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Nurse Education Key to Scope-of-Care Debate

Cheryl Clark, for HealthLeaders Media, August 15, 2011
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The nursing profession is in an upheaval.

On one hand, there is pressure to push registered nurses and their teaching colleges to begin or augment nurses’ careers with higher levels of training and skill, so nurses will be better prepared for new tasks required as the industry changes. These nurses need to manage quality metrics and patient care continuum models, hospital chiefs and doctors say. Nurses need to be critical thinkers, and understand value-based purchasing and what that could mean to the hospital’s bottom line.

Nurses want more opportunities to learn alongside doctors, in classrooms and in direct patient care settings with more and longer residency programs in hospitals. And more faculty members are needed to train them.

But there is also tension on another front between nursing leadership and some physician groups over limits now placed in many states over the scope of what advanced practice nurses, including nurse practitioners, should be allowed to do. They should be able to function to the full extent of their education and training and be paid directly for their services, nursing advocates say. Organized medicine groups who are fighting these efforts, such as the American Medical Association and the American Academy of Family Practitioners, should get over it, nursing advocates say.

After all, the shortage of physicians across all specialties is expected to quadruple, with a shortfall in the workforce of 63,000 by 2015 and 91,000 by 2020, according to the Association of American Medical Colleges. Who, the nursing advocates ask, will pick up the slack? It’s going to be the nurses, they say.

Someone’s going to have to work alongside—and in some cases instead of—doctors to guide the 32 million newly insured, plus meeting the demands of aging boomers who will be seeking high-quality care in greater numbers. Surely that will be the task for the estimated 266,000 advanced practice registered nurses, if not many of the 2.7 million other registered nurses in the United States: making sure patients stay healthy and compliant, preventing them from coming back to or entering the hospital in the first place.

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6 comments on "Nurse Education Key to Scope-of-Care Debate"


D. Andrews, CRNA, MHS (9/27/2011 at 10:05 PM)
Shi Zang, We do carry our own liability insurance at the same limits as physicians. The difference is, our rates have dropped over the past decade due to decreased claims. Do your homework before commenting.

Phyllis Carmichael RN, BSN (9/25/2011 at 3:05 PM)
I enjoyed your article. I am currently in an masters program. A recent discussion centered on nursing skills post graduation. I came from a diploma school in 1998. The hospital was next door to school. Thus, I was confident in my hands-on skills regarding starting IVs, inserting naso-gastric tubes, inserting urinary catheters, performing sterile dressing changes, etc. I wish that I would have gone on to obtain my advanced degree straight away. Now I see how valuable the added education is to my practice. Our discussion turned briefly to nurse residency programs. Little information exists on that subject. Part of the "upheaval" you spoke of? Phyllis

Julia Harris CRNA (9/5/2011 at 3:18 PM)
In response to the previous comment, I do in fact carry my own malpractice insurance and I am very much liable for the outcomes of the patients that I care for. With increased autonomy comes increase in responsibility and I have embraced that as part of my profession.