The writer is president of the Nebraska Medical Association.
A Dec. 11 World-Herald article, “A setback for key health player,” reports that Nebraska’s nurse practitioners “seeking more independence” in patient care had their efforts thwarted by a powerful dissenting opinion — that of the state’s chief medical officer, Joseph Acierno, M.D.
Critics decried his decision, pointing to two committees’ recommendations that collaboration wasn’t really necessary. The Nebraska State Board of Health cautiously stated, “Additional measures of ongoing competency, above and beyond current continuing education, should be developed” for nurse practitioners.
I think Dr. Acierno made the right decision in the interest of Nebraska patients.
There is no question that the model of health care provided to Nebraskans, and Americans in general, will no longer resemble that which our previous generations received. The number of senior citizens needing care will nearly double with the aging baby-boom generation. Increased financial demands for medical equipment, ancillary services, pharmaceutical costs and labor shortages will strain our current system even more.
What we do not need is more fragmentation of care or health care providers trying to define and solve the upcoming problems we face through legislative or regulatory means. Year after year, the assault on the Legislature to expand the scope of practice by subsets of health care providers has been divisive and counterproductive. It is time for us all to change strategies if we truly want to improve health care for Nebraskans.
There are efforts being made across Nebraska to adapt to these challenges. It is in the best interests of our patients that we work together to design processes that provide measurable quality care, are cost-efficient and truly meet the needs of those we serve. Creation of health care teams and collaborative agreements will still allow nurse practitioners and physician assistants to work to the top of their licensure. “Independence” is not required to perform at that level.
I have had the good fortune in my 30 years as a family medicine physician to work with many excellent professionals. I have yet to find anyone who functioned better in isolation. With the ever-increasing complexity of care for our patients, ongoing education and communication is essential. Networks, not barriers, are called for.
Working roles and relationships will be best developed by those involved and should be guided by what is in the best interests of the patient. Integration of care in both the inpatient and ambulatory arenas will play a vital role if we are to achieve that goal.
In that regard, the importance assigned to the providers’ levels of training and skill sets will have major implications. The article cites 500 to 1,000 hours of clinical training for a nurse practitioner, while a physician accumulates 12,000 to 16,000 hours. Most physicians would agree that nurse practitioners and physician assistants are valuable members of the health care team and are capable of providing basic primary care.
However, inexperience and lesser amounts of training will increase the likelihood of error and decrease efficiency when the unexpected or unfamiliar are encountered. Further fragmentation is exactly the opposite of what we should demand as the basic standard for health care development.
There is no perfect template as to how to transform this process in Nebraska. I know we can do better by working as a team. Dr. Acierno’s decision was not against the nurse practitioners’ value as providers of health care. It was made in favor of Nebraska patients.
It left us the opportunity to combine all of our efforts, recognizing skills and limitations, and collaborating to get it right. And that benefits all Nebraskans.