The Nurse Practitioner Will See You Now

Laura A. Stokowski, RN, MS

Disclosures

June 29, 2010

In This Article

Nurse Practitioners: The Evidence for High-Value Care

Pohl[5] emphasized that NPs are well positioned to be part of the solution to issues of access to primary care. Forty years of evidence confirms that NPs provide high-quality, cost-efficient care and therefore can contribute significantly to narrowing the primary care gap. According to Pohl, there is no place for limitations on practice or other regulations that are not based on evidence.

Naylor and Kurtzman[9] conducted a structured literature search to identify and synthesize available evidence on the value of NPs in delivering primary care. They found evidence of the equivalence of care provided by NPs and physicians, beginning with the first randomized trial conducted in 1974. This and numerous subsequent studies confirm that care provided by NPs is as effective as, and no different from, that of physicians in terms of health status, treatment practices, and prescribing behavior. Moreover, NPs achieved consistently better results than their physician colleagues on measures of patient follow-up, consultation time, satisfaction, and the provision of screening, assessment, and counseling.[9]

The intent of allowing NPs to practice at their full potential is often misconstrued as an objective to replace physicians with nurses. This, maintains Pohl, is not the case. The reason for permitting NPs practice to their full potential and preparation is to be able to fully use NPs to provide primary care, the need for which is great enough for both physician and NP providers. The regulatory disparities that result in NPs being able to practice as they are prepared to practice in one US state but being supervised by a physician in another state are not evidence-based. Such regulations are more about a discipline protecting its turf, says Pohl, than about protecting patients, which is what regulations ought to be doing.

Where do we go from here? Pohl's recommendations are to:

  • Use each primary care provider to the full extent of his or her education and scope of practice;

  • Expect collaboration, but hold each primary care provider accountable for care delivered under his or her own license;

  • Expect all primary care providers to be accountable for outcomes of care; and

  • Create a vision for ideal primary care teams and educate learners from each discipline about these effective practices.

If these recommendations come to fruition, patients will be able to receive appropriate and cost-effective care from skilled and fully functional health teams.[5]

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