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NURSE PRACTITIONERS.
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Their impact on patient care and medical costs.... More...
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Paper Abstract:
Their impact on patient care and medical costs. Using nurse practitioners in place of physicians for various functions including treatment diabetes patients (nurse certified as diabetes educator), general physical examinations, health-promotion activities and education, data analysis, treatment plan development and implementation. Discusses studies and trends.
Paper Introduction:
The position of nurse practitioner began in 1965 in the United States, and has made steady progress since that date to where today, state practice laws are in many cases not requiring physician supervision, and some states give nurse practitioners prescriptive authority (Adams, 2002; Roberts, 2002). A review of the literature has shown that collaborative efforts between physicians and nurse practitioners can improve patient care. The use of nurse practitioners has been shown to reduce costs and bring improvements in the quality of patient care in nursing homes, emergency rooms and in surgical settings.
Research studies have shown that patients generally receive the same care from a nurse practitioner as they do from a general practitioner (Roberts, 2002). Roberts (2002) reviewed several studies of nurse practitioners treating diabetes patients.
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These studies show that nursing practitioners canprovide as good, if not better, treatment for diabetic patients as doctors,and that patient acceptance of nurse practitioners is not a problem. The nurse practitioners had an average age of 46.3 years.Eighty-five percent of the nurse practitioners were found to be practicingin primary care, and the remainder in specialty care such as surgery,cardiovascular, emergency medicine, etc. This suggestsnurse practitioners have an important role to play in the future of medicalcare in the United States. Of these, 58,512 were actually employed as nursepractitioners. Hooker (2 2) cites a study comparing nonphysician providers withphysicians which found that they both provided equal care when taking intoaccount nurse practitioners with the same degree of independence asphysicians, a group not considered in earlier studies. (2 2). (2 2). A recent study estimated that there were 1 3,612 nurse practitionersand physician assistants employed in clinical settings in the United Statesin 2 1 (Hooker and Berlin, 2 2). Hooker, R. Looking at trends, the study found that in 2 , there were 1 2,829qualified nurse practitioners, mostly having master's degrees (Hooker andBerlin, 2 2). Gibbs (2 1) suggested that nurse practitioners need to educate theconsumer about the benefits of seeing a nurse practitioner. Our opposition is right under our nose. Another study showed that patients were just ashappy to be treated by a nurse practitioner as by a doctor, and that theirAIC values were similar whoever treated them. A review of the literature has shown that collaborativeefforts between physicians and nurse practitioners can improve patientcare. NursingScholarship, 33, 6. References Adams, D. JAAPA, 15, 51. The study compared1,316 patients randomly assigned to a nurse practitioner or physician forprimary care, followup, and ongoing care following emergency room or urgentcare treatment. The Balanced Budget Act of 1997 provides for prevention and screeningservices, which are well in the domain of nurse practitioners (Thomas,2 1). They provide tremendous opportunities for nurse practitioners in theareas of prevention and screening in a variety of settings. Hooker and Berlin (2 2) predict that the nurse practitioner demandwill continue to increase as more people become eligible for medical carecoverage and as economic factors dictate a reduction in the costs ofproviding medical care. (2 1). Roberts, S. HealthAffairs, 21, 174-181. (2 1). Research studies have shown that patients generally receive the samecare from a nurse practitioner as they do from a general practitioner(Roberts, 2 2). Doctor-nurse practitioner collaboration can befruitful. E. News., 45, 17. Nurse practitioners and outcomes. They are often able to make better communication with patientsthan doctors are. Patients were interviewed six months after their initialvisit, and health care records were analyzed after six and 12 months.Patient satisfaction and physiological tests were compared between thenurse practitioner-treated and physician-treated groups. These changes werebrought about by the ever-increasing need for more consumer services andthe need for concurrent cost reductions in providing this extra medicalcare. Hooker, R. The results show that under the same circumstances, nursepractitioners can provide the same degree of patient care as physicians ina primary care setting where both have the same authority. They were eligible to sit fornational certification by one of the following four accreditors: theAmerican Academy of Nurse Practitioners; the American Nurses CredentialingCenter; the National Certification Board of Pediatric Nurse Practitioners;and the National Certification Corporation for the Obstetric, Gynecologic,and Neonatal Nursing Specialties. In Wichita, a medical practice owned and operated by nursepractitioners is expanding rapidly (Siebenmark, 2 1). (2 2). Although one study showed that78 patients cared for by six nurse practitioners did not receive theminimum care outlined by the American Diabetes Association, neither didthose