Taking nurses beyond the basics

Nurses across the United States are throwing their support behind state legislation that would allow nonphysician providers to practice independently of physicians, thereby helping fill voids left by the physician shortage.

In fact, thanks to some broader mandates proposed around the country, tens of thousands of nurses could run their own primary care practices, according to The Washington Post. About 6,000 nurses operate independent primary care practices.

With the scope of practice expanding and the number of nurse-run practices growing, pressure is mounting for the U.S. healthcare system to embrace more high-level roles for nurses in delivering care

Across the pond, that's not the case. Nurses in the U.K. will be getting sent back to basics, thanks to a pilot program requiring that aspiring nurses spend up to a year on basic care tasks, such as washing and dressing patients, before they can apply to become a nurse.

The program stems from a February report from the Mid Staffordshire NHS Foundation Trust Public Inquiry that linked a "lack of care, compassion, humanity and leadership" to 1,200 unnecessary patient deaths at Mid Staffordshire Hospital.

The Inquiry's report took particular aim at nurses and nursing leaders, stating, "As a result of poor leadership and staffing policies, a completely inadequate standard of nursing was offered on some wards in Stafford."

So under the new program, would-be nurses in the U.K. have to spend more time working as a healthcare assistant or support worker to gain hands-on care experience.

That "back to basics" plan seems like the opposite of what is needed to improve healthcare in the United States--where myriad  research calls for nurses to take on a larger, more independent role in healthcare reforms, especially in accountable care organizations and patient-centered medical homes, to increase coverage and lower costs.

Still, U.S. hospitals can learn from the inquiry report as they make more use of nonphysician providers. Acknowledging nurses and nurse leaders "lie at the heart of what is required to protect patients," the inquiry emphasized the need to empower nurses with "effective" support and recognition.

Issues with inadequate support for nursing bring to mind the "turf war" between doctors and nonphysician providers. Physicians largely are worried about losing income and authority, as well as compromising quality of care by using less educated and trained healthcare professionals.

"In general, I have nothing against NPs or PAs and, in fact, employ two great NPs," Denise Mills, a solo family physician in Dracut, Mass., and past president of the Middlesex North District Medical Society, told FiercePracticeManagement in an interview. "I know their limitations and understand … that they serve as a wonderful complement and resource for patient education and care coordination, but I have a hard time seeing them as independent PCPs."

But while some physicians still oppose the identification of nonphysician providers as primary care practitioners, others are softening their stance, especially in medically underserved communities.

With physician shortages predicted to explode as 30 million new patients gain insurance coverage, healthcare organizations must maximize valuable nurse resources. Doing so requires creating a supportive, high-performance work environment for nurses.

Hospital work environments that value and support front-line workers including nurses saw higher rates of patient satisfaction and lower likelihood of adverse events, according to a July 2012 study. Moreover, research earlier this year showed a good hospital work environment doesn't only mean happier nurses, it means lower readmission rates.

The industry needs to achieve better cost, access and quality, and having nurses go beyond the basics could help drive those improvements. - Alicia (@FierceHealth)