My most recent blog post – which commented on an Academic Medicine article titled “Primary Care Workforce Shortages and Career Recommendations from Practicing Clinicians” – touched a nerve with some readers. People have responded in a number of ways. Some felt that the blog was “out of touch” and “tone deaf” to the issues of concern for primary care nurse practitioners (PCNPs), in essence abandoning our shared commitment to the preparation, profession and position of nurse practitioners.
Nothing could be further from the truth! To be clear, in my earlier blog posts (e.g., “Reducing the Impact of the Doctor Shortage in a Year,” from July 2014), published articles (e.g., “Nurse Practitioners: Implementing the Affordable Care Act,” in San Francisco Medicine, April 2013) and numerous national presentations, I have consistently made the case for PCNPs being able to practice to the full extent of their education and license. The recent blog post is most definitely not a departure from that position.
The Institute of Medicine’s 2010 report on The Future of Nursing framed the future in the context of health care reform. In essence, the country needs a larger, stronger and more integrated health care workforce to meet the nation’s health care needs. To meet the real and growing challenge of providing quality care, the IOM stressed the development of educational standards for practice; the education of doctorally prepared nurses for leadership, education and research; and the need to address the scope of practice whereby nurses can fully practice to the level of their education.
In California, we have had some disappointment in making progress toward these goals. In 2013, Senate Bill 491, which would have allowed nurse practitioners to operate without physician supervision at certain medical facilities, did not pass. Among others, I was asked to and did provide research in support of independent practice. In addition to summarizing the research base that has found nurse practitioners provide high-quality and safe care, with outcomes and patient satisfaction comparable to primary care physicians, I also presented the case that it is much more cost-effective to train nurse practitioners and that they graduate with much lower debt compared to physicians. I argued for the importance of having expanded practice restrictions eased as a means to expand the health care workforce to meet the increasing needs associated with health care reform. The early version of this bill was discussed with the deans of all the UC schools of nursing, who similarly expressed support. Additionally, a letter in support of the bill came from the University of California, Office of the President.
There can be no doubt of where I stand on the issue of independent practice for nurse practitioners. And we will continue to fight for this becoming a reality in California as it already has in some states. Hopefully, the 2013 bill will be reintroduced and will pass in the next legislative session.
All of that said, a larger workforce – even one enhanced by making full use of NPs’ unique skill set – is not enough. Coordinated, team-based care is health care’s future. Thus, we need to do better in terms of training together, working together and supporting each other. Listening to and understanding the views and concerns of our professional colleagues moves us closer to these important goals.
RN, PhD, FAAN