By now most of us have heard of a nurse practitioner. But what exactly is a nurse practitioner? What can they do? How can they be incorporated into a medical practice?
A Nurse Practitioner is a Registered Nurse who has completed graduate-level education and advanced-practice training. Nurse practitioners can see a wide range of patients, both well and sick, and perform many in-office procedures. Prescribing medications, ordering and interpreting tests, hospital admitting and discharge privileges, and hospital rounding are just a few of the privileges falling within the scope of a nurse practitioner.
The next question is what is so special about a nurse practitioner? The answer, for the most part, lies in the approach nurse practitioners take in their patient care. The physician typically uses a disease-based or problem-based approach meaning that the focus is more on diagnosing a problem and treating that problem. Nurse practitioners use an approach that is nursing-based, focusing on the patient and his/her environment as a whole. Nurse practitioners not only diagnosis problems and treat those problems, but we incorporate that treatment and that response into their family, their culture, their daily lives and their community. We focus on teaching people ways to stay healthy and have the capability to treat people for their acute and chronic illnesses. Both approaches to care are important and together give the patient a more complete resolution and stabilization of their condition.
In our practice we do a lot of collaboration; not only from nurse practitioner to physician but also physician to nurse practitioner. Many times either I have gone to a physician or a physician has come to me to work with a patient. The benefit of this collaboration is that the patient’s immediate need is met and she does not have come back for another visit, ultimately resulting in a quicker resolution of the problem. Since the nurse practitioner can practice independently, when our doctors leave the office to go to the hospital for a delivery, the nurse practitioner can see the patients. Again, the patient is seen avoiding an appointment that needs to be rescheduled. Thus, patient satisfaction is increased, problems are immediately addressed and patient outcomes are improved.
For instance, in our practice, most of our OB patients with diabetes get seen twice a week. One day the patient sees her physician who manages her pregnancy. The other day she sees the nurse practitioner. Although her pregnancy is monitored when she sees the nurse practitioner, the focus of this visit is on her diabetes and how to maintain good glycemic control and still check blood sugars four times a day, eat six times a day, take care of three children and work full-time. This type of visit can be very time consuming. Using the nurse practitioner in this manner allows the physician to continue to focus on those patients that need physician-specific attention. It also gives the patient more education, individual attention, encouragement and incorporation of her disease into her individual lifestyle. The benefit to the patient is she gets the best of both worlds, which ultimately optimizes the outcome for her and her pregnancy.
With the current and future changes in health care, nurse practitioners will become an even more important part of a medical practice. By using nurse practitioners to see well-checks and to monitor established therapies, the physician is freed up to focus on surgical cases and those conditions that fall outside the scope of a nurse practitioner.
But how do patients view nurse practitioners? My experience is that most patients love nurse practitioners. All for the above reasons plus more. There are many patients in our practice that will see their physician for certain problems and the nurse practitioner for other problems. Some patients are not comfortable talking to a physician about certain issues. Although the care that the patient receives from both the physician and the nurse practitioner is the exact same, the title “doctor” can still intimidate some. The nurse practitioner is a little more on their level on the totem pole and can be less intimidating. After talking to many patients regarding nurse practitioners once they see one, they are be hooked. This keeps your patient in your practice, helps to grow your practice, and gives your patient complete and “holistic” management of their condition, and other options for care.