press. But while advanced-degree nurses, who claim they've long been undervalued, cheer the opportunity, critics, including the American Medical Association, caution that broadening nurses' authority could pose a danger to patients.

The best U.S. study, according to the AP, comparing nurse practitioners and doctors randomly assigned more than 1,300 patients to either a nurse practitioner or a doctor. After six months, overall health, diabetes tests, asthma tests and use of medical services like specialists were essentially the same in the two groups.

The difference between NPs and physicians, argues Daniel Lucky of Modesto, Calif., an NP adjunct nursing lecturer with University of Southern Indiana and adjunct faculty for Indiana State University, is not a matter of qualifications, but rather approach. "NP practice is based on the nursing model of care--not the medical model," he wrote in a commentary for the Evansville Courier Press. "Nursing teaches us that we should not reduce human beings to mere signs and symptoms, place a disease label on someone, give them a pill and send them off. As nurses we are trained to look at the entire patient from a holistic perspective and then, actively partner with the patient and family to not only correct problems, but also enhance optimal health. Nursing care places the patient--not the provider--as the central focal point."

Current state laws vary as to what NPs can and cannot do. In Massachusetts, for example, a 2008 state law requires health plans to recognize and reimburse nurse practitioners as primary-care providers. In Montana, nurse practitioners don't need a doctor involved with their practice in any way, whereas NPs in Florida and Alabama are prohibited from prescribing controlled substances. New legislation in Maryland maintains the need for NPs to collaborate with physicians but shortens their credentialing process to about a month, reports the Baltimore Sun.

The new national healthcare law also expands the role of nurses, with 10 percent bonuses from Medicare from 2011 to 2016 for primary-care providers, including nurse practitioners who work in areas where doctors are scarce.

To learn more:
- read the Associated Press article
- check out this community comment in the Evansville Courier Press
- read this piece in the Baltimore Sun