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Nurse Practitioners are the GOAT

We have decades of research now that makes very clear the nurse practitioner provides high-quality primary, acute, and specialty health care services across the life span and in diverse settings, including our own private practices (AANP, 2023; Everett et al., 2019; Everett et al., 2013; Gracias, 2008; Jackson et al., 2018; Kuo et al., 2015; Kuo et al., 2015; Kurtzman et al, 2017; Lutfiyya et al., 2017; Melillo et al., 2015; Mundinger et al., 2000; Ohman-Strickland et al., 2008; Sacket et al., 1974; Tapper et al., 2020). What we don't do well though, is promote this fact. Our profession is much more worried about sustaining relationships with our physician colleagues, because we depend on them to practice in half the states in our country because of laws that restrict our trade. We even write many of our practice standards to appease physician groups as a priority over letting the body of science guide our care.


The fact is that the entire healthcare infrastructure is a system that depends on referrals and relationships, which is why many clinics have free lunches brought in regularly by vendors or have a multitude of sticky note pads and pens with specialty clinic branding because those practices depend on our referrals to grow. Not one of us can do it all so we depend on each other and must network to grow and develop. However, it is the nurse practitioner that often gets locked into legally binding agreements, not because without one they would have no access to the collective, but because these written agreements restrict their trade which impedes on physicians. The American Medical Association, or the physician union and lobby group, works really hard to protect their professionals, respectfully, and really have been quite successful in this regard. This is not an effort to protect the healthcare consumer; this is a business move to protect the profit potential for physicians. Nurse practitioners are consistently chosen as the preferred provider when compared to several other provider types, including Physician Associates and Medical Doctors (Kippenbrock et al., 2019).


This is no secret. There is no improved clinical outcomes because of these required written collaborations. The only difference they demonstrate is reduced access to care because it can be a challenge to find a physician willing to assume liability they need not acquire otherwise, and when they do agree, often they impose limitations to limit their own competition or significant cost that can really challenge the new practitioner or one who wants to maintain a smaller practice.


NPs Blend Clinical Expertise with Education & Wellness


Our training and approach as nurse practitioners is unique in that not only are we trained to be clinical experts in diagnosing and treating acute and chronic health conditions, but we have the added training of working to prevent disease, to enhance wellness, to implement lifestyle changes that optimize lifelong vitality, and to provide education and counseling that enhances outcomes (Kurtzman et al., 2017; Ohman-Strickland et al., 2008; Ritsema et al., 2014).


Since the establishment of the profession in 1965, research has consistently demonstrated nurse practitioners achieve excellent outcomes and offer high quality of care (AANP, 2023; Borgmeyer et al., 2008; Everett et al., 2019; Everett et al., 2013; Gracias, 2008; Jackson et al., 2018; Kuo et al., 2015; Kuo et al., 2015; Kurtzman et al., 2017; Lutfiyya et al., 2017; Mundinger et al., 2000; Ohman-Strickland et al., 2008; Tapper et al., 2020). The continuing body of literature supports nurse practitioners as safe, effective, efficient, equitable, and evidence-based clinicians who are patient-centered. Furthermore, and this is the biggest area we water-down the evidence in effort to not offend is the literature is clear that nurse practitioners provide as good as care, if not better, than our physician colleagues - there are no statistically significant differences across outcomes measured, at least with regards to our being midlevel or substandard. There is some evidence that demonstrates we are superior (Kippenbrock et al., 2019; Kuo et al., 2015; Kurtzman et al., 2017; Lutfiyya et al., 2017; Ohman-Strickland et al., 2008; Rantz et al., 2018; Ritsema et al., 2014; Tapper et al., 2020), but again, we keep that fairly well under wraps because we don't want to appear petty in spite of the ongoing oppression we suffer by physicians groups.


Let's face it, when women speak about our oppression, we are chastised as men-haters, so we soften our message. The nursing profession is predominantly female and historically physicians have largely been men, so this societal rule to not cause a fuss, to be sweet and kind and tolerant continues to plague our efforts. But when in the ocean, while it is true that very few sharks ever attack a human, the reality is that we treat them all as if they might. In the healthcare arena, while nurse practitioners are well aware of their outcomes, we have been well trained to cower in the presence of a physician because they almost always have the power to shut us down and until proven otherwise, they are assumed to be hostile whether this is ever spoken aloud or not.


Better. Better. Better.


Consumers of healthcare under the care of a nurse practitioner endure fewer unnecessary hospital readmissions, fewer unnecessary trips to the emergency room, and fewer potentially preventable hospitalizations when compared to those cared for by physicians (AANP, 2023; Buerhaus, et al., 2018; DesRoches et al., 2017; Landsperger et al., 2016). Studies also report that consumers are more often satisfied with the care they received from their nurse practitioner when compared to physicians (Kippenbrock et al., 2019; Roblin et al., 2004) and have shorter hospital stays and less likely to die during ICU admission (Landsperger et al., 2016).


References

Borgmeyer, A., Gyr, P. M., Jamerson, P. A., & Henry. L. D. (2008). Evaluation of the role of the pediatric nurse practitioner in an inpatient asthma program. Journal of Pediatric Health Care, 22(5), 273-281.

Buerhaus, P., Perloff, J., Clarke, S., O'Reilly-Jacob, M., Zolotusky, G., & DesRoches, C. M. (2018). Quality of primary care provided to Medicare beneficiaries by nurse practitioners and physicians. Medical Care, 56(6), 484-490.

