A Nurse Practitioner's View

"Hey, How are you doing today?" This is supposedly the way that many nurse practitioners (and physician assistants) introduce ourselves to patients according to Gary Larkin, M.D. who recently conducted a study published in the American Journal of Bioethics entitled, "Patient willingness to be seen by physician assistants, nurse practitioners, and residents in the emergency department: Does the assumption of assent have an empirical basis?" This study is a thinly veiled turf attack on both nurse practitioners and physician assistants. From the beginning of the article, the authors write: "...physician substitution has often been covert in the emergency department (ED), confusing patients as to provider identity and appropriate scope of practice. This confusion may be heightened as junior doctors and nonphysician clinicians alike wear the same long white coats and Littmann stethoscopes as experienced physicians." I retrieved the article myself to unde...

An article appears in Health Magazine advising its readers " when its OK to skip the Doc ." But of course in doing so, nurse practitioners get slapped. You see, the article refers to convenient care clinics - a continually hot topic - and how their nurse practitioner staffed model makes it OK for them to treat minor boo-boos but aren't capable of treating more serious maladies. Now in all fairness, most clinics aren't currently designed to treat conditions beyond episodic-type care and health screenings though there are reports that say this trend may be slowly changing to include other conditions. I just don't understand why the inference is always that the NPs staffing them are limited to treating just those conditions as well. I know plenty of instances where NPs referred patients to other providers based on subtle signs picked up during a convenient care visit which might've otherwise gone unnoticed. Further, patients in these settings were easily abl...

Here is a great post from a medical student about retail clinics. Here is someone who clearly understands the need the clinics are filling and more importantly (in my opinion), how nurse practitioners are part of that solution. It's good to see such an un -jaded perspective and how we can all work together in today's complex health system.

As nurse practitioner-staffed retail clinics continue to open and expand (despite what many recent reports say otherwise), they continue to fall victim to physician-centric comments undermining the competence and professionalism of other health care providers. Am I surprised? Not at all. It has all come to be so routine now. Take for example, a recent article written in the Topeka Capital Journal . The end of the article quotes a pediatrician's take (by the way, the American Academy of Pediatrics opposes the use of retail clinics - whatever that means) on why one shouldn't use retail clinics. The article goes on to say: As for people who don't have insurance, Cain said there is always a place for them. "We have plenty of places for people to get care," Cain said. When looking for a physician, Cain advised finding someone who has flexible hours and cares about patients. "I would find a doctor who can provide you with a good medical home," she said. ...

Benjamin Brewer, M.D. writes a regular column in the Wall Street Journal entilted, "The Doctor's Office." Yesterday, he wrote the article, " Primary Care Has Rewards Despite Hassles ." I suppose the article is intended to give you the warm and fuzzy's about what it should be like being a primary care physician today - he talks of saving lives and delivering babies. However, I guess Nurse Practitioners are among the "Hassles" that he speaks of: "The future competition from retail clinics, various physician extenders and the opening of 200 Ph.D. nursing programs that will churn out "doctor nurses" is just a symptom of our health system's ills, not necessarily a cure for them." By the way, those programs are Doctor of Nurse Practice (DNP), not PhDs. I don't believe any of those "hassles" purport to be the cure-all for the ills of the healthcare system. They are however, an attempt to address many of today's dy...

Here is a comprehensive article written in the Physician's News Digest entitled, " Growing role of nurse practitioners ." This balanced article gives a synopsis of the current state of the profession and where we might be headed. Also written this past week was an article about nurse practitioner-staffed retail clinics in Atlanta.

Once again, an article about retail health appears on the WSJ Health Blog site and the discussion ends up being about NPs versus MDs . Under that thread, a whole firestorm is set off when someone by the alias of "real doctor" claims that patients have returned to his office following visits to the retail clinics because they "were not treated appropriately." I certainly felt the need to respond to this arrogant attack on NPs and did so as "Real Nurse Practitioner." So what follows is the typical rhetoric from purported physicians and includes: if you want to be a doctor go to medical school, being a doctor means that you have to spend 11 to 15 years of post graduate training after high school, wearing a stethoscope and a white coat doesn't make you a doctor and the list goes on. NPs don't become NPs to "play" doctor. This is a profession that was borne from a need of primary care and pediatrician shortages in under-served areas. In 1...

I came across this website of Healthy Trust Immediate Medical Care in Wheeling, Illinois. This appears to be an urgent care center. On a post from 4/8/08, they have an entry entitled, " The difference between Immediate Care and Retail Care ." Now, I understand that healthcare is a business and retail clinics can impede on urgent care centers. Most of the retail clinics that I am familiar with (at least the ones that are NP staffed) do not purport to be an emergency/urgent care clinic. But, once again NPs become the brunt of the argument against the clinics. Here are examples from their posting: "These centers are generally staffed with nurse practitioners not true physicians." I don't think NPs try to pass themselves off as "true physicians" or even false physicians for that matter. The vast majority of NPs are proud of the fact that we are nurses first and bring that added level of caring to our encounters. We also enjoy collaborating with physici...

An article was written in The Baltimore Sun about Rite Aid's plans to open physician-staffed retail clinics in the Baltimore & Washington, D.C. Bravo to the author for presenting balanced information regarding NP practice. There are even quotes from Mary Jo Goolsby, director of research and education at the American Academy of Nurse Practitioners: "We're part of the health care team," said Mary Jo Goolsby, director of research and education at the American Academy of Nurse Practitioners. "Nurse practitioners take care of acute minor illnesses, but we also have long taken care of complex chronic conditions," such as heart disease and diabetes. "We have the ability to recognize when something else is indicated and know when further" care should be recommended, Goolsby said. "There is a huge body of evidence that has looked at the quality of care provided by nurse practitioners, and it's considerably demonstrated that we provide safe, ef...

An article about retail clinics in Michigan appeared on today's Crain's Detroit Business website. For those of you not having the pleasure of reading the typical retail clinic article in mainstream media, I'll summarize 95% of them for you now: 1. They usually start out talking about the fast growth of retail clinics. Some even throw in a "joke" of getting a tetanus shot where you shop for toilet paper. 2. Sometimes they interview an actual patient seen in the retail health setting. The patient usually has sinusitis or streptococcal pharyngitis and remarks about the convenience of the clinic's hours, location, price, accessibility, etc. The patient's experience is positive and state they would return again in the future. 3. Here it comes: "Doctors feel threat, have concerns, are skeptical," etc. This is the part for good ole fashioned nurse practitioner-bashing. Here is my case in point: "Nurse practitioners play an important role in heal...

Just when I thought that I've seen it all: An article appears about a physician and his 'new' practice, Wellnessmart . This is a retail-based practice where "...people walk in and get what they need." The article goes on to say: "The store doesn't sell vitamins or medication but markets preventive health services like screenings that may tell a 33-year-old man he has a 17 percent chance of a heart attack over 30 years. It sells annual checkups, weight management, vaccinations and travel immunizations." Hmm, screenings, weight management, vaccinations, health education?? Sounds a lot like nursing interventions to me. Would anyone accuse this physician of practicing nursing without a nursing license (as NPs are routinely accused of practicing medicine without a [medical] license)? If this seems similar to retail health, its because it's clearly lifted from that model: transparent pricing, no appointment necessary, vaccinations - just not episodic c...

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...