Paper
Sunday, November 4, 2007
196
Nurse Practitioners' and Physicians Views of NPs as Providers of Primary Care to Veterans
Carol E. Fletcher, PhD, RN, Health Services Research & Development, Veterans Health Administration (11-H), Ann Arbor, MI, USA, S. Jill Baker, MA, MSW, Health Service Research & Development (11-H), Veterans Health Administration, Ann Arbor, MI, USA, Pamela J. Reeves, MD, Veterans Integrated Service Network 11, Veterans Health Administration, Ann Arbor, MI, USA, and Julie C. Lowery, PhD, Health Services Research and Development, Veterans Health Administration (11-H), Ann Arbor, MI, USA.
| Learning Objective #1: examine the perceptions of nurse practitioners (NPs) and physicians (MDs) regarding NPs' roles. |
| Learning Objective #2: determine barriers to the full acceptance of NPs as primary care providers to veterans or others with multiple comorbidities. |
We report quantitative and qualitative findings from our study involving primary care nurse practitioners (NPs) (n=74) and physicians (MDs) (n=79) employed in 7 Veterans Health Administration (VHA) medical centers. There was a range of 3.6 to 9.9 NPs per 10,000 patients at the study sites. Subjects responded to a survey containing 26 questions for MDs and 28 for NPs. The last 4 questions to each group were open-ended. The study objectives were to examine both groups’ perceptions regarding the role of NPs and to identify factors that may be contributing to the inefficient use of NPs. NPs saw their role as one of autonomous practice with physician back-up as needed, while MDs pictured a role akin to a physician extender. Both the NPs and MDs shared at least some concerns about the expectations for NPs, MDs at a significantly higher rate. Most of the physicians did not think NPs could provide adequate primary care to veterans who tend to be sicker and have more comorbidities than the average patient. Yet both groups considered their relationships to be collegial. MDs particularly valued NPs teaching and interpersonal skills leading to greater patient satisfaction. The study also highlighted the need for physicians to have adequately protected time to support NPs when the NP recognizes that care of the patient is beyond her/his scope of practice and training. Although this was a VHA study, due to the large numbers of citizens without adequate health insurance, it is to be expected that the findings may apply to NPs’ roles as providers of primary care to the civilian population as well. Better understanding and support of the NPs’ role by physicians and administrators is essential in attempts to translate research into practice by using more NPs to improve patient care.