Term Paper on "Nurse Practitioners' Autonomy the Current Role"

Term Paper 6 pages (2015 words) Sources: 6

[EXCERPT] . . . .

Nurse Practitioners' Autonomy

The current role of nurse practitioners in the United States will need to be upgraded significantly in the near future for two important reasons. For one, as components of the new Affordable Care Act (ACA) become law, and the Act covers an additional 32 million Americans who will need healthcare, there will be a critical shortage of physicians to provide the healthcare needed for all those new patients (many of them Baby Boomers moving into and past retirement). In fact recent estimates report that there will be 45,000 too few physicians by 2020. For another reason, nurse practitioners (NPs) have been trained to handle many -- if not most -- of the duties of a primary care doctor, and the severe shortage of doctors means that people will be receiving their primary care from a nurse practitioner -- simply because the dearth of doctors will place those responsibilities on the shoulders of nurse practitioners. Hence, NPs will gain respect in the field as competent, talented healthcare professionals, which they have not always achieved in the past.

Thesis: It is time now for nurse practitioners to be given the autonomy they deserve so that they may provide primary care for patients independently. The time has come for the healthcare industry -- and for the public -- to accept nurse practitioners as primary care givers.

The core role of the NP: professionalism and clinical leadership

A peer-reviewed article in the Journal of Clinical Nursing points to an empirical study conducted in New Zealand and Australia that clearly illustrates the core role of a nurse practitioner. The research involved in-depth interviews with 15 nurse practitioners in both countries; it also involved scrutinizing available published scholarship in journals, examining nurse practitioner program curricula in universities, and reviewing policy documents that were germane to this issue. Since the nurse practitioner position is a relatively new one in these two countries, the authors felt that by developing "…a clearly articulated" and empirically informed "description of the core role of the nurse practitioner," they could provide the basis for new and updated "educational and practice competency standards" (Carryer, et al., 2007, p. 1819).

What the authors discovered in their research was that NPs are providing three core competencies -- very similar to what primary care physicians provide. They list "dynamic practice" as the first core competency noted in this research. The NPs showed "…highly developed clinical practice skills" (Carryer, 1822). Also, "Comprehensive skills in patient assessment" were central to the healthcare practice that NPs engage in (Carryer, 1821). The NPs in this research learned that the NPs assessment included "…direct physical and psycho-social assessment of the person"; moreover, in several cases, the NPs were conducting assessments of the communities where the patients lived and the circumstances under which their health issues were affected (Carryer, 1821).

The second core role that NPs are carrying out was "professional efficacy," which entails providing healthcare services in an autonomous environment. "Whilst collaboration is important" to the nurse practitioner, the "very nature of the NP role allows that the nurse is responsible for the complete episode of care," Carryer pointed out (1822). This point is also the salient point of this paper: the nurse practitioner is trained to act autonomously and he or she should be given that latitude by the healthcare industry.

The third core role that was reviewed and examined by the authors of this article is "clinical leadership," which involves delivering "…both extensive and extended clinical skills" to the patient (Carryer, 1823). Clinical leadership also means that these NPs expect to "inform and guide" national and local healthcare policies that are relevant to good nursing practices.

Nurse practitioners and their independence

The core and thesis of this paper is that it is long overdue for nurse practitioners to become wholly independent of doctors and hospitals per se. Nurse practitioners are proven to be competent, they are robustly informed and trained, and moreover, as mentioned, with the looming doctor shortage (due to the Affordable Care Act) the nurse practitioner will in the near future be playing a bigger and very important role in the field of American healthcare.

An article in the peer-reviewed Journal of the American Academy of Nurse Practitioners states very clearly what the problem has been in terms of NPs not getting the respect they deserve. The legal authority for NPs to practice their trade independently has long been acknowledged, the author asserts. However, the ability for the NP to "…put that authority into practice" has been consistently "undermined" due to the "…historical failure of political, professional, and social entities to recognize NPs as providers capable of providing primary care autonomously" (Weiland, 2008, p. 345).

Notwithstanding nearly forty years of "proven safe practice," nurse practitioners in America continue to find themselves in a "…financially dependent relationship" that has restrained because of "non-recognition" by the existing authorities in healthcare (Weiland, 345). The author notes that in the past, the nurse practitioner was used as a "substitute" for physicians, especially in those rural areas and to low income people. That said, the nurse practitioners were not wholly independent even in the above-mentioned role; they were "supervised" by physicians and in that role they were basically used as "low-cost labor" albeit they greatly improved physician productivity (Weiland, 347).

The author makes clear that today nurse practitioners are not "physician substitutes," but rather they are "independent providers with a unique approach to healthcare" (347). And yet in many instances, NPs continue to bill under a physician's name. Why is this so? Weiland (350) points out that: a) NPs are not getting good information regarding reimbursement (from Medicare and Medicaid) information albeit they are credentialed providers; b) many NPs practice medicine without a "provider number" from Medicare; and c) many NPs simply don't have the knowledge to wade through the regulations from insurance companies and Medicare; and also, NPs don't always keep up with the changes in reimbursement policies (Weiland, 350).

The social and financial ramifications of the above-mentioned issues -- and the ongoing problem of non-recognition and underutilization vis-a-vis nurse practitioners -- results in decreased patient access to care and to "denial of primary provider status" for NPs (Weiland, 345). Is the underutilization of nurse practitioners costly for Americans? The answer is yes, and on page 345 Weiland asserts that the underutilization of NPs costs the U.S. society "…approximately $9 billion annually."

Nurse practitioner role and job satisfaction issues

In the Journal of the American Academy of Nurse Practitioners the authors -- after collecting data from 254 nurse practitioners -- make several key points that help present the current realities of NPs in terms of their job satisfaction among other issues. For one thing, these 254 NPs are, in general, satisfied with the benefits, with the challenges they face and with the autonomy they have achieved, De Milt explains (2010).

However, they were "…minimally satisfied with professional growth, intrapractice partnership, and collegiality" (De Milt, 42). That having been said, the number one "predictor" for job satisfaction -- based on this research and on previous research reported in the article -- for NPs is "autonomy"; in other words, if the nurse practitioner is given independence to practice, he or she will experience a fulfillment to duty that can't be experienced when under the supervision of a physician. The data used for this research article was gathered during the 23rd National Conference of the American Academy of NPs in 2008. The majority of the 254 participants (67.7%) indicated that they had: a) a full schedule; b) prescriptive authority; c) a state "controlled substance certificate" (58.7%); and d) had a Federal Drug Enforcement Administration license (72.8%) (De Milt, 45).

On the plus side, the "overwhelming majority" (98.4%) of the nurse practitioners surveyed for this article had "…actively prescribed" medication to their patients and the participants said they spent 85% of their time in "direct care activities" (De Milt, 45). The bottom line in this article is basically that job satisfaction revolves around autonomy, which again is the salient point of this paper.

The value of advanced practice nursing roles in healthcare

This article in the Journal of Advanced Nursing points to the need for a greater understanding of the role that nurse practitioners play in the healthcare milieu. The authors agree that the role of the advanced practice nurse (also known as nurse practitioners) has been increasing on an international level, there are nonetheless "inconsistencies" around the definition of the roles played, around the educational standards and credentialing requirements established for NPs (Lowe, et al., 2011, p. 682). Hence, the salient point of the piece is that when there is a "wider understanding" of advanced practice nursing (and what those NPS actually are trained to do and should be allowed to do), the profile of NPs will be raised dramatically (Lowe, 682).

The authors conclude with the thought that when there is more clarity around the roles of NPs, a solution for the continuing problem of too few physicians can easily… READ MORE

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