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Discussion summary: Perceptions of APNs in practice

The focus of this week's discussion was upon the 'trust factor' regarding the expanding roles APNs are playing in healthcare. The original article which acted as a springboard to the discussion suggested that patients are often more satisfied with APN-directed care than physician-provided care, perhaps due to the greater sensitivity and better bedside manner of APNs. There was an extended discussion amongst the participants about how to offer care that was attenuated to patient's emotional as well as physical needs, yet still efficient and mindful of time constraints of the healthcare environment.

Gender may also be a factor when dealing with female patients, particularly in regards to gynecological matters: more APNs are female, so women often feel that APNs are more sensitive about female health needs. However, gender stereotypes can also work against APNs, since some women may feel that male physicians have greater knowledge of medicine and more technical skills. There may also be resentment between physicians and APNs: physicians may feel that APNs are allowed more time to get to know their patients, which they cannot, given the ways their hours are scheduled. However, this tension can be resolved if the APN is willing to see patients when the physician is 'backed up' and vice versa: such was the case for many of the participants at their workplaces.

There is no hard and fast rule regarding patient perceptions: some patients may simply accept the APN as 'the doctor' because of the role function she fulfills while others might be mistrustful because the APN is not a 'real' doctor in their eyes. While clearly all healthcare practitioners have both the potential and obligation to be caring, the personality type that is drawn to become an APN and the worldview of nursing conveyed in nursing school may place a higher value on the principle of caritas than other paradigms of medicine. It was agreed that 'marketing' the role of the APN and the unique services she can provide to patients is an important component of patient acceptance and improving patient perceptions of the role.

There was also some discussion about the confusion of the roles of different types of nurses, such as the clinical nurse specialist (CNS) (a specialist on a patient population, disease, or type of problem) and a nurse executive (NE) (whose role focuses in delegation, supervision and resource utilization). In some practice settings, nursing roles may be more differentiated than others.

All discussion participants unanimously agreed that the quality of care disseminated by APNs was comparable to that of physicians. Many APNs also have additional levels of certification to further expand their ability to provide care. However, although the quality of care may be the same, there remains a difference in the overall paradigm adopted by APNs vs. physicians: APNs tend to view treatment in a more holistic fashion. This may be yet another reason that APNs are valued so highly by patients. The majority of patients judge providers based upon interpersonal rather than technical skills. Interestingly enough as well, more and more medical schools are trying to teach such components of caring to aspiring physicians, principles which have been integral to the education of nurse-practitioners for a long time.