Advanced practice nurses (APNs) deliver medical care that's just as safe and effective as, and in some cases superior to, that provided by physicians, concludes a review of studies conducted within the past 18 years. The results support the idea of an expanded role in health care systems for APNs, which would help to bridge the growing gap between health care needs and the number of primary care physicians.

The studies reviewed involved NPs, clinical nurse specialists, clinical nurse midwives (CNMs), and certified registered nurse anesthetists (CRNAs), although none of the studies included in the final analysis involved CRNAs. The researchers analyzed 69 studies performed between 1990 and 2008 in the United States that compared APNs' and physicians' effectiveness when treating patients with the same illnesses. APNs and physicians performed similarly in studies of patient satisfaction, patient-reported perceived health, and patients' functional status, as well as glucose and blood pressure control and mortality outcomes. APNs scored even better than physicians in terms of lipid control, lowering the length of hospital stays, complication rates, and costs of care. CNMs performed fewer cesarean sections and episiotomies, prescribed fewer epidurals and analgesics during labor, induced labor less often than physicians, and promoted breastfeeding more effectively than physicians.

"APNs and physicians bring different, yet overlapping, skill sets to patient care," coauthor Julie Stanik-Hutt, director of the master's program at the Johns Hopkins University School of Nursing told AJN. For example, CNMs listen more to what a laboring woman wants, which helps to prevent unnecessary cesarean sections. And APNs are more willing to help patients control hypertension with exercise and dietary changes to avoid the adverse effects and costs of medications. "That takes more time and coaching and a different skill set than physicians have," said Stanik-Hutt.

The study isn't about who's a better health care provider, according to Stanik-Hutt; rather, it suggests the value of enabling both physicians and APNs to do what they do best in a collaborative, but autonomous, environment. That's a "win-win for patient care and for providers alike," she said.-Carol Potera

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