Quality of Care Via Nurse Practitioners

Family Nurse Practitioner

The expansion of healthcare coverage through the Affordable Care Act (ACA) is expected to create an enormous increase in the number of people seeking medical treatment and healthcare. A number of demographic issues exacerbate the situation: An aging population requiring more extensive treatment and care, a rising national population, and a shortage of primary care physicians (Iglehart, 2013). The shortage of primary care physicians is one of the most crucial for national medical care because of two substantive dynamics: 1) The number of graduates from medical school who plan to enter careers as primary career physicians is currently estimated at 25%; and 2) the care that advanced practice registered nurses (APRN) can provide is constrained by the current scope-of-practice laws on the books in any states (Iglehart, 2013).

An enduring tension exists between the American Medical Association and nursing advocates regarding the scope of practice that should be permitted for advance practice registered nurses (Iglehart, 2013). Because the medical licenses are issued by states, the federal government has not addressed issues related to the scope-of-practice with respect to advanced practice nursing (Iglehart, 2013). The question is not simply one of whether advanced practice nurses should provide care that utilizes the full measure of their training and expertise, but whether advanced practice nurses should be permitted to function independently as clinicians or if they should be members of physician led teams (Iglehart, 2013).

Successfully integrated systems, such as those operated in Kaiser Permanente, Geisinger Health System, and the Department of Veterans Affairs, utilize hierarchically structured physician led teams with collaborative relationships between advanced practice nurses and other non-physician providers (Iglehart, 2013). Nayler and Kurtzman (2010) reviewed the current and projected workforce of nurse practitioners, and found within the available evidence regarding advanced practice nurses that substantive contributions were made toward improving the provision of primary care and effectively reducing the usage cost of healthcare resources. Indeed, Nayler and Kurtzman (2010) recommended standardization of nurse practice state laws and the provision of equivalent reimbursement rates for commensurate services regardless of the type of practitioner engaged in the service. Moreover, Nayler and Kurtzman (2010) argue that the performance outcomes of advanced practice nursing be reported in publically accessible formats in order to build awareness and credibility regarding the high-quality care provided by advanced practice nurses.

The literature shows consistent findings regarding the quality and outcomes of patient care by advanced practice nurses, such that patients who saw nurse practitioners were more satisfied with their care, experienced consultations that were longer in duration, were referred for more tests, and yet, experienced "no appreciable differences in patient outcomes, processes of care, or resource use" (Naylor & Kurtzman, 2010, p. 895). Indeed, the Office of Technology Assessment (OTA) provided for two independently conducted reviews of non-physician providers in the United States, for which the conclusions were as follows: "within their areas of competence, nurse practitioners, physician's assistants, and certified nurse-midwives provide care whose quality is equivalent to that of care provided by physicians ("OTA Policy Analysis," 1986, p. 5; as cited in Naylor & Kurtzman, 2010, p. 894)).

Family Nurse Practitioner Competencies

The focus of care for family nurse practitioners is the family unit and the members of the family as defined by those members (NONPF, 2002). The context in which family nurse practitioners provide care is the community, which includes a broad base of knowledge and experience of people from all age groups (NONPF, 2002). As specialists in family nursing, family nurse practitioners are committed to family-centered care (NONPF, 2002). From a clinical perspective, most of the care provided by family nurse practitioners is in ambulatory care settings (NONPF, 2002).

The research literature on the performance of advanced practice nursing and family nurse practitioners consistently reports positive outcomes with no discernable differences attributable to the type of care provider. Indeed, patient safety has been shown to be enhanced as consultations with family nurse practitioners foster more focused interaction and time to fully understand the healthcare and medical needs of family members.