Running head: NURSE PRACTITIONER PRACTICE SCOPE 1

NURSE PRACTITIONER PRACTICE SCOPE 7

 

Nurse Practitioner Practice Scope

Kimberly Colbert

Chamberlain University

ENGL147N Advanced English Composition

July, 2019

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Nurse Practitioner Scope of Practice

 

A nurse practitioner is not a doctor. All studies and statistics aside, the simple fact is that the two professions are not the same. They follow different courses of study, have different qualification standards, and have different levels of clinical training. There is no question that nurse practitioners will continue to fill a major role in medicine. The question is: what should that role be? That role should be independent practice by nurse practitioners, and the elimination of the physician supervision requirement in the states which have not already moved to allow independent practice; opponents of this do not have sufficient evidence to support their position.

1st Counter-Argument

Opponents of expanding scope of practice believe that the intent of the nursing profession in promoting is the replacement of physicians with nurses. According to Dr. Rebekah Bernard, the push to increase nurse practitioner scope of practice is simply the promotion of that agenda to replace physicians with nurses, without considering the training and educational differences between doctors and nurse practitioners. Dr. Bernard cites lobbying and media activities as attempts to obscure the educational and training differences between doctors and nurses (Bernard, 2019).

1st Rebuttal

There is no research or data to support this position. The medical schools are not producing enough graduates to fill the growing need for primary care physicians. North Carolina has attempted to alleviate the shortage by mandating that state medical schools graduate at least fifty percent of their students in primary care specialties. At five years after graduation, only thirteen percent were working as primary care physicians (Skipper, 2019). To the contrary, nurse practitioners are seen as a way to increase the reach of primary care medicine. The United States as a country has problems in providing primary care. There aren’t enough physicians in general, and there is an extreme lack of primary care physicians in rural and low income areas. Nurse practitioners are more likely to practice in rural areas than primary care medical doctors (Buerhaus, 2019). Research indicates that regulations restricting scope of practice actually restrict access to healthcare. Independent nurse practitioners are more likely than physicians to work with rural and underserved populations, something they can’t do if they are required to be supervised by a physician.

There is no research or data to support this position. The medical schools are not producing enough graduates to fill the growing need for physicians. It is estimated that there will be a shortage of nearly 50,000 primary care physicians by 2030. To the contrary, nurse practitioners are seen as a way to increase the reach of primary care medicine that the medical schools cannot solve. The United States as a country has problems in providing primary care. There aren’t enough physicians in general, and there is an extreme lack of primary care physicians in rural and low income areas. Nurse practitioners are more likely to practice in rural areas than primary care medical doctors (Buerhaus, 2019). Research indicates that regulations restricting scope of practice actually restrict access to healthcare. Independent nurse practitioners are more likely than physicians to work with rural and underserved populations, something they can’t do if they are required to be supervised by a physician

 

2nd Counter-Argument

The educational differences between nurse practitioners and physicians as reason to restrict independent practice. A primary care physician will have nearly 15.000 of clinical training, while a nurse practitioner will have a fraction of that; it’s possible to complete the nurse practitioner program with as few as 500 clinical hours. This difference in training proves that nurse practitioners cannot be allowed to practice without the supervision of a primary care physician. There are significant concerns over patient safety when a nurse practitioner is allowed to practice independently; nurse practitioners are more likely than physicians to make mistakes. (Cheney, 2019).

2nd Rebuttal

The emphasis on educational differences masks the fact that nurse practitioners aren’t expected to be doctors. They are expected to be highly skilled clinicians operating in a narrow range of practice. All nurse practitioners must complete a master’s or doctoral program, and will have a great deal of clinical training (Buerhaus, 2019). Nurse practitioners offer a solution to basic primary care. Increasing scope of practice doesn’t mean that nurses replace doctors; it means that they can perform primary care services consistent with their training and professional standards. Primary care clinicians typically treat the ordinary things for which people seek treatment; high blood pressure, diabetes, asthma, arthritis, and back pain. They perform physicals and provide vaccinations. These are not typically complicated cases; they’re the ones a step higher than taking two aspirin. This is what nurse practitioners are trained to do. They’re not expected to know everything about everything, but to be competent in their limited area of training. There is no evidence to support the idea that limitations on scope of practice are necessary to protect patients from low quality providers (Buerhaus, 2019).

 

3rd Counter-Argument

Removing physician supervision negatively impacts patient care. There is nothing simple about diagnosing a patient. Physicians make mistakes, but they’re not the same type of mistakes made by nurse practitioners. There are countless examples of nurse practitioners misdiagnosing patients or missing the diagnosis entirely, a consequence of their lack of training and education. Nurse practitioners are responsible for excessive or inappropriate testing. They order more tests, scans and labs than physicians, increasing the cost of care. Claims of improper prescribing and management of controlled substances are rising (Bernard, 2018).

 

3rd Rebuttal

There is no indication that physician supervision improves patient care. A 2018 Cochran evidence review found that nurse practitioners are rated more highly than physicians and spend more time with their patients than physicians. The review found that patient outcomes in several areas were similar for physicians and nurse practitioners, and that there were no differences in the number of test and prescriptions written (Greene, 2018).

 

Conclusion

There is no evidence that restrictions on the scope of practice by nurse practitioners serve any useful purpose. Practicing within the scope of their training, they are the equal of physicians performing the same treatments, and are often rated more highly than doctors in patient surveys.

Nurse practitioners are not meant to be replacements for physicians, but are meant to broaden the reach of primary care.

 

References

.

Bernard, R. (2018), Independent Practice: Both Nurse Practitioners and Physicians Should be

Outraged. Retrieved from https://www.kevinmd.com/blog/2018/01

Buerhaus P. Nurse Practitioners: A Solution to America’s Primary Care Crisis. Missouri State Board of

Nursing Newsletter. 2019;21(1):16-23. https://search-ebscohost-

com.chamberlainuniversity.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=134467647&site=

eds-live&scope=site. Accessed July 21, 2019

Cheney, C. (2019) Why Physician Assistants and Nurse Practitioners Need Supervision.

Retrieved from (https://www.healthleadersmedia.com/welcome-ad?toURL=/clinical-

care/why-physician-assistants-and-nurse-practitioners-need-supervision-say-physician-groups

Greene, J. (2018). Nurse practitioners provide quality primary care at a lower cost than

physicians. Managed Care (Langhorne, Pa.), 27(11), 34. Retrieved from https://search-ebscohost com.chamberlainuniversity.idm.oclc.org/login.aspx?direct=true&db=mdc&AN=30620307&site=eds-live&scope=site

 

Skipper, M. T. (2019). Positive Partnerships: Rural Communities and the Primary Care Nurse

Practitioner. North Carolina Medical Journal, 80(3), 174–177. https://doi-

org.chamberlainuniversity.idm.oclc.org/10.18043/ncm.80.3.174