Nurse Practitioner (NP) Care as Good as That Provided by Physicians
An article in the Washington Post (Michelle Andrews, published May 9, 2011) expressed some concerns about coordination of care if nurse practitioners are involved in “house calls”. Marla Weston, CEO of the American Nurses Association, responded in a letter (June 6, 2011) by pointing out that patients have full confidence in nurse practitioners’ ability to deliver high quality primary health care. NPs have been providing high-quality services for more than 40 years. This response cited a 2010 report from the Institute of Medicine that emphasized the crucial role NPs and other nurses will play in a redesigned health care system. In fact, this IOM report called for reforms that allow NPs and other advanced-practice registered nurses to practice autonomously to the full extent of their education and training In addition, many references: [link to “References Show NP Care as Good as That of Physicians” ] show that nurses provide high quality and compassionate care.
The media sometimes suggests that physicians deliver better care than Advanced Practice Registered Nurses (APRNs). Is that true? A meta-analysis (Advanced Practice Nurse Outcomes 1990-2008: A Systematic Review) just released (August, 2011) in Nursing Economic$ (Newhouse RP, Stanik-Hutt J., White KM, and colleagues, Johns Hopkins School of Nursing) stretching over 18 years compared care provided by advanced practice registered nurses (APRNs) to care provided by physicians. Care was compared in 24 different categories.
APRNs performed equal to physicians in 13 categories.
APRNs performed better than physicians in 11 categories.
Physicians performed better than APRNs in zero categories.
The categories in which APRNs outperformed physicians:
For Nurse Practitioners:
- lower blood sugar levels
- lower serum lipid levels
For Certified Nurse Midwives:
- lower C-section rates
- fewer epidurals
- less analgesia
- better breastfeeding rates
- more VBACs (vaginal births after delivery)
- fewer NICU admissions
- fewer episiotomies
- fewer perineal lacerations after delivery
- lower rate of labor induction and augmentation
Clinical Nurse Specialist (CNS) augmented care was measured in 4 categories and found it provided:
- fewer complications
- lower cost care
- shorter length of stay
In response to this study, in an interview on 97.3 KIRO FM, Bob Smithing, a Nurse Practitioner with a practice in Kent, Washington, stated that “Physicians are an integral part of a health care team” and also stated, “Our approach is that our patient is the head of our health care team and we listen to them”. He suggests, as did the meta-analysis study, that physicians and nurses view patients through “distinct but complementary prisms”. Enabling both doctors and NPs to do what they do best in a collaborative, but autonomous environment, will benefit patients and providers and may be an answer to a physician shortage.
Washington State Prescription Monitoring Program (PMP)
State law, RCW 70.225, authorized the Washington State Department of Health to establish the Washington State Prescription Monitoring Program (WA PMP). Pharmacies and practitioners that dispense Schedules II, III, IV, and V controlled substances in Washington State, or to an address in the state, must electronically report to the WA PMP starting October 7, 2011. A dispenser is a practitioner or pharmacy that delivers these scheduled substances or other drugs identified by the Board of Pharmacy in WAC 246-470-020 and does not include those who only administer a controlled substance or other drugs or a licensed wholesale distributor or manufacturer.
Data for this program must be submitted weekly using the American Society for Automation in Pharmacy (ASAP) format Version 4.1. Health Information Designs, Inc. (HID) hosts the Prescription Review data site. If you need any technical assistance with the system, please call HID’s WA PMP Helpdesk at 866.205.1222, or send an e-mail to: wapmp-info@hidinc.com. If you have policy related questions please contact the WA PMP Director at 360.236.4806, or at: prescriptionmonitoring@doh.wa.gov.
The WA PMP promotes public health and safety and helps improve patient care. Practitioners and pharmacists have access for reviewing patient prescription histories to help determine appropriate medical treatment and referral needs.
Resources for the PMP
Petition Requesting that the Nursing Care Quality Assurance Commission include Clinical Nurse Specialists (CNS) as Advanced Practice Nurses
WSNA petitioned the Nursing Care Quality Assurance Commission to include Clinical Nurse Specialists as advanced practice nurses. Currently, Washington Administrative Code (WAC’s) address LPN’s, RN’s and ARNP’s. To include CNS’s as advanced practice nurses will require a change in WAC 246-840, sections -302, -342, -344, and -410.
The NCQAC considered this issue at its regular Business Meeting on July 8, 2011 and unanimously passed a motion by means of a letter [insert link to pdf titled “CNSs as Advanced Practice Nurses”] stating that the NCQAC will commence rulemaking to amend the WACs regarding advanced practice nurses as soon as the statewide rules moratorium is lifted in January of 2012.
Resources for CNS
CNS as Advanced Practice Nurses [CNS as Advanced Practice Nurses]
Advanced Practice Links
From the Medicare Learning Network: “Medicare Information for Advanced Practice Nurses and Physician Assistants” Booklet
A Medicare Learning Network® booklet titled “Medicare Information for Advanced Practice Nurses and Physician Assistants” was published in September 2010 in downloadable format (here), followed by an errata sheet in December 2010 here. This booklet is designed to provide education on Medicare requirements for advanced practice nurses (APN) and physician assistants (PA) and is available in downloadable format. This publication provides information about required qualifications, coverage criteria, billing, and payment for Medicare services furnished by APNs and PAs.
