Letter to the editor: Nurse practitioners are not 'mid-level' providers

Fifteen physicians are expected to be let go from the suburban Edward-Elmhurst Hospital in the next year, as reported by Becker's Hospital Review. These physicians, who work in immediate care clinics, will be replaced by nurse practitioners.

This has understandably upset physicians and hearing of anyone losing their job is distressing.  But as a group of nurse practitioners, we take umbrage with two things:  the use of the term "mid-level" by Becker's and the implication patients are being put in danger by this decision.

The term "mid-level" is outdated and derogatory toward nurse practitioners because it suggests that the care they provide is not "high-level."

Nurse practitioners, trained at the masters and doctoral level, are visited 1.06 billion times a year by patients. In addition to being healthcare providers, nurse practitioners educate, innovate, conduct research and are involved with the development of health policy at the state and federal level.

Since the introduction of the role of the nurse practitioner in 1965, researchers have rigorously studied the quality of care nurse practitioners provide as well as their outcomes. This large body of research has consistently demonstrated that nurse practitioners provide safe, effective, patient centered, timely and efficient care.

2014 study demonstrated a link between nurse practitioners having full practice authority and a decrease in readmission rates for Medicare-Medicaid patients. Readmission rates are one of the quality indicators CMS uses to gauge the safety and efficacy of hospitals. 

2012 study from Australia demonstrated similar patient outcomes between physicians and nurse practitioners in a fast-track emergency department, although the nurse practitioners had higher patient satisfaction rates. Similarly, in critical care settings, nurse practitioners have demonstrated improved time to consultation/treatment, mortality, cost savings and patient satisfaction.

Nurse practitioners are 25 percent of healthcare providers in rural America, where access to care has been a long-standing problem and healthcare providers are desperately needed. The number of nurse practitioners in rural practice settings increased 43.2 percent between 2008 and 2016.

Nurse practitioners also fill critical healthcare gaps in densely populated areas, and particularly so among the most vulnerable such as low-income families, immigrants, and persons suffering from homelessness, mental illness, and substance abuse.  In Illinois, approximately 50 percent of the nearly 4,000 Illinois-licensed nurse practitioners provide care in the Chicago metro area and do so among some of the city's neediest populations. 

The high quality care that nurse practitioners bring to healthcare was recognized by the Department of Veterans Affairs in 2016. The VA announced full practice authority for advanced practice nurses, joining the now 20 states with full practice authority in the United States. With this policy change the VA recognized that nurse practitioners provide safe and effective primary care while improving patient access to care.

To be sure, all members of the healthcare team are valued and indispensable to producing excellent outcomes for our patients. We are disappointed our physician colleagues have been laid off as many of us work alongside physicians in equitable practice-settings. 

But the care nurse practitioners provide is not "mid-level," nor are we physician replacements. We have our own clearly defined profession and our goal is to provide the highest standard of care to patients whether that is inpatient or outpatient, rural or urban areas. There is plenty of work for us all — our patients need us. 

All authors are faculty, nurses and nurse practitioner clinicians at Rush University College of Nursing and Rush Health in Chicago.

More articles on integration and physician issues:

5 hospitals that gained, lost residency accreditations in 2019
3 in 4 female physicians experience discrimination — 4 notes 
Tufts removes Sackler name from medical school

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