Saturday, November 6, 2010

Guest Blog: The IOM report on the future of nursing

Stephen Ferrara, NP is a family nurse practitioner at Montefiore Medical Center in New York City. The following post originally appeared in his blog, A Nurse Practitioner's View.

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The big news this week in the world of nurse practitioners and health care was the release of the Institute of Medicine's (IOM) Report, "The Future of Nursing: Leading Change, Advancing Health." It's a logical read and echoes what NPs, patients, and some other professions have been saying for years: let NPs do the work they are already educated and trained to do without arbitrary and archaic state and/or federal barriers. This is not a "scope of practice" issue; it is allowing us to practice to the full extent of our educations.

For example, when I reflect back on my NP education, there was no course entitled, "How to sort of take care of chronic conditions but when you get in over your head, make sure you have your collaborating physician's number on speed dial." We were taught to function as primary care providers that included acquiring the knowledge base to evaluate, diagnose and treat our patients and their conditions using the skill sets and tools needed to care for our patients. NPs don't practice witchcraft or voodoo - we are providing high-quality, cost-effective and culturally congruent care.

Predictably, organized medicine is playing the "patient safety" and "quality of care" card. Bad outcomes occur when there are breakdowns in communication and from care that is uncoordinated - not usually because the clinician is incompetent.

The bottom line is (at least in New York where I practice), without a collaborating physician on record, the 14,000 or so NPs are unemployed and can't legally do anything that we were trained or educated to do. It is time to remove these non-evidence based barriers and retrospective reviews and allow us to function as true partners on the health care team. Collaboration among providers would still continue to happen, and I promise pigs wouldn't start to fly. Fourteen states have already transitioned to to an autonomous model of practice model for NPs. Lawmakers must not cave to special interests and, instead, make the tough decisions that will enable greater access to care.

2 comments:

  1. I'm from WA and in our state nurse practitioners can work independently. Although my observation is that family physicians have a significantly stronger fund of knowledge, the care provided by ARNPs is very much adequate. With the concern about not enough primary care providers, we need to make it less hassle for ARNPs to practice.

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  2. ARNPs as well as PAs specialize at the same rate as medical student and residents specialize. ARNPs practicing with less restriction is not going to help with the primary care shortage.

    With a large number of medical schools opening new regional campuses and the creation of new medical schools, the pathway to independent practice is becoming less of a hassle - apply to medical school and become a physician.

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