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Nurse Education Key to Scope-of-Care Debate

Cheryl Clark, for HealthLeaders Media, August 15, 2011
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Without that kind of consensus, “It’s a rather hollow promise to say, ‘Now we’re going to provide these 33 million people with insurance’ and not be able to provide them that care,” Rowe says, pointing to what happened in Massachusetts when expanded rolls of insured sought care but many couldn’t get timely appointments because physicians were so booked up.

 On a practical level, both sides say, the war is not being fought in the physicians’ offices or the hospital’s hallways. In areas where there are barriers to nurse practitioner practice, doctors and nurses have found ways to work collegially.

Nevertheless, a coalition of physician groups, including the AMA and the AAFP, is opposing efforts to relax limits on nursing scope of practice, saying that the IOM’s recommendations were not sufficiently evidence-based.

Roland Goertz, MD, is CEO of the Waco Family Health Center in Texas and this year’s AAFP president. He declined to say what he thinks these nurses should or shouldn’t be able to do. But he insists that nurses should not be thought of as replacements for physicians.

For starters, he says, there is too much variation in the way nurses have been educated, and standardization among nursing colleges—setting up minimum requirements that were established for medical colleges for 100 years—has only been put in place in the past five years.

“Do they really do have the same level of education, and how has that standardization of education been applied?” asks Goertz, whose center operates a large family medical residency program.

“I don’t deny that there’s a shortage of primary care physicians, and there’s a need to care for their patients. But the question remains: What’s the model of care that should work together in a team approach to provide that care? Should it be based on whoever is available? Or should it be based on a rational approach to a model of training and education, and on what level of training, knowledge, and skill they should have?”

One of the loudest objections to relaxing scope-of-practice rules comes from the California Medical Association, which went to court to appeal a decision by former Gov. Arnold Schwarzenegger to waive CMS’ requirement that advanced practice nurse anesthetists be required to have physician supervision when administering sedation to a patient.

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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.