As nurse practitioners lobby to expand their authority and scope of practice in many states, a New England Journal of Medicine study released Wednesday documents a deep chasm between doctors and nurses on that issue. The study found the two groups overwhelmingly agreed that nurse practitioners should be able to practice to the full extent of their schooling and training. But doctors were less likely to concur that advanced practice nurses should lead medical homes, which deliver team-based, coordinated care to patients. Only 17 percent of the 505 primary care physicians surveyed agreed with that notion, compared to 82 percent of the 467 nurse practitioners surveyed.
As state governments get ready for the Affordable Care Act coverage expansion, some are taking a close look at their networks of health care professionals to make sure they will be able to meet increased demands as more people gain health insurance. California is one of 15 states expected to consider legislation this year that would give advanced practice nurses more independence and authority. Tina Clark is a nurse practitioner at Glide Health Services, a clinic in San Francisco's Tenderloin district, a low-income section of the city. Glide is run by nurses with advanced training. A physician visits the clinic 12 hours a week, to sign forms and consult on difficult cases.
As our nation prepares to implement the bulk of the provisions of the Affordable Care Act, the issues of access to care and unsustainable cost continue to loom large. What can we do about an aging population with increasing chronic health issues and millions more needing care? How can we meet the increasing demand, maintain quality and not break the bank? Legislators looking for solutions to these questions can unleash the skills of nurse practitioners by removing regulatory barriers that prevent them from practicing to the top of their education and training. Studies find that Advanced Practice Registered Nurses who provide preventive care are as effective as primary-care physicians in accuracy of diagnosis and prescription.
As the nation celebrates Nurses Week (today-Sunday), we recognize the contributions of all nurses as compassionate caregivers, clinicians and leaders whom Tennesseans historically have relied on for high-quality health management and prevention. We also celebrate the opportunities for nurses to contribute even more significantly to the transformation of health management by improving access to affordable care. We have an access to care problem in Tennessee, and nurses can help. The Update to the Health Care Safety Net Report, prepared by the Tennessee Department of Health, provides an assessment of health care resources including "the array of services, adequacy of services and access to care."
A woman posing as a health care worker at a Billings hospital accompanied doctors on multiple patient checks, leading Montana health officials to warn employees at other facilities to be on the lookout for an impostor wearing scrubs or a lab coat. The woman has breached security at Billings Clinic an undetermined number of times, prompting Billings' other hospital, St. Vincent Healthcare, to circulate surveillance photos and a warning memo to employees. "She is a talented liar and will invent all sorts of stories as to who she is and what she is doing," Curtis Harper, St. Vincent's regional director of Public Safety, Emergency Management and Forensic Investigation, said in the memo.
Nurses deal with drugs every day. Most do so professionally, safely, reliably. A very few abuse them, getting high or selling them for a profit, mostly opiates. And a tiny minority — a handful in the history of nursing — turn medicines into a murder weapon. One such nurse was Charles Cullen, who is the subject of my book The Good Nurse. A former Navy electronics technician who used his technical acumen to enable his crimes and avoid detection, Cullen got away with medical murder in at least nine hospitals over the course of his 16-year career. He eventually admitted to 40 murders, but experts familiar with the case believe that number is low, perhaps by several hundred.