Sunday, September 30, 2012
Nurse Practitioners and Primary Care
Fort Worth Orthopedic Surgeon
In a Sept. 14 guest editorial in the Fort Worth Star-Telegram, Sandy McCoy, a Plano nurse practitioner and president of the nurse practitioners’ state association, fashioned a plea for increased scope of practice for her profession. She made several correct statements that are worth repeating: Texas is low compared with other states in availability of primary care physicians, and it is undoubtedly going to get worse; there are not enough Texas medical residency slots to further the training of Texas medical school graduates; and, in her words, “nurses are crucial to the future of healthcare in our state.” She also quotes one of several economic models that show a positive economic impact to fully actuating primary care in the state.
However, she makes one statement that is arguable and leaves out two important factors. She asks for significantly increased ability to diagnose and prescribe — duties traditionally held by doctors — and states that such is “well within the bounds of (nurse practitioners’) education and training.” She is welcome to make that plea, but it is enough to say that not every stakeholder within health care would agree with her. She also fails to note that the shortage in access to health care is primarily rural, and that there is a chronic and recurring shortage of nurses functioning in their traditional role. Her solution would not address the first issue, and would tend to aggravate the second.
Nurses are an indispensable part of the health care team. Think about it — if you are a hospital inpatient, or in a post-anesthesia recovery room, or in an intensive care unit, you are there because you need access to a nurse. Health care as we know it today cannot exist without nurses. Further, nurse practitioners in their current role are a valuable part of the delivery of care, and I enjoy their input every day. However, converting our current advanced-practice registered nurses (i.e., nurse practitioners) to proto-physicians by allowing an expanded, unsupervised role in diagnosis and prescription is not the best solution to the problem Ms. McCoy describes.
We need enough funding for residency programs so that Texas medical graduates can stay here to train. We need loan repayment programs so that medical school graduates with six-figure education debts can get relief by practicing in rural areas (the 185 of 254 counties that Ms. McCoy mentions). We need to adequately pay for and respect nurses in their current role as members of the health care team. Anything else can compromise quality of care and patient safety.