April 2013

Empowering Practice:The Time is Now

By Bobbie Berkowitz, PhD, RN, FAAN

Dean, Columbia University School of Nursing

scope of practice

Earlier this year, a rider to New York State's budget stipulated that nurse practitioners be allowed to practice without a collaborating agreement with a physician. Lobbying by special interests resulted in the rider being dropped from the subsequent budget that was recently signed into law.

In New York, nurse practitioners are required to establish a collaborative agreement with one physician prior to beginning practice and maintain that agreement in the practice setting. Our state also limits the number of nurse practitioners each physician may work with, thus restricting the number of nurse practitioners, and thereby access by patients to care by nurse practitioners.

On a national basis, as well as here in New York, nurse practitioners could provide enormous service to patients in a wide number of areas if they were able to practice to the full extent of their scope of practice without restrictions.. The addition of 30 million or more Americans to the ranks of the health-care insured, coupled with new and growing care demands precipitated by the aging of baby boomers, are converging to create projected physician shortages as soon as 2015.

And the shortage coincides with an area of expertise of nurse practitioners. For example, only about one in ten medical students nationally goes on to specialize in family medicine. Since these physicians provide much of the basic care Americans receive (including preventive care), nurse practitioners could be a lifeline for those seeking to stay well through access to primary care and informed, healthy lifestyle choices. Indeed the Robert Wood Johnson Foundation concluded that "The patient-centered nature of nurse practitioner training … makes nurse practitioners particularly well prepared for and interested in providing primary care."

Patients with chronic conditions would also benefit. A literature review conducted by the National Governors Association showed that "nurse practitioners are capable of successfully managing … hypertension, diabetes, and obesity." That same report found that in terms of time spent with patients, prescribing accuracy, and preventive education, nurse practitioners “provided at least equal quality of care" as physicians.

Several studies show that 70–80 percent of patients who see nurse practitioners are as satisfied -- and sometimes more satisfied -- with the quality of care they receive compared to that supplied by physicians. In fact, the National Governors Association report found that “None of the studies in [our] literature review raise concerns about the quality of care offered" by nurse practitioners. This and a similar conclusion by the Robert Wood Johnson Foundation are particularly important since they undermine as ill-founded the assertion that allowing nurse practitioners greater independence in caring for patients puts patients at risk.

As a school emphasizing advanced practice nursing, we know the critically important role nurse practitioners can play in providing access to healthcare through the diagnosis and treatment of disease, as well as helping patients prevent illness and stay well. Which is why, when the specialty practice of Columbia University Medical Center, ColumbiaDoctors, opened its doors in its new midtown New York facility it was joined by Columbia Advanced Practice Nurse Associates (CAPNA) to provide same-day immediate and primary care. Our NPs work in partnership with the more than 2,000 physicians at ColumbiaDoctors and, like all nurse practitioners in New York State, our nurse practitioners have had the authority to write prescriptions for more than 20 years and provide the full range of primary care.

A few months ago, for the 12th time in the past 13 years, nurses were voted the most trusted profession in America in Gallup's annual survey ranking professions for their ethical standards. Americans recognize that nurses put patients first. Nurse practitioners embody the skillful compassion that reassures patients that they are in good hands.

Nearly a third of the states and the District of Columbia have expanded patient access to advanced practice nursing care by eliminating obstacles imposed on NPs by requiring supervision and direction from physicians -- all with no evidence at all of reduced patient safety.

It’s time for our elected officials in the state of New York to also recognize that our own nurse practitioners have the skills, judgment, and character to provide safe, high-quality care to patients, particularly those without easy access to physician-directed care, both now and in the future.