A Nurse Practitioner's View

It's been a busy last few months as the legislative agenda has heated up of the NP organization where I am the Chair-Elect. I have been to some fundraisers and legislative visits to try and garner support from lawmakers to sponsor and support the bill that will eliminate statutory collaboration between a physician and nurse practitioner in New York State. The bill is known as the NP Modernization Act. We have been at this for about the last 5 years and up until now, there has not been much forward movement. While we had a sponsor for the bill and many co-sponsors, it was stuck in both the Senate and Assembly 's Higher Education Committee (where all of the professions in NY state are regulated). The bill basically sat idle in these respective committees. We finally experienced a breakthrough after countless visits and grassroots efforts. The IOM Future of Nursing report absolutely helped make the case for increasing access to care as did the positive press that nurse pr...

I started to write this post and then said to myself, I'm not going there...its so passé. I saved it as a draft with little intention of completing it. Then I come across this " media kit " posted on the American Academy of Family Physician's (AAFP) website and just can't believe my eyes with their approach. They have set out to point out the obvious: NP education and training is different than that of physicians! Who knew?!?! I am so disappointed in the AAFP. Perhaps no other specialty works as closely together as NPs and family practice physicians. Up until now, I've generally come across very supportive family practice physicians of nurse practitioner practice. This is a slap in the face of sorts. And now the original post: Another day, another article about nurse practitioner's filling roles traditionally held by physicians, and another physician-centric theme by organized medicine. It's nice to read an article with some NP input and perspective....

An op-ed piece was recently written by the president of the Nurse Practitioner Association of New York, entitled, Take Advantage, New York, of our nurse practitioners . As if on cue, the medical society in New York played the same old card under the guise of "patient safety" and responded with their take on the issue, Rules exist to protect patients . Any regular reader of this blog knows the countless times I have pointed out the bogus claims that organized medicine uses as scare tactics that ultimately translate into turf protection. In this article, the author claims a "maldistribution" of the physician and nurse practitioner workforce. See, we don't really have a problem, its just that patients are in the wrong areas of the state! Perhaps we can find some grant money to redistribute patients to where there are so many providers in the vast utopia where most of us in NY live. This of course is where no one needs to wait for an appointment and access to provid...

Here is another positive view of NP guided care specifically in New York. Of course, it is not without the organized medicine tagline of playing the "quality of care" card under the guise of protecting patients. However, we know that retrospective chart reviews (the current requirement in NY and in many other states) is not about quality of care. In fact, peer chart review should be a requirement for all clinicians. Every professional should engage in ongoing chart reviews (I actually prefer benchmarking and looking at actual data/outcomes against versus simply reviewing a chart). I just don't understand the constant undertones that NPs are prone to making mistakes or will "miss something" and that having a collaborating physician review the chart 3 months later somehow will "ensure quality." NPs see thousands of patients every day and we have proved and will continue to do so that we provide quality evidence-based care. And now to the video...

I thought that I'd start this post with a definition of collaborate (via Merriam-Webster On-Line) : Main Entry: col·lab·o·rate Pronunciation:\kə-ˈla-bə-ˌrāt\ Function: intransitive verb Inflected Form(s): col·lab·o·rat·ed; col·lab·o·rat·ing Etymology: Late Latin collaboratus, past participle of collaborare to labor together, from Latin com- + laborare to labor Date: 1871 1 : to work jointly with others or together especially in an intellectual endeavor Working jointly with others or together. Isn't that what most providers do when caring for our patients? NPs collaborate with physicians, other NPs, physical therapists, pharmacists, nurses, etc. Physicians also collaborate amongst themselves and with other members of the health care team. I bring this up because the majority of states require a collaborative relationship between an NP and MD. (Conversely, some states use an independent practice model while others use a supervisory one). The regulations among models can vary sig...

Here is a well written article from today's Tennessean about Nurse Practitioners filling key rolls in primary care. To no one's surprise, The Tennessee Medical Association opposes this and even wants to add more barriers to nurse practitioner practice and therefore block access to affordable, high-quality care. They even find a way to throw retail clinics in the mix. My question is why do they feel a need to impose stricter limits on NP practice? Are there studies to show that NP-practice is unsafe or not as good as physician-practice? In fact, studies show the contrary. I like to think of myself as a person of proof. If you can show me other than anecdotal evidence, that NP practice needs limits rather than autonomy, I'd welcome the proof. I also don't want this to be a nurse practitioner vs. physician rant. We are all members of the healthcare team and need each other to collaborate and critically think when caring for patients. I certainly can't do it all by my...