Progress Toward Full Practice

These are historic times for our profession.

On April 1st, Governor Cuomo of New York signed the Nurse Practitioner Modernization Act into law. The legislation removes the need for written collaborative practice agreements between experienced nurse practitioners and physicians as a condition of practice, a goal we have pursued for the past several years. (Nurses with less than two year’s full-time experience will still be required to maintain such an agreement.)

In May, two other milestones were reached. Beginning this July, advanced practice registered nurses in Connecticut who have worked for three years under a practice agreement will now have full practice authority. And as of January 2015, nurse practitioners and clinical nurse specialists in Minnesota who have one full year of professional experience will no longer be required to practice under an agreement. With these advances the roster of states that recognize APRNs as full practice providers stands at more than a dozen.

But along with this wave of progressive legislation came an April 29th opinion piece published in The New York Times by Dr. Sandeep Jauhar, a cardiologist, entitled “Nurses are not Doctors.”

The piece argued that nurse practitioners should not be allowed to provide unsupervised primary care because they are not sufficiently trained. It also claimed that nurse practitioners exacerbate the high cost of health care because they order more diagnostic tests than their physician counterparts. These assertions were, in my opinion, soundly refuted by two letters published in the Times in response to the piece, one by the co-presidents of the American Association of Nurse Practitioners and the second by two nursing professors at Yale.

A more comprehensive rebuttal of the op-ed was published on the ANA’s Nursespace blog by Peter McMenamin entitled “Nurses do not pretend to be physicians.”  In that piece, McMenamin takes the author of the op-ed to task on the issue of diagnostic test utilization, beginning with the observation that Dr. Jauhar’s only citation is of a study published 15 years ago.

Space constraints in the newspaper prevented publication of a letter I co-wrote with Diana J. Mason, PhD, FAAN, RN, director of the Center for Health, Media, and Policy at Hunter College-Bellevue School of Nursing, and Eileen Sullivan-Marx, PhD, RN, FAAN, dean of New York University College of Nursing. In addition to citing more recent evidence of the quality and cost effectiveness of nurse practitioner practice, we emphasized the importance of assuring access to primary care. While it is important to keep utilization and patient outcome data in clear focus, we also have to remember that when nurse practitioners practice to the full scope of their education and training, millions of individuals in our country who lack adequate access to primary care stand to benefit.

Nurses are ready, willing, and able to help address the current shortfall of primary care physicians, which is projected to rise to 40,000 in six years. The recent legislative strides cited above are clear evidence that the message is getting through to many elected officials. Nurses love being nurses. We thrive on providing the compassionate, comprehensive care that inspired us to pursue a career in nursing in the first place. An increasing number of physicians recognize nurse practitioners as their professional colleagues, working together as members of care-provider teams whose collective wisdom provides an increased benefit to the patient. Framing the discussion as “physicians versus nurses” only aggravates an erroneous perception that ultimately deprives patients of safe, effective, and timely care.