DesRoches, C. M., Clarke, S., Perloff, J., O'Reilly-Jacob, M., & Buerhaus, P. (2017). The quality of primary care provided by nurse practitioners to vulnerable Medicare beneficiaries. Nursing Outlook, 65(6), 679-688.

Everett, C. M., Morgan, P., Smith, V. A., Woolson, S., Edelman, D., Hendrix, C. C., Berkowitz, T., White, B., & Jackson, G. L. (2019). Primary care provider type: Are there differences in patients' intermediate diabetes outcomes? Journal of the American Academy of Physician Assistants, 32(6), 36-42.

Everett, C., Thorpe, C., Palta, M., Carayon, P., Bartels, C., & Smith, M. A. (2013). Physician assistants and nurse practitioners perform effective roles on teams caring for Medicare patients with diabetes. Health Affairs (Project Hope), 32(11).

Gracias, V. H., Sicoutris, C. P., Stawicki, S. P., Meredith, D. M., Horan, A. D., Gupta, R., Schwab, C. W. (2008). Critical care nurse practitioners improve compliance with clinical practice guidelines in “semiclosed” surgical intensive care unit. Journal of Nursing Care Quality, 23(4), 338-344.

Jackson, G. L., Smith, V. A., Edelman, D., Woolson, S. L., Hendrix, C. C., Everett, C. M., Berkowitz, T. S., White, B. S., & Morgan, P. A. (2018). Intermediate diabetes outcomes in patients managed by physicians, nurse practitioners, or physician assistants: A cohort study. Annals of Internal Medicine, 169(12), 825–835.

Kippenbrock, T., Emory, J., Lee, P., Odell, E., Buron, B., & Morrison, B. (2019). A national survey of nurse practitioners’ patient satisfaction outcomes. Nursing Outlook, 67(6), 707-712.

Kuo, Y. F., Goodwin, J. S., Chen, N. W., Lwin, K. K., Baillargeon, J., & Raji, M. A. (2015). Diabetes mellitus care provided by nurse practitioners vs primary care physicians. Journal of the American Geriatrics Society, 63(10), 1980-1988.

Kuo, Y., Chen, N., Baillargeon, J., Raji, M. A., & Goodwin, J. S. (2015). Potentially preventable hospitalizations in Medicare patients with diabetes: A comparison of primary care provided by nurse practitioners versus physicians. Medical Care, 53(9), 776-783.

Kurtzman, E. T. & Barnow, V. S. (2017). A comparison of nurse practitioners, physician assistants, and primary care physicians' patterns of practice and quality of care in health centers. Medical Care, 55(6), 615-622.

Landsperger, J. S., Semler, M. W., Wang, L., Byrne, D. W., & Wheeler, A. P. (2016). Outcomes of nurse practitioner-developed critical care: A prospective cohort study. Chest, 149(5), 1146–1154.

Lutfiyya, M. L., Tomai, L., Frogner, B., Cerra, F., Zismer, D., & Parente, S. (2017). Does primary care diabetes management provided to Medicare patients differ between primary care physicians and nurse practitioners? Journal of Advanced Nursing, 73(1), 240–252.

Melillo, K. D., Remington, R., Lee, A.J., Abdallah, L., Van Etten, D., Gautam, R. & Gore, R. (2015). Comparison of nurse practitioner and physician practice models in nursing facilities. Annals of Long-Term Care, 23(12), 19-24.

Mundinger, M. O., Kane, R. L., Lenz, E. R., Totten, A. M., Tsai, W. Y., Cleary, P. D., Friedewald W. T., Siu A. L., & Shelanski, M. L. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians: A randomized trial. Journal of the American Medical Association, 283(1), 59-68.

Ohman-Strickland, P. A., Orzano, A. J., Hudson, S. V., Solberg, L. I., DiCiccio-Bloom, B., O’Malley, D., et al. (2008). Quality of diabetes care in family medicine practices: Influence of nurse-practitioners and physician’s assistants. Annals of Family Medicine, 6(1), 14-22. doi:10.1370/afm.758

Rantz, M. J., Popejoy, L., Vogelsmeier, A., Galambos, C., Alexander, G., Flesner, M., & Petroski, G. (2018). Impact of advanced practice registered nurses on quality measures: The Missouri quality initiative experience. Journal of the American Medical Directors Association, 19(6), 541-550.

Ritsema, T. S., Bingenheimer, J. B., Scholting, P., & Cawley, J. F. (2014). Differences in the delivery of health education to patients with chronic disease by provider type, 2005-2009. Preventing Chronic Disease, (11)33.

Roblin, D. W., Becker, R., Adams, E. K., Howard, D. H., & Roberts, M. H. (2004). Patient satisfaction with primary care: Does type of practitioner matter? Medical Care, 42(6), 606-623.

Sacket, D. L., Spitzer, W. O., Gent, M., & Roberts, M. (1974). The Burlington randomized trial of the nurse practitioner: Health outcomes of patients. Annals of Internal Medicine, 80(2), 137-142.

Tapper, E. B., Hao, S., Lin, M., Mafi, J. N., McCurdy, H., Parikh, N. D., & Lok, A. S. (2020). The quality and outcomes of care provided to patients with cirrhosis by advanced practice providers. Hepatology, 71(1), 225-234.

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