The Role of Nurse Practitioners - Term Paper Example

The Role of Nurse Practitioners Introduction The growing number of the elderly population and shortage of primary health care physicians have considerably increased the role of nurse practitioners (NPs) and physician assistants (PAs) in the United States (US). Cross, Boukus, Samuel, and Yee (2013, p. 1) suggest that the best way to alleviate “pressures on the primary care workforce is greater use of nurse practitioners and physician assistants, which could both increase the number of primary care providers and potentially free up physicians to care for more complex patients.” Since their introduction in the 1960s, both disciplines have a proven record of offering satisfying quality healthcare to the general public. Studies reveal that almost 90% of patients are satisfied with the quality of healthcare offered by NPs and PAs and further validate that these healthcare providers play pivotal roles in primary healthcare through commendable services that enhance access, efficiency and quality of care (Atwater, Bednar, Hassman & Khouri, 2008). This paper seeks to explore the similarities and differences between NPs and PAs in terms of their education, scope of practice, prescribing authorities, and legal responsibilities. Education The minimum educational requirements for admission into PA programs are at least two years of undergraduate coursework in the basic and behavioral sciences. PA programs must be accredited by the Accreditation Review Commission on Education for the Physician Assistant. On average, an institution consists of 27 months of instructional and clinical content focusing on the care of patients over the lifespan (Ponte & O’Neill, 2013). Over the years “PA training has evolved into an advanced competency-based and accredited educational program, with the broad core curriculum content resembling that of medical school training” (Atwater et al, 2008, p. 729).The curriculum follows the medical model, which is similar to physician education in terms of didactic courses, clinical hours and orientation to patient care (Apold & Mittman, 2011). While the didactic aspect consists of “courses in basic medical sciences, clinical laboratory sciences, behavioral sciences, disease prevention, and clinical medicine,” the clinical aspect involves inpatient and outpatient rotations in various settings including family and internal medicine, pediatrics, gynecology and obstetrics, general surgery, psychiatry, and emergency medicine (Atwater et al, 2008, p. 729).Contingent on the program, the PA student is conferred a Master’s, Bachelor’s, Associate’s, or Certificate degree. To attain licensure, all PA students take the same certifying exam administered by the National Commission on Certification of Physician Assistants (Ponte & O’Neill, 2013). NP programs, graduate programs based on the nursing model, are approved by the state board of nursing and are accredited by a national nursing accreditation body such as the Commission on Collegiate Nursing Education (American Association of Colleges of Nursing, 2013; Ponte & O’Neill, 2013). Dependent on the NP program, the average minimal requirement for admission is a baccalaureate degree in nursing or a baccalaureate degree in another field (Ponte & O’Neill, 2013). In either case, to begin the program, a student must first obtain a registered nursing (RN) license in the state the school operates. Additionally, majority of NP programs require the student to have at least one year of experience as a RN. Programs include two years of classroom instruction and clinical rotations; additionally students must undergo a minimum of 500 clinical hours to complete requirements (Atwater et al, 2008; Cross, Boukus, Samuel & Yee, 2013).Moreover, unlike the PAs, NPs choose an area of specialization. The aim of the curriculum is to build core competencies of nursing knowledge under seven identified domains: professional role, health promotion, disease prevention and treatment, health protection, cultural competence, managing and negotiating health care delivery systems, and monitoring and ensuring the quality of health care practice (Atwater et al, 2008). Henceforth, the program prepares practitioners to undertake various health professional roles such as counselor, consultant, manager, researcher, educator, mentor and advocate (AANP, 2010). Similar to PAs, NPs are conferred a master degree, are licensed at the state level and must pass a certification exam for practice. In addition, “NPs may be certified in both a population focused area and specialty area of practice and must be certified by a national specialty or certifying agency that is acceptable to their state board of registration in nursing” (Ponte & O’Neill, 2013, p. 330). Scope of practice The scope of professional practice of PAs and NPs are determined by regulatory policies, state