Editor's note: The following is an edited excerpt of the transcript of an editorial webcast, “New rounds for nurses?” conducted by Modern Healthcare on Dec. 1, 2010. The two panelists discussed the implications of a new Institute of Medicine report that recommended expanding the role of advanced-practice nurses as a way to deal with the growing need for primary-care services. The panelists were physician Roland Goertz, president of the American Academy of Family Physicians; and Penny Kaye Jensen, president of the American Academy of Nurse Practitioners. Modern Healthcare reporter Joe Carlson moderated the webcast.
Nursing roles in the spotlight
Panelists discuss IOM's recommendations for new practice models
Joe Carlson: What do you think is the main point that is sort of lost in all of the discussion? What's the point that maybe doesn't get enough attention that you think should be made?
Roland Goertz: I think the debate always sort of comes back to this issue of independent practice for nurse practitioners and how that is framed and based on what? The Institute of Medicine report goes through very lengthy explanations of the problems within the educational system of nursing at all levels. The statement yesterday at the meeting was essentially that with available evidence, there is equal or similar outcomes for primary-practice services between nurse practitioners and some physicians. The problem is: What's that definition? If you take away all certification barriers and don't define what those core primary-care services are, I don't know how you protect the safety of the public without any type of certification process and placement when you don't know what the standard of training is that results in what level of core primary-care services can be provided. The American Academy has always said that there are many individuals that can provide primary-care services, but primary-care services cannot equal what a family physician can provide to the patients and patient care in an ongoing way.
Carlson: Penny Kaye Jensen, I would ask you the same question: What do you think is the main point that has been sort of lost or not mentioned enough in all of the debates on this topic?
Penny Kaye Jensen: Patient-centeredness. I think that in all of this debate, we are forgetting the patient. And that is very unfortunate because the medical home model really focuses on the patient. And really the patient is the point of the healthcare system, and that's who we all should be focusing on as a team—physicians, all the allied healthcare professionals and nurse practitioners. Though I strongly believe it's patient-centeredness.
Carlson: Given the history and opposing interests of physicians and advanced-practice nurses, do you think there's an expanded role for APRNs that physicians could ever accept?
Goertz: I definitely think so. I'm living proof of it. I'm the CEO of a federally qualified health center that has teamwork that has been in place for 14 years—well, actually over 14 years. We have family physicians and nurse practitioners paired together, working seamlessly to deliver care to a population of patients that need more than just those two can provide. And then we have support services that include nutrition counseling availability, other case-management capabilities and a true teamwork. So I think that there's a lot of common ground. I mean, Penny's organization represents about 21% of all nurse practitioners, according to the data that I have. And the data yesterday that the IOM says that about 10% of nurse practitioners, maybe 16%, do want independent practice, and I, honestly, as long as we get the definitions of what that means and what that composes, what those core primary-care services are encompassed by that, I think we can have a lot more common ground. The majority of family physicians ... are already working with nurse practitioners in very creative ways to help address patient care.
Carlson: Do you think there's an expanded leadership role for advanced-practice nurses that physicians could accept?
Goertz: I see nurse practitioners and other nurses in leadership roles in hospitals and health plans all over the place, as many, actually, in those roles as I do see physicians these days.
Carlson: Is it the goal of the AANP to substitute for or replace primary-care physicians?
Jensen: Absolutely not. We just would like to be able to take care of our patients and work to the full scope of our licensure. Many of us have worked for years with physicians, and the majority of nurse practitioners within our organization work in private practices with physicians. I have worked hand in hand with physicians through the VA system, and our organization is not saying that we want to replace the family physicians, but we want to meet the healthcare demands of the nation.
Carlson: And in terms of the leadership aspect, where do you think the advanced-practice nurses fit into leadership?
Jensen: They can lead practices. Many nurse practitioners work in nurse-owned practices, and we, again, within the VA system, I will relate to that, we have led patient panels for many years alongside of our physician colleagues. So I believe that nurses can be leaders in the medical home, and I think that we will continue to provide excellent care to our patients and alongside of our physician colleagues.
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