A doctor's response: Nurse practitioners are truly needed, but they are not doctorsOn May 6 the News Tribune published an article about the aspirations of nursing students and staff from the College of St. Scholastica who want greater autonomy for advanced-practice nurse practitioners. Essentially, they want the nurse practitioners to be able to practice independently of medical doctors (“St. Scholastica staff, students lobby for change in nursing law”).
By: Dr. Joseph F. Just, Duluth News Tribune
On May 6 the News Tribune published an article about the aspirations of nursing students and staff from the College of St. Scholastica who want greater autonomy for advanced-practice nurse practitioners. Essentially, they want the nurse practitioners to be able to practice independently of medical doctors (“St. Scholastica staff, students lobby for change in nursing law”).
I have some fairly strong feelings about this I think should be aired, and I fully expect some flak for so doing.
It’s a bad idea.
Granted, there is a predicted shortage of primary-care physicians looming that needs to be addressed, but lowering educational standards and training is not a sound way to do it. I will admit to not being fully aware of how much training an advanced-practice nurse practitioner gets, but I am pretty certain it does not match the four years of college, four years of medical school, and several years of internship and residency MDs get.
There is another branch of RN care that has been common for quite a while: CRNAs, or certified registered nurse anesthetists. There are a lot of them, and they work out very well. In larger institutions they work under the immediate direction of an MD anesthesiologist who may monitor and supervise several at a time. In smaller hospitals, including rural hospitals, they may well function independently of necessity, and it seems to work well.
But anesthesia, while demanding, is a fairly circumscribed field, not involving the much broader range of diagnostic and therapeutic talent needed in primary medical care.
Proper and accurate diagnosis is a vital part of successful case management and treatment, and sometimes it can be challenging. Only adequate education and experience can provide a doc with this ability, especially in more obscure or complex cases. It does not come easily or quickly.
I spent the last eight months of my career as medical director of quality assurance and utilization review of a large suburban hospital. I worked with a small group of RNs who reviewed all charts and referred to me cases where they felt care might be deficient. In that position, I learned all docs are not of equal talent or ability; and there are, unfortunately, some few who are sadly lacking. That is a reality, but it doesn’t alter my contention that adequate education — and experience — is vital.
Allow me to cite a case; I will keep details vague to protect confidentiality. I know of a patient several years ago who was suffering rather severe, nearly disabling symptoms from a distinct physical abnormality. The patient was under the care of a nurse practitioner who did not recognize the source of the problem, made an incorrect diagnosis, and instituted treatment that was totally ineffective because it did not address the cause of the symptoms. This went on for some months until the patient was seen by a physician, who immediately recognized the cause and instituted proper therapy. The problem disappeared. Case made?
One more point: the article indicated the American Medical Association, or AMA, opposes this change, and that is understandable. But lest I be regarded as a reactionary voice parroting the party line, let it be known I have never been an AMA member. Shortly after getting my degree I began to suspect the AMA was perhaps a bit more involved in the welfare of its members and the profession than the public, and thus I chose not to support it.
I truly do not have a problem with nurse practitioners. We need them — and will need them more in the future.
But they need to acknowledge their limitations and practice accordingly. They are not doctors.
Dr. Joseph F. Just of Ely is a retired general practitioner.