licensure, and education level (Atwater et al, 2008).Four parameters determine the boundaries of the PAs scope of practice (SOP): education and experience, facility policy, state law and the supervising physician’s delegator decisions (AAPA, 2011). The SOP of a PA consists of “assessment and diagnosis, performing and assisting with procedures and other treatments, patient education, and disease management” (Ponte & O’Neill, 2013, p. 331). The American Medical Association (AMA) sets professional standards or guidelines to which PAs must follow. A PA must work under the supervision of a physician though the physical presence of the physician is not necessary at the time of providing care. The extent of the role is determined by the supervising physician’s assessment of the PA in addition to the the physician’s scope of practice in accordance with the state law. Nevertheless, services of the PA are limited to only those areas for which the physician can offer adequate supervision (Atwater et al, 2008; Ponte & O’Neill, 2013). In parallel to PAs, the NPs SOP encompasses treating, assessing, educating, and diagnosing patients. Unlike the PAs, the NPs are “independently licensed practitioners who can practice advanced nursing autonomously regardless of the collaborating MD’s specialty” (Ponte & O’Neill, 2013, p. 330). This offers the NPs a greater SOP than the PAs. However, contingent on the state in which the NPs practice, the NPs may work independently or must work in collaboration with a physician. State SOP laws govern and limit the degree of independence. Practitioners are permitted to practice in 18 states without physician oversight; prescriptive practices require oversight in seven states; and oversight is mandatory in 25 states to treat, prescribe and diagnose (Cross, Boukus, Samuel & Yee, 2013; Ponte & O’Neill, 2013). Prescribing authority PAs are authorized to prescribe and write medications only when the supervising physicians delegate prescriptive authority. Once authorized, the PAs may apply for a Federal Drug Enforcement Administration (DEA) license specifically categorized for PAs as midlevel practitioners (AANP, 2010). The various categories of prescribed medications including controlled substances must be consistent with the state laws and the supervising physician’s practice (AAPA, 2009).Moreover, the name of the supervising physician is to be shown on the prescriptions written by PAs and dispensed from pharmacies (Atwater et al, 2008). Various states in the US have specific guidelines depicting the NPs prescription practice. Notwithstanding, there are specific principles that apply to all states: NPs are authorized to prescribe medication in every state without the physician’s name or co-signature and “a controlled substance will include the NP prescriber’s federal DEA number, denoting the NPs independent or plenary authority to prescribe in accordance with state scope of practice” (Atwater et al, 2008, p. 742). Legislative efforts are made by many states to enhance the prescriptive authority of NPs. For instance, California’s legislature passed SB 1524 removing “the 6-month, 520-hour, post-graduation supervision requirement to obtain prescriptive authority in California” (Phillips, 2013, p. 22). As such, the prescribing authorities of NP s are likely to be increased in the near future. Legal responsibilities regarding oversight of the NP and PA The NPs and PAs abide by the state regulations regarding supervision or collaboration of physicians. A licensed allopathic or osteopathic physician may undertake responsibility for the care delivered by a PA (AAPA, 2009). The competency and performance of the PA is evaluated and judged by the supervising physician to ensure quality healthcare is catered to the patient’s needs (AAPA, 2011).Guidelines for state regulation of physician assistants provide principles of supervision: to protect public health and safety; preserve the PA access to the supervising physician when consultation is needed; and in situations with several supervising physicians, a method should be devised to document which physician is supervising the PA (AAPA, 2009). The AAPA, while postulating guidelines for state regulation of physician assistants, encourages PAs to undertake “any legal medical service that is delegated to them by the supervising physician when the service is within the PA’s skills and is provided with supervision of a physician” (AAPA, 2009, p. 5). Statutes of state legislature determine oversight of prescribing authority of NPs in certain states whereas the Board of Nursing of the state is authorized to establish regulations in others. Regulations over the oversight and autonomy of NPs are uneven among states: “In 28 states, the state board of nursing is the sole regulator of nurse practitioner practice, whereas in 22 other states, boards of medicine or pharmacy