NURSE PRACTITIONERS in Maryland won a victory recently when the General Assembly passed legislation giving HMOs the option of allowing enrollees to choose either a physician or a nurse practitioner as their primary care provider.
The average person seeking quality health care now has greater choice and ultimately more control over where he or she decides to go for care. For nurse practitioners, however, the legislative battle was not easy one, but definitely worth the fight.
Gov. Parris N. Glendening still must sign the legislation.
Started in 1965 as a solution to improve pediatric primary care, nurse practitioners have emerged as permanent figures in all health care settings, especially primary care, but also in hospitals and physician specialist offices. David Letterman recently attributed his recovery from heart surgery to, in part, a nurse practitioner. Nurse practitioners are even present in the funny papers in the serial comic strip, "Rex Morgan, M.D."
Nurse practitioners are one of several types of advanced practice nurses, which include midwives, psychotherapists, anesthetists and other types of nurse specialists. Nurse practitioners are registered nurses with master's-level education who also have acquired medical skills such as diagnosis and treatment of common health problems and stable chronic diseases. They are certified and licensed and work cooperatively with physicians.
Nurse practitioners have an excellent track record for giving high-quality care, and their malpractice rates remain quite low. Every state and the District of Columbia grants nurse practitioners the authority to write prescriptions. Not a single research study in 35 years has demonstrated that nurse practitioner care results in poor health or financial outcomes. Some studies have even shown better outcomes compared with physicians.
In 1994, the Pew Health Professions Commission urged doubling the number of nurse practitioner graduates to offset the shortage of primary care physicians. Underutilization of nurse practitioners has been estimated to cost the nation $9 billion a year because of restrictions in state laws.
Not everyone, however, wants to see the ranks of nurse practitioners grow.
Despite a steady decline of medical school graduates entering primary care residencies, powerful state medical societies stormed the political arena during the recent General Assembly session. They were determined to stop any encroachment of the female-dominated nursing profession on their pocketbooks or their egos. This time, though, common sense won out, resulting in greater choice for patients.
The recent legislation may even help put a dent the current nursing shortage by attracting more men and women to the profession of nurse practitioner.
The nursing profession is hemorrhaging. It is bleeding because of aging nurses, poor image, low pay, mandatory overtime, stressful work conditions and competing career opportunities. Why would anyone oppose a bill that gives more people greater opportunities to receive care? What will happen to society when there are no nurses?
Janet Selway is a nurse practitioner and clinical instructor at the Johns Hopkins University School of Nursing.