The effectiveness and quality of care provided by nurse practitioners (NPs) is well documented in numerous studies. In this month's 19th Annual Legislative Update, Susanne Phillips places into context the issue of physicians' continued resistance to NP autonomous practice, despite surmounting evidence that NPs are safe providers.
Toward Autonomous Practice
Recently, researchers examined the acceptability of collaborative physician-NP care for a proposed NP-Based Model of Outpatient Chronic Disease Management in Primary Care Settings. After adjusting for potential confounding variables, NPs were four times as likely as physicians to more strongly support the proposed model.1
The model is designed so that NPs would provide the majority of routine ongoing care for patients with chronic medical conditions during regular, brief, nonacute visits using an evidence-based encounter form; physicians would see patients primarily for acute problems and exacerbations. The more common approach in primary care is for NPs, in the same manner as physicians, to treat acute and chronic illnesses during unstructured visits. The researchers hypothesized that NP support was stronger than physician support because "physicians may not be aware of the ability of NPs to practice in a highly autonomous manner" or "physicians feel somewhat threatened by the model." Researchers were encouraged nonetheless because overall, most physicians (80%) and NPs (95.7%) believed that the proposed model would improve the control of chronic illness and, thus, improve health outcomes for these patients. Similarly, a different research team demonstrated in two related studies that collaborative (physician/NP) multidisciplinary management of hospitalized patients resulted in reduced length of stay and more cost-effective delivery of care, leading to greater profits (cost savings) for the hospital.2,3
Natural Research Partners
To position ourselves as autonomous practitioners without oppressive restrictions, we must communicate intelligently with legislators. Practice drives research. Research supports practice. Research and practice influence legislators.
Nurse practitioners are natural partners to research. We are:
* Respectful of individual rights, beliefs, values, and preferences
* Empowering to patients
* Safe practitioners grounded in advanced knowledge and skills
* Effective at improving health outcomes for patients
* Accessible in rural/urban areas to marginalized populations
* Resourceful in finding a way when there seems to be no way
* Competent to make clinical decisions based on evidence and experience
* Holistic caregivers who care for the whole person.
As you read the Legislative Update, consider the work that has gone into achieving even small victories toward autonomy. Scope of practice and regulation are by no means ideal in every state; there is still much work to be done. As Susanne Phillips exhorts, we should, "Continue to document the research supporting safe, quality healthcare. Research supports our right to provide care to our patients."4
Jamesetta Newland, PhD, APRN, BC, FNP, FAANP, FNAP
Editor-in-Chief
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