have regulatory authority over nurse practitioners, along with the state boards of nursing” (McCaffrey, 2012, p. 278). The regulations on NPs’ prescribing authority vary from state to state: certain states confer NPs the authority to practice independently; others require NPs to practice under the direction and supervision of physicians or offer them complete autonomy except for prescribing controlled substances. For instance, by the end of 2006, only eleven states authorised NPs to practice independently whereas others required different levels of physician involvement (Christian, Dower & O’Neil, 2007). However, there have recently been a number of SOP laws that grant greater autonomy to NPs for treatment and prescription of medicines. Cross et al (2013, p. 2), in this respect, point out that “18 states plus the District of Columbia permit NPs to diagnose and treat patients and prescribe medications without physician oversight, while seven states require physician oversight of NP prescribing only, and 25 states require oversight of NPs’ diagnoses, treatment plans and prescribing.” However, laws on oversight of NPs in many states are ambiguous as they neither “specify the requisite extent or form of physician oversight” in non-restricted states nor do they clearly pinpoint whether NPs in restricted states can “perform diagnoses, order tests or refer patients to other providers” (Christian, Dower & O’Neil, 2007, p. 11-12). However, the Federal law requires all NPs “to register with the DEA prior to dispensing controlled substances” (Christian, Dower & O’Neil, 2007, p. 4) even though DEA licence will not be administered to NPs in those states where the SOP is regulated by oversight of prescribing authority (Christian, Dower & O’Neil, 2007). Conclusion Regardless of the similarities and differences of the NPs and PAs, the nature and type of health care works undertaken are similar. NPs and PAs are professionals performing similar healthcare services though differing in education, scope of practice, and prescribing authorities. While PAs are general healthcare professionals, NPs have an added advantage of having specialized knowledge in a particular domain and possess the freedom to work autonomously. However, Apold and Mittman (2011, p. 131) hold a different outlook, explaining NPs and PAs reach “the same diagnoses using the same information” and that “there are no “PA ways” to diagnose an acute MI and no “NP ways” to treat an infection.” Ponte and O’Neill (2013) expand on this conclusion stating that their practice will stop preferential hiring of either PAs or NPs as both possess core skills and competencies required of a healthcare professional. References American Academy of Physician Assistants. (2011). PROFESSIONAL ISSUES: PA Scope of Practice. Retrieved from http://www.aapa.org/uploadedFiles/content/The_PA_Profession/Federal_and_State_Affairs/Resource_Items/PI_PAScopePractice_110811_Final.pdf American Academy of Physician Assistants. (2010). PROFESSIONAL ISSUES: Physician assistant prescribing. Retrieved from: http://www.aapa.org/uploadedFiles/content/Common/Files/PI_PA_Prescribing_v4-052611-UPDATED.pdf American Academy of Physician Assistants. (2009). Guidelines for State Regulation of Physician Assistants. Retrieved from http://www.aapa.org/uploadedFiles/content/Common/Files/05-GuideforStateRegs.pdf American Association of Colleges of Nursing. (2013). CCNE accreditation. Retrieved from http://www.aacn.nche.edu/ccne-accreditation American Association of Nurse Practitioners. (2010). Nurse Practitioner Curriculum. Retrieved from http://www.aanp.org/images/documents/publications/curriculum.pdf Apold, S & Mittman, D. (2011). Do nurse practitioners and physician assistants do things differently? The Journal for Nurse Practitioners, 7(2), 130-131. Atwater, A., Bednar, S., Hassman, D & Khouri, J. (2008). Nurse Practitioners and Physician Assistants in Primary Care. Disease-a-Month, 54, 728-744. Christian, S., Dower, C & O’Neil, E. (2007). Overview of Nurse Practitioner Scopes of Practice in the United States – Discussion. Retrieved from http://futurehealth.ucsf.edu/Content/29/2007-12_Overview_of_Nurse_Practitioner_Scopes_of_Practice_In_the_United_States_Discussion.pdf Cross, D., Boukus, E., Samuel, D & Yee, T. (2013). Primary Care Workforce Shortages: Nurse Practitioner Scope-of-Practice Laws and Payment Policies. National Institute for Health Care Reform Research Brief No. 13, 1-7. McCaffrey, R. (2012). Doctor of Nursing Practice: Enhancing Professional Development. Philadelphia: F.A. Davis Company. Phillips, S.J. (2013). Evidence-based practice reforms improve access to APRN care. The Nurse Practitioner, 38(1), 18-42. Ponte, P.R & O’Neill, K. (2013). Hiring Into Advanced Practice Positions: The Nurse Practitioner Versus Physician Assistants Debate. Journal Of Nursing Administration, 43(6), 329-335. Read More