Nurse practitioners key to unlocking health care access

In an April 20 commentary, Steve Chapman wrote about nurse practitioners (NPs) and their role in primary care. Without question, the new health care law will increase access to health care for many individuals, as more than 32 million additional Americans will soon be gaining health insurance.

Will this challenge our primary care systems?

Yes, but challenges are good things if we respond to them strategically.

This is the time to carefully review the capacities and competencies of all health care providers and to ensure that we are fully utilizing the skills of all clinicians.

Even more importantly, this is the time for all individuals, families and communities to become better educated about what they can expect when they seek and receive health care.

Let's start with the facts about nurse practitioners:

-- Currently there are over 158,000 nurse practitioners practicing in the United States.

-- Approximately 80 percent of NPs provide primary care services in the United States.

-- They work in clinics, primary care practices, emergency rooms, long-term care facilities, hospitals, schools, employee health centers and rural, frontier and underserved settings. Many own and operate their own practices.

-- NPs have a graduate degree and must maintain national certification.

-- NPs are authorized to practice and have diagnostic, treatment and prescriptive privileges in all 50 states.

-- In many states they have been granted independent practice.

-- The specialty areas of NP practice include acute care, adult, family, geronotology, neonatal, oncology, pediatric, psychiatric/mental health and women's health.

-- NPs are highly qualified clinicians who provide cost-effective, accessible, patient-centered care and have the education to provide the range of services at the heart of the health care reform movement.

Many research studies have examined the quality of care provided by NPs and there is a solid body of evidence showing that when NPs are able to use all of their skills and expertise, their patients did as well as those seeing a primary care physician.

Furthermore, patients were often more satisfied with the care they received from the NP.

This may be a result of the NP spending more time with each patient and the distinct but complementary skills they bring to health care based on their nursing education.

Specifically, in addition to diagnosis and treatment, NPs focus on patient education, self-care, family support and prevention.

They address two ends of the health care continuum: Teaching patients how to stay healthy and helping patients with chronic illness manage their care and prevent further problems from developing.

This is exactly the type of care we need to enhance in this country if we are to improve the health of our citizens and lower health care costs.

The real challenge is allowing nurses to do nursing to the fullest extent. We must remove state barriers to NP practice and regulations that block their ability to function at their highest level.

We must leave behind the unfounded rhetoric of "endangerment if patients do not see a physician." Once again, let the facts speak for themselves. Malpractice rates for NPs are extremely low with only 1.4 percent having been named as a primary defendant in a malpractice case.

And finally we must accord these nurses the titles they have earned. If a nurse achieves a Ph.D. or DNP (Doctor of Nursing Practice) degree then he or she has earned the right to be called "doctor."

A doctor is an honored academic degree and not an occupation, as evidenced by the many other providers who have earned the title of doctor: dentists, pharmacists, veterinarians, physicians and psychologists, to name a few.

We in South Carolina have enormous health care needs. To serve our citizens well we must fully support nursing programs, such as the MUSC College of Nursing, which "fuels the nursing pipeline" as a major producer of nurse practitioners in the state.

We have the key to unlock access to care -- let's use it.

GAIL W. STUART, Ph.D., R.N.
Dean and Distinguished University Professor
MUSC
College of Nursing
Jonathan Lucas Street
Charleston