seen by doctors. Nonphysician providers and physicians provideequal care. Since nurse practitioners, rather than physiciansassistants, are involved to a greater extent in primary care, theirpresence will be even more necessary in the near future. NursePractitioner, 27, 4 . Perhaps as the shortage of doctorsincreases, they will come to appreciate the role of nurse practitionersmore, and see them as essential to providing all their patients with thedegree of care they deserve. The position of nurse practitioner began in 1965 in the UnitedStates, and has made steady progress since that date to where today, statepractice laws are in many cases not requiring physician supervision, andsome states give nurse practitioners prescriptive authority (Adams, 2 2;Roberts, 2 2). Trends in the supply ofphysician assistants and nurse practitioners in the United States. S. Patients also appreciate that nurse practitioners canusually spend longer with them than their doctors do, and this allows formore exchange of information between them. Five year trends in 243 schools where nursing practitioners cangraduate show a decrease of an average of 682 nursing practitioner studentsand 92 graduates per year (Hooker and Berlin, 2 2). Nursing Economics, 19, 115-119. Gibbs, J. Wichita Business Journal, 16, 9. HealthCare LLC proves that nurses can run asuccessful medical clinic. Edmunds, M. For example,the American Academy of Family Physicians does not believe that nursepractitioners should function as independent health practitioners, andbelieves they should always work in collaboration with a practicing,licensed physician. There were nosignificant differences between patient satisfaction or physiologicalresults for diabetes or high blood pressure problems between the twogroups. Siebenmark, J. The use of nurse practitioners has been shown to reduce costs andbring improvements in the quality of patient care in nursing homes,emergency rooms and in surgical settings. Roberts (2 2) reviewed several studies of nursepractitioners treating diabetes patients. Should a nurse practitioner manage yourmedical care? Nurse practitioners were found to beemployed predominantly in primary care, while physicians assistants'employment was divided between primary and specialty care. The American Medical Association is also stronglyopposed to nurse practitioners being able to practice unsupervised(Edmunds, 2 2). Now the nurse practitioners alsodiagnose medical conditions and diseases, plan and provide necessarytreatment, and can write prescriptions for drugs. S., & Berlin, L. Nursepractitioners have been found to be better than doctors in teachingpatients about their illnesses, medications, treatment and preventionstrategies. (2 2). Diabetes Forecast, 55, 24-26. S. (2 1). The group can operate because they have a collaboratingphysician who gives them advice and approves medical care plans fordiagnosis, treatment and prescription writing. Thomas, J. A third study which lookedat diabetes patient care by nurses certified as diabetes educators foundthey had better AIC values than those treated by doctors and also lowerfasting glucose levels. Am. At thesame time, enrollment and graduation in physician assistant programs hasincreased steadily. The authors believethis decline is due to the overall nursing shortage in the United States.From 1996 through 2 there was a decline in entry-level baccalaureatenursing programs of an average 3, 1 students and 1,216 graduates. Med. Occupational health services are provided to localemployers. Medicare, prevention, and the role of the nursepractitioner. J. The study alsofound that the number of graduating nurse practitioners is declining, whilethat of physicians assistants is rising. At a meeting earlier this year, they passed a resolutionto formulate, "clearer definitions of the scope of practice of physicianextenders to include direct appropriate physician supervision." This is inspite of the fact that there is a state nurse practice act which says thatnurse practitioners do not need physician supervision. However, there is still resistance from many doctors and medicalorganizations which need to be overcome before nurse practitioners canattain their full potential in medical care (Adams, 2 2). (2 2). It is not believed likely that the number of nursepractitioners and physician assistants will be able to fill the gap. They take Medicare andMedicaid patients, do pre-employment drug and alcohol screenings, andimmunizations. The study estimates that if current trends continue,over the next few years, nurse practitioners and physicians assistants willrepresent one sixth of the health care providers in the United States: atthe same time, there is a predicted shortage of doctors approaching severeproportions by 2 2 . The practice isthree years old and was originally established to provide physicalexaminations for insurance companies. In the Act, nurse practitioners were defined as fully qualified toprovide all Medicare Part B services, with reimbursement at the rate of 85percent of that paid to physicians for those services. Nurse practitioner education placesemphasis on health assessment, diagnosis, and treatment. Ways must be found to encourage more nurses tobecome nurse practitioners, and more doctors to accept them as an integralpart of the health care system. Nurse practitioners can providesuch services as physical examinations, health-promotion activities, healtheducation, data analysis, treatment plan development and implementation,and promote knowledge of available community services to patients (Thomas,2 1).
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