Increasing the role of nurse practitioners

Beginning next year, nearly 5 million uninsured Californians will rapidly gain health coverage thanks to the Affordable Care Act.  This is wonderful news, especially for those who need it most– the 1.4 million newly eligible for Medical.

However, the reality is that coverage does not necessarily mean access to care.   Simply having insurance doesn’t guarantee Californians can actually receive attention if there is a shortage of caregivers, namely primary care physicians (PCPs).  Even with health care reform, California does not have enough of these doctors; this is partly due to the shortage of primary care physicians and the lure of higher pay in specialty practice. Medical students entering family practice medicine as a specialty is on the decrease as well.

Not to mention, clinics in rural and urban areas will receive a flood of millions of newly insured patients. Training physicians can take up to 10 years and frankly, patients can’t afford to wait.

As a result, the newly insured will be eager to receive care, but they won’t have access to a PCP.  However, there is a viable, and extremely timely, solution that will make California an innovator in use its medical professionals to serve newly insured patients: This National Nurses Week let’s increase access by expanding the scope of responsibilities for the often de facto primary care givers– nurse practitioners.

Nurse practitioners have an advanced education, and thus have the ability to evaluate, to diagnose, to prescribe and to treat patients who have various ailments. Many of them practice in their own nurse-managed clinics, in clinics within hospital facilities, and in emergency rooms. They just need policy makers to give them a broader scope of practice and more autonomy in order to have a bigger role in the delivery of primary care.
I went to into nursing because I believe in the old fashioned bedside care that makes a difference in the lives of patients and their families.  And I went on to teach nursing because I know that with a little innovation and education, we can expand that role to broaden the scope of practice to providing quality primary care.  I want to continue the traditional care of training, but also meet the demands of tomorrow.  These demands include allowing advanced care nurses to prescribe medications, management treatments, order diagnostic tests, and perform many of the tasks that the general family medicine physician can typically provide.

During my time at Charles R. Drew University of Medicine and Science, I’ve seen many graduates meet this demand in their practicum.   My students are training and practicing in South Los Angeles, an area with one of the highest rates of uninsured in California. Studies have shown a high percentage of our graduates continue to practice and serve patients in the community and underserved areas.

The truth is many nurses will be doing what they’ve already been trained to do.  Their work would be limited to what they’re already qualified to practice but often not allowed to do. California already has about 17,000 nurse practitioners. They can be trained more quickly than doctors and at considerably less expense. Some nurse practitioners in California already see patients without a doctor in the room.

Increasing the role of nurse practitioners is a health workforce policy topic that has been discussed at the state and national level for years.  Seventeen other states have expanded the scope of nurse practitioners and studies from these states have proven time and time again that there is no increase in medical errors because of this model.

Even retail markets are taking notice and stepping up to the demand for treatment. Wal-Mart, Target and CVS are hiring nurse practitioners to offer basic treatment for the management of chronic conditions like diabetes, heart disease and asthma to its consumers. Just last month, Walgreens became the very first retail store chain to expand its health care services to include diagnosing and treating patients for chronic conditions.

By changing the rules so that these health care professionals can provide direct service would make better use of their skills and provide at least some care for people who can’t find a doctor. For this change to occur, buy-in and support for the advanced practice nurses will need to come from the physicians, policy makers, the public, and other stakeholders.

Our system of coverage is reformed, why don’t we give it the level of quality care it demands? Nurse practitioners are waiting in line to fill that gap.

— Ed’s Note:  Lisa Jones PhD, RN, MSN, CRRN, PHN is the Assistant Dean for Faculty Affairs and Professor at the Mervyn M. Dymally School of Nursing at Charles R. Drew University of Medicine and Science in South Los Angeles.