Nurse Education Key to Scope-of-Care Debate

Cheryl Clark, for HealthLeaders Media , August 15, 2011
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“Nursing advocates are pushing very hard for expanded scope of practice,” says John Rowe, MD, a former CEO of Aetna, and before that of Mount Sinai New York University Health, who now teaches at Columbia University’s Mailman School of Public Health. “They want to pull those barriers down, they want payers to pay nurses directly and pay them more, and they want to have leadership roles, be team leaders. But on the other side, you have physician advocates who are concerned about losing turf. These two sides are fighting with each other.

“Physicians think nurses believe they are effective substitutes for physicians. But physicians say they train longer, more intensely than nurses so they must know more. And they also think, though they don’t say, that you have to be a better student to get into medical school as opposed to a nursing school, so physicians start their careers with greater capacity.”

It’s exasperating, says Rowe, who says both sides end up yelling at him. “Of course doctors know more. But I don’t think doctors know how to provide core components of primary care better than an advanced practice nurse. Doctors know more about other things, and what we should do is have those doctors do those other things.

“I’m not a nursing advocate; I’m not physician advocate. It’s about the patients, and doctors and nurses should think about these issues from that point of view,” he says.

Rowe has thought about it a lot. He was one of the 18 committee members who produced last fall’s 701-page Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health, a document many say changed the entire conversation about the role of the nurse in healthcare. Rowe says there are hundreds of articles “summarizing research over decades that clearly show, when it comes to core components of primary care, an advanced practice [nurse] can do it as well as a physician.”

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6 comments on "Nurse Education Key to Scope-of-Care Debate"

D. Andrews, CRNA, MHS (9/27/2011 at 10:05 PM)
Shi Zang, We do carry our own liability insurance at the same limits as physicians. The difference is, our rates have dropped over the past decade due to decreased claims. Do your homework before commenting.

Phyllis Carmichael RN, BSN (9/25/2011 at 3:05 PM)
I enjoyed your article. I am currently in an masters program. A recent discussion centered on nursing skills post graduation. I came from a diploma school in 1998. The hospital was next door to school. Thus, I was confident in my hands-on skills regarding starting IVs, inserting naso-gastric tubes, inserting urinary catheters, performing sterile dressing changes, etc. I wish that I would have gone on to obtain my advanced degree straight away. Now I see how valuable the added education is to my practice. Our discussion turned briefly to nurse residency programs. Little information exists on that subject. Part of the "upheaval" you spoke of? Phyllis

Julia Harris CRNA (9/5/2011 at 3:18 PM)
In response to the previous comment, I do in fact carry my own malpractice insurance and I am very much liable for the outcomes of the patients that I care for. With increased autonomy comes increase in responsibility and I have embraced that as part of my profession.




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