NR510 week 7 Discussion Part One Nurse Practitioners and their Impact on Health Care

NR510 week 7 Discussion Part One Nurse Practitioners and their Impact on Health Care You are attending a large continuing education conference for primary care providers. In the audience are physicians, nurse practitioners, and physician assistants from all over the country. Seated at your table are physicians and nurse practitioners. Following the lecture on teamwork and interdisciplinary collaboration, a debate ensues at your table. One physician stated: I am against nurse practitioners who want to take my job. There is a huge difference in the two professions. Primary-care physicians receive extensive and diverse medical education and clinical experience. The nurse practitioner should not function as an independent healthcare provider...they should only function in an integrated practice arrangement under the direction and responsible supervision of a practicing, licensed physician. Discussion Question: How would you respond to the physician’s statements? Use logical reasoning and evidence from the literature to support your response. Topic responses • • Questions • More Sort By:    Molly McIntyre Part 1 8/14/2016 4:41:24 PM I would address his statement respectfully by explaining where he is incorrect with his knowledge. It is proven that Advanced Practice Nurses (APN) provide high quality and cost effective care (Poghosyan, Boyd, & Knutson, 2014). When compared to physicians, both the physicians and the independently practicing nurse practitioners provided safe care with appropriate management (Poghosyan et al., 2014). One study displayed that when controlling blood pressure in patients, both the physician and the APN had similar management strategies and positive patient outcomes (Poghosyan et al., 2014). It has been shown that APNs provide better communication and develop patient relationships faster than with physicians (Poghosyan et al., 2014). Another study explored the similarities and differences between APNs and physicians and discovered that both services provided high quality care and resulted in improved outcomes, but that APNs had high patient satisfaction scores (Hain & Fleck, 2014). Typically this mindset or argument originates from lack of knowledge from the physician's standpoint regarding the APN's scope of practice (Hain & Fleck, 2014). There is strong backlash from major physicians organizations such as the American Medical Association regarding scope of practice, but of 505 physicians interviewed 70% wanted APNs to be able to function to their fullest extent of education and licensure (Hain & Fleck, 2014). There needs to be uniformity about APN role across the country before we can expect physicians to fully understand out capabilities. Once this is achieved, physicians need to be informed about the major role APNs play in healthcare and this mindset was backed through a support paper written by the American College of Physicians (Hain & Fleck, 2016). Again, APN licensure, accreditation, certification, and education is essential before APNs can make forward movement into autonomous practice. Hain, D., & Fleck, L.M. (2014). Barriers to NP practice that impact healthcare redesign. The Online Journal of Issues in Nursing, 19(2), 1. doi:10.3912/OJIN.Vol19No02Man02 Poghosyan, L., Boyd, D., & Knutson, A.R. (2014). Nurse practitioner role, independent practice, and teamwork in primary care. The Journal for Nurse Practitioners, 10(7), 472-479. doi:10/1016/a.2014.05.009 Show Less Instructor Duncanreply to Molly McIntyre RE: Part 1 Molly, 8/15/2016 11:42:06 AM For so long, since inception really, the healthcare landscape has been 100% under physician control. Now we expect physicians to collaborate more and understand NPs can provide efficient, cost-effective, exceptional care. This has caused much havoc in many states, but has been successfully implemented in others. Hopefully the laws will change in even more states moving forward. Dr. Duncan Show Less Dana Harbuckreply to Molly McIntyre RE: Part 1 Hello Molly, 8/16/2016 1:34:42 PM I enjoyed reading your post. I agree with you that major physician organizations road blocks to full practice authority for advanced practice nurses. This interaction with the physician is a good opportunity to educate them on the benefits and expertise nurse practitioners bring to the health care profession. The points you made in your post are perfect examples of how we can educate physicians. In the fall of 2010 the Robert Wood Johnson Foundation, met with twelve leaders from physician and nursing organizations, is a project to develop a consensus on future collaboration between physicians and advance practice nurses. They drafted a document of the dialog between the leaders and called it, “Common Ground: An Agreement between Nurse and Physician Leaders on Interprofessional Collaboration for the Future of Patient Care.” Unfortunately, the report became public and several physician organizations withdrew from the project. These organization cited concerns for patient safety, lack of continued access to physicians’ medical expertise, and quality of care. One thing learned from this meeting, was that physicians and nurses more easily find common ground when they have face to face dialog, then their professional organizations (Robert Wood Johnson Foundation 2013). Physicians and nurse practitioners approach health care in different ways and with different philosophies, although with both, patient health and safety is a priority. If we educate physicians on the nursing approach to