John Zimmerman, a nurse anesthetist for the Veterans Administration in Minneapolis, leans over a patient. Under a proposed rule, nurse anesthetists would be allowed to work independently rather than under a physician's close supervision. By Aug 04, at 9: This includes nurses performing work that anesthesiologists have been doing — and that has some physicians irate.
The next day she had brought her son back to the clinic, where they were seen by the nurse practitioner, who gave prescribed steroids and bronchitis medicine instead. I was a young white woman, a stranger, bluntly telling her she had let her child suffer from a lung disease that might scar him for life.
The nurse practitioner was someone from her neighborhood who spent time in the room and knew her. She still thinks of the boy, reminding herself to be careful in how she handles her patients.
While physicians maintain the solution to this problem is to train more doctors and increase government funding for residency programs in the state, nurse practitioners contend that allowing them to practice without doctor supervision is the answer to the primary care shortage.
Nurse practitioners say that they are already overseen by the Texas Nursing Board and their licensing board, and stand to lose their licenses if caught practicing outside of their training.
Having to pay a doctor — who is usually not even on site — to officially oversee their work costs money and makes it more difficult for nurse practitioners to open up their own clinics. Melissa Herpel is a nurse practitioner who has run her own clinics in Spring and Conroe for about five years.
Herpel decided to open her own clinic after she got a job in a family practice.
The job started out well, but about six months in, she noticed she was not getting as many patients because insurance companies balked at paying the full rate for an office visit to a nurse practitioner.
Melissa Herpel, who operates two clinics, maintains nurse practitioners are not trying to be primary care physicians. Lawrence Elizabeth Knox Herpel says the fees make some sense because the physician is ultimately responsible and liable if anything goes wrong.
But these fees, paired with the supervisor requirement, can make it difficult for other nurse practitioners to open their own practices. But she cannot do so without finding another doctor who will supervise the nurse practitioners at the clinic — doctors are allowed to supervise only seven nurse practitioners in a clinic setting — and that has proved difficult.
About three years ago Molly went to the hospital for a hip problem — her condition has caused numerous health issues and she has been wheelchair-bound her entire life.
While she was in the hospital, she gradually stopped eating, even refusing fried fish, sweet potato fries and other foods she had always liked. Her weight dropped from about pounds to pounds within days, and she grew so weak the hospital doctors started discussing hospice options with Frazier and his wife.
They refused to consider it, and Molly was discharged and settled back into the group home she lives in on the suburban outskirts of the city, but her appetite was still almost nonexistent.
Frazier took her to various doctors, including a gastroenterologist, but no one could figure out what was wrong. And then she ordered a blood test and diagnosed Molly with a bacterial infection in her stomach.
The infection was causing Molly pain whenever she ate, so Molly stopped eating, the nurse practitioner explained. The nurse practitioner put Molly on a round of antibiotics. She started gaining weight and her energy returned within days, Frazier says. If they can do something like that for other people, they should be allowed to.
Tiffany Eckhardt Each meeting of the Texas Legislature seems to inch nurse practitioners a little closer to their goal.
This session, nurse practitioner lobbyists filed multiple bills — including the usual proposed legislation to end the physician supervision requirement — but got only a few of them through.
However, when the session wrapped up, nurse practitioners had been awarded the right to treat Medicaid patients and sign birth and death certificates.
Texas Nurse Practitioners even counted the bill to end the supervision requirement a success since it made it further through the legislative process than it ever has before, according to the group. These developments have left many doctors incensed. Irving dismisses the idea that freeing nurse practitioners from physician supervision will result in more medical care in rural areas.
Even though Texas lawmakers loosened the prescriptive supervision requirements inthe number of nurse practitioners working in metropolitan areas of the state has remained about the same, according to Texas Board of Nursing statistics.
Why would they when they can make so much money in the city? Still, it is looking increasingly likely that nurse practitioners will be even more involved in the health-care system going forward. With the new care system being considered at hospitals, nurse practitioners will handle all the basic stuff and come to the doctor with any problems, Baker, the Memorial Hermann hospitalist, explains.
A few years ago, a young woman came into the emergency room where Baker was working, short of breath and complaining of pain.
The nurse practitioner gave her morphine for the pain. However, the woman, young and outwardly healthy, was actually experiencing heart failure, and the morphine the nurse practitioner prescribed could have killed her.
As the supervising doctor, Baker will be responsible for both ten to 15 patients she will handle herself and five to eight patients each nurse practitioner cares for.
This type of scenario has frustrated a number of physicians, who insist the decrease in control over nurse practitioners means the patients will ultimately be the ones to suffer.
I knew it and I saved a life. When we start compromising on our standards of training and knowledge, then we will have to be prepared as a nation for a huge sacrifice, because when you stop investing in medical education at the highest levels, there is a price.
I can make a difference in how someone handles their diabetes. Irving partners with a nurse practitioner to see nursing home patients. I can trust her to do that, so I can trust her.Watch video · Highly trained clinicians such as certified nurse midwives and nurse practitioners believe they should be allowed to practice independent of physician supervision.
APRNs have consistently argued that they should be allowed to make diagnoses and prescribe treatments without physician supervision.
The Institute of Medicine has recommended APRNs be granted what is known as “full practice authority,” and countless studies have documented that APRNs provide safe and effective care at lower costs than. (Nurse practitioners, unlike physician’s assistants, are allowed to treat patients without a doctor’s on-site supervision.) “It was exasperating,” Livy says now.
“I know the difference in the training and I was very aware she was not a doctor. Texas Nurse Practitioners Providing essential healthcare services throughout the state, Nurse Practitioners are a vital part of healthcare delivery in Texas. Members of TNP enjoy important benefits such as education, advocacy, networking and career services.
the advanced registered nurse practitioner shall be eligible to obtain recognition as authorized by the Boardto prescribe, as defined by rules and subject to the medical direction of a supervising physician.
practitioners [NPs], certified registered nurse anesthetists [CRNAs], and clinical nurse specialists [CNSs]), the rules establish both the range of services APRNs may deliver and the extent to which APRNs are permitted to practice without physician supervision (Gilman and Koslov, ).