Opinion: Elevating nurse practitioner status can aid patients

by Carol Gullo Mest, PhD, RN, ANP-BC | Apr 28, 2014

Please note, this opinion originally appeared in The Morning Call, Monday, 4/28/14:

Approximately 500,000 Pennsylvanians will be added to health insurance rolls as a result of the Affordable Care Act. These citizens will seek primary care services, many for the first time, from a system facing a health care provider workforce shortage.

According to the Pennsylvania Academy of Family Physicians and the state Health Department, 5,000 family doctors provide primary care to 12 million Pennsylvanians. It is estimated that more than 25 percent of those physicians plan to leave practice by 2015. The family physician pipeline is not being replenished, as most physicians seek to enter the highly paid specialty fields.

Enter the nurse practitioner.

Dr. Carol Gullo MestThere are 8,500 nurse practitioners in Pennsylvania who provide direct services to patients. They are educated at the master's or doctoral level, building upon their basic nursing education as well as, in many cases, decades of nursing experience.

Nurse practitioners must maintain national board certification as well as have ongoing continuing education. They work in hospitals, clinics, private practices, urgent care centers, retail clinics, schools and mobile units. They provide comprehensive heath care by evaluating health status, diagnosing medical conditions, treating acute and chronic health conditions via prescriptions or medical treatments, and promoting overall health through screening and education. They collaborate with patients and their families and with other health care providers to determine the optimum plan of care. There are 23 colleges and universities in Pennsylvania providing nurse practitioner education. Nurse practitioners represent the fastest-growing career in health care.

Dozens of studies during the last 50 years have found patient outcomes are the same as or better under nurse practitioner care when compared to physician care. Five decades of sustained research supports the safety, cost-effectiveness and quality of nurse practitioner practice.

Of the 48 Pennsylvania counties classified as rural, 37 are populated by citizens who earn below the U.S. median household income and who are likely to become insured as a result of the Affordable Care Act. Many of these counties have one physician provider for every 3,000 residents dispersed across many miles of rural landscape.

A growing health care demand, coupled with restriction of nurse practitioners as primary care providers, will have a profound impact on these individuals who already have limited access to care. Because of an outdated 1976 law mandating a written collaborative agreement between the nurse practitioner and a physician, access to nurse practitioner services is limited, additional patient and insurance company costs are incurred, and precious health care resources are wasted.

The Institute of Medicine, National Governors Association, AARP, Josiah Macy Jr. Foundation, U.S. Department of Veterans Affairs, Federal Trade Commission, 18 states and the District of Columbia support doing away with mandated collaborative agreements. By keeping such mandated agreements, Pennsylvania is lagging — and losing.

The Institute of Medicine and the Centers for Medicare & Medicaid Services support granting of hospital privileges to nurse practitioners to admit patients, deliver treatment and hold medical staff membership to support efforts to provide seamless transitions through the care system. This is not only an efficient but also a safe means for providing care.

It is past the time to put the patient first. Patients need access to care when they need it, not when it is convenient for the system. Inefficient or absent services result in patient harm and add to the overall burden on the commonwealth. Healthy individuals contribute to healthy communities and a healthy workforce. Granting full practice authority to nurse practitioners would result in an overall positive economic and health impact on the commonwealth through timely treatment of acute health concerns, ongoing treatment and support for chronic health conditions, fewer lost work days, fewer emergency department visits for nonurgent conditions, patient choice of a primary care provider, and improved quality of life.

Nurse practitioners have always agreed that the team-based approach to health care is the best approach, and that the patient needs to be at the center of these teams, receiving the benefit of cooperative partnerships among the patients and health care professionals on the team. Removing restrictive collaborative agreements for nurse practitioners strengthens the ability of the team to respond to the needs of patients.

Senate Bill 1063, introduced by Sen. Pat Vance (R-Cumberland/York) and co-sponsored by Sen. Pat Browne (R-Lehigh), seeks to remove these barriers to nurse practitioner services. Nurse practitioners from across the state will converge Tuesday in Harrisburg to engage further support of SB 1063. Health care consumers and providers are urged to sign a petition at in support of the efforts of the Pennsylvania Coalition of Nurse Practitioners to move this bill out of committee and into the Senate for voting.

Passage of SB 1063 would provide patients full and direct access to nurse practitioner care by updating the outdated regulations and giving nurse practitioners full practice authority. The ultimate goal is to diminish restrictions on nurse practitioner practice, lower health care costs and improve access to care.

Carol Gullo Mest is director of the master of science in nursing programs at DeSales University. She holds a doctorate in public health planning and evaluation, is a registered nurse and is board certified as an adult nurse practitioner.

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