medicine and create a dialog between physicians and nurses, at some point we may be able to come to some type of common ground. Reference: Robert Wood Johnson Foundation. (2013). How to foster Interprofessional collaboration between physicians and nurses? Incorporating lessons learned in pursuing a consensus. Retrieved from Show Less Mijanou Marretta-Lewis Discussion Part One Dr. Duncan and Classmates, 8/14/2016 5:08:26 PM The statement made by the physician is not new in the State of Ohio. There is fear that nurse practitioners (NPs) will get equal pay for the same services rendered by physicians in states that do not have independent authority. The Institute of Medicine (IOM) (2010) released a study, The Future of Nursing: Leading Change, Advanced Health that called for a redesign of our health care system. The IOM recommended that all nurses should be allowed to practice to the full extent of their license and training (Donelan, DesRoches, Dittus & Buerhaus, 2013). The recommendation to revamp state scope of practice acts implies that all advanced nurses (APRNs) should be allowed to work independently. In addressing the physician, the use of animosity would not be a constructive approach to a working solution. It would best be pointed out that the American College of Physicians (ACP) and the IOM do agree on some elements of involvement. The ACP agrees that the APRN and the medical professionals have accountability to their patients to give quality care that is patient- centered with a team approach to fully realize the expertise of both professions (Coniglio,2013). The physician needs to know that the IOM recommends the elimination of scope-of-practice barriers and request legislators to reform those barriers to conform to the National Council of State Boards of Nursing APRN model rules and regulation that would allow APRNs to practice independently. Using a team and collaborative approach the clinician should incorporate a multidisciplinary professional team approach to ensure the patient receives best practiced patient-centered, comprehensive care within the whole of the healthcare team. It is true that nurses and physician have training at varied levels of skills, knowledge at are complementary and yet not equal. Physician must complete four years of medical school and continue with residence for another two years and possibly another three years of raining if they specialize. APRNs in most states but not all are required to receive a Master’s degree and a certification through exams on a national level. They are required to have practicums and advanced classes in pharmacology, pathophysiology and Assessments as well. It is important that physicians also understand the APRN is in school for seven to ten years depending on the program and longer if they started out with an Associate’s degree or diploma. It is now recommended that APRNs also obtain a Doctor of Nursing Practice (DNP) of Doctor of Philosophy (PhD). In many colleges there is a combined Master’s and Doctorate program that takes three years depending on the program to complete. Due to the lack of primary care providers, the nurse practitioners through research has become a valuable professional to fill those needed gaps, especially for the under-served population and those in a rural setting (Donelan et al., 2013). The need to understand ones scope of practice and have the ability to refer or hand-off a patient to a more skilled practitioner is paramount to best practice and patient-centered care. The IOM also recommends that the Antitrust Division of the Department of Justice should be required to review all state regulations concerning APRNs and aid in the identification of unreasonable issues that do not contribute to the health and safety of the community. This physician should understand that states with unreasonable restrictions on regulations that govern the practice of the APRN should amend these restrictions and allow the APRN to provide care to patients they are qualified to do so. It is understood that state laws and regulations are there to protect the patients and that all health care providers have the required skill sets, education and training to provide a specific level of care (Kirch, Henderson & Dill, 2012). Currently in Ohio an APRN is not allowed to care for patients in a medical home yet their skill set and education should allow them to do so. Currently the Veterans Administration is reviewing the ability of nurse practitioners to function independently across the United States. This delivery model would be an example to provide evidence-based practice from research and allow for patient-centered care (Bodenheim, 2011). As this debate continues the need to collaborate with a multidisciplinary team to help meet the complex education and needs of our patient population remains a common ground we can all meet. Mijanou References Bodenheim, T. (2011). Lessons from the trenches—a high-functioning primary care clinic. New England Journal of Medicine, 365(1), 5-8. doi:10.1056/NEMp1104942 Coniglio, D. (2013). Collaborative practice models and team-based care in oncology. Journal of Oncology Practice, 9(2), 99-100. doi:10.1200/JOP.2012.000859 Donelan, K., DesRoches, C. M., Dittus, R. S., & Buerhaus, P. (2013). Perspectives of physicians and nurse practitioners on primary care practice.New England Journal of Medicine, 368(20), . doi:10.1056/NEJMsa1212938 Kirch, D. G., Henderson, M. K., & Dill, M. J. (2012). Physician workforce projections in an era of health care reform. Annual review of medicine, 63, 435-445. doi:10.1146/annurev- med