Time to end physician-nurse 'turf-wars,' ANA president says

The long-standing debate of whether to expand the role of advanced practice registered nurses has heated up as more healthcare organizations experience staff shortages and patients struggle to access timely care.

In November, the American Medical Association and 87 other physician associations spoke out against the Improving Care and Access to Nurses Act, which would remove barriers to practice under the Medicare and Medicaid programs by increasing access to health care services provided by advanced practice registered nurses. 

Medical associations are concerned the law would allow nurse practitioners to provide services outside their education and training, would increase costs and utilization of services and would lower quality of care.

Becker's asked nurse practitioners why they believe advanced practice registered nurses should have their scope of practice expanded.

Editor's note: Responses have been lightly edited for length and clarity.

Ernest Grant, PhD, RN. President of American Nurses Association.

Advanced practice registered nurses, such as nurse practitioners, nurse anesthetists, nurse-midwives and clinical nurse specialists, are often the primary source of care for many communities, providing quality patient care and, in some instances, lifesaving treatments.

Perceived "hierarchies" and "turf wars" that interfere with the ability of APRNs to practice at the fullest extent of their capabilities are counterproductive to realizing a modern healthcare system that prioritizes the needs of patients and communities. APRNs have an evidenced-based skillset and the demonstrated clinical expertise and track record to meet the complex demands of diverse patient populations, respond to public health challenges and improve health equity.

Marylee Pakieser, MSN, RN. Family nurse practitioner at Advanced Health Care (Franklin, Tenn.).

The proposed legislation ICAN is about APRNs practicing to the full extent of their license, education, certification and clinical expertise. Currently the U.S. is experiencing barriers in accessing primary care providers such as APRNs, physician assistants and physicians, especially in rural areas.

For the past three years, I have provided primary care to three county jails in Northern Michigan. Most of the inmates that I see do not have any primary care at all outside of the jail environment. We cannot afford as a country or a caring society to allow people to suffer without adequate healthcare. 

Medical associations continue to see APRNs and PAs as a threat — we are not. Nurses have always believed and practiced collaboration with all healthcare professionals. There is a plethora of research — 40 years and ongoing — that has supported the excellent care provided by APRNs. The nursing profession is NOT under the medical profession. I do find it irritating that physicians continue to state we need to have "oversight in our clinical practice."

Patricia Wells, MSN, RN. Family nurse practitioner at Matrix Medical Network (Scottsdale, Ariz.) and CVS MinuteClinic (Minneapolis).

Nurse practitioners are not denying physicians have on average 10-14 years of education compared to six to eight years of education. However, the average advanced practice registered nurse spent 13 years providing patient care. Registered nurses had to learn diagnosis and management. We had years of practice prior to advancing our career. For instance, if a patient had fluid overload, I knew the medical diagnosis was congestive heart failure. Due to being a RN, I could only say fluid overload, but I knew what the physician would need to manage congestive heart failure. 

There are several reasons why nurse practitioners should have an expanded role with full practice authority. 

First, nurse practitioners have the education and experience to provide high-quality patient care. Nurse practitioners have at least three years of education in advanced nursing, and many have more than 10 years of experience in nursing. This allows them to provide care that is at least equivalent to that of physicians.

Second, there is a shortage of primary care providers in the United States. Nurse practitioners can help fill this gap by providing quality care to patients. Additionally, nurse practitioners can practice to their highest level of education, which allows them to use their skills and knowledge to the fullest extent possible.

Third, nurse practitioners play an important role in the healthcare system. They provide care to patients across all age groups, from newborns to the elderly. Nurse practitioners also work in a variety of settings, including hospitals, clinics and private practices. This allows them to reach more people and provide them with the care they need.

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