The Role of Nurse Practitioners (NPs)

Abstract

The following paper seeks to explore the lasting debate concerning the role of nurse practitioners. For a long time, nurse practitioners have been perceived as subordinates. However, the current changes that are taking place in the U.S. healthcare system are warranting a shift in this opinion. Furthermore, the advanced skills and competencies that these healthcare professionals acquire by engaging in high-level training and education, including postgraduate degrees, have made many of them demand a revision of their role.

However, various laws and policies continue to limit their scope of practice. This research presents the arguments of the two sides that have confronted as this develops. The first part of the paper assesses the views of those supporting the expansion of the role of nurse practitioners while the second one will study the opinion of those that oppose this expansion. Finally, the research presents a conclusion that the paper makes with regard to the debate question at hand.

Keywords: role, nurse practitioners, healthcare system, the scope of practice

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Introduction

For a long time, the role of nurse practitioners (NPs) has been limited in the scope not only in the US but also all over the world. This trend has been supported by the establishment of a number of laws that have set the scope of practice of NPs. According to The American Academy of Family Physicians (2012), NPs who make up the largest group of healthcare providers serve patients under varying degrees of supervision by physicians. It is so despite the fact that NPs have the ability to perform most primary healthcare services just as physicians. These laws have placed certain restrictions in such areas as the prescription authority, diagnoses, and general autonomy in the care of patients. Consequently, it is difficult for NPs to meet the needs of patients adequately.

It is crucial to address the current state of the role of nurse practitioners in the healthcare system. The goal can be achieved by reviewing the laws that are governing this role, as well as limiting its scope. The reason for choosing this strategy is the anticipated increased demand for primary care in the country, which can be attributed to the changes that are taking place in the U.S. healthcare system today. Barbarito (2015) asserts that the 2010 Patient Protection and Affordable Act (ACA) has become one of the factors that pushed the overall transformation of the healthcare system. Consequently, increased demand for healthcare caused a strain in its provision.

Another significant change that is taking place in the U.S. healthcare system today, and which is further threatening the efficient healthcare delivery, is a rapidly aging population as emphasized by Dower, Moore, and Langelier (2013). This social pattern has increased the extent of demand for chronic healthcare and further strained the capacity of the healthcare system. These changes represent some of the main reasons as to why there is a need for well-prepared healthcare professionals. Another essential fact that has been brought to light by these shifts and alternations is that physicians will need more help in order to meet this increased level of demand for their services.

The thesis of this paper asserts that the role of nurse practitioners needs to be broadened in order to ease the current pressure on the healthcare system, enable the provision of healthcare despite the shortage in the number of physicians, facilitate the public access to it, and ensure the provision of efficient and quality services. The expansion of the NPs’ roles will not only relieve physicians of the heavy workload as a result of the changes in the healthcare system but also improve the patient outcomes. Consequently, the reputation of the sector will be significantly boosted.

Literature Review

Overview of the Literature and Methodology

This paper seeks to carry out an up-to-date review of literature that considers the role of nurse practitioners. The purpose of this analysis is to decipher the extent, to which this role has been able to officiate the implementation of the changes that are taking place in the healthcare system today. The selection of the articles used in this review has been made via the use of a systematic search in the peer-reviewed journal articles, as well as relevant reports provided by credible healthcare organizations. Their relevance or irrelevance to the research was determined through the evaluation of both abstracts and full articles. In addition, papers prepared by various credible healthcare organizations and institutions are included. It is essential to note that this literature review is conducted in a manner that allows providing a balanced view of the topic at hand.

  1. The first part of the review covers a general discussion of NPs and their duties and responsibilities. It highlights the extent, to which the role of NPs is limited, and provides a basis for understanding why this scope needs to be expanded in the light of the current reforms in the healthcare system.
  2. The second part of the literature review provides information that advocates the need for expanding the role of nursing practitioners.
  3. The third part will present a counter-view on this question by analyzing reasons against such an expansion.
  4. The review will conclude with a chosen position regarding whether expanding the role of NPs is a necessary step to be taken or a matter that should be disregarded under the current circumstances.

Nurse Practitioners and Scope of Practice

Nurse practitioners are a specific type of high-quality registered nurses. The main thing that makes them different from the other registered nurses is their level of education. According to Epstein and Street (2011), NPs have higher education qualifications that, in many cases, include postgraduate degrees, for example, Master’s degree. In the United States, nurse practitioners and their scope of practice (SOP) are regulated by the laws of individual states. For this very reason, each state has developed own laws concerning how these healthcare providers should practice medicine and under what conditions.

Fletcher and Dahl (2013) point out that states are able to shape this role through enforcing control over the licensure and certification of NPs. This tool has worked with the view to ensuring that all healthcare professionals, including NPs, provide services that commensurate with their skills and education level. Nurse practitioners are trained to deliver primary healthcare to both adult and pediatric patients in the variety of care settings. Some of these care settings include private practices, community centers, hospitals and their affiliates, and nurse-managed centers as Kleinpell, Hudspeth, Scordo, and Magdic (2011) explain.

 

NPs are tasked with providing a continuum of care that ranges from initial contact with a patient to different follow-up care activities. The regulation of their practice by various state laws has affected their optimal use in the healthcare system. Thus, under the current laws that are controlling the SOP of NPs, the fact that these healthcare professionals have training that qualifies them to work beyond their limit does not affect the nature of their work.

This control of the NPs’ SOP has been met with resistance that leads to various forms of SOP confrontations throughout the control as it is asserted by Liego (2013). The need for expanding SOP has become a significant debate topic, and a lot is being done on both sides of the platform: those who are advocating this expansion and those who oppose it. According to Iglehart (2014), over 100 suits associated with the issue of defining the role of NPs have been put forth in the period between 2011 and 2013.This figure clearly illustrates the extent of these battles over SOP and what each side is doing in order to win. It further indicates that states have also divided into those supporting a change in the role of NPs and those that do not.

An example of the first group of states is New York, which granted the full practice authority to NPs by loosening its SOP laws in 2015. Thus, here, nurses that have 3,600 hours of clinical experience have permission to practice without the need for any supervision from a physician. According to Newhouse, White, Johantgen, Bass, and Zangaro (2011), New York has joined 19 other states in providing the autonomy of practice to NPs.

Reasons for Expanding the Role of Nursing Practitioners

There are several groups that support the expansion of the role of nursing practitioners. A large number of these groups make use of the 2010 report of the Institute of Medicine in order to affirm their position. The report put emphasis on the need for states to remove restrictive laws that have worked to prevent NPs from practicing care to the full extent of their training. This idea was further reinforced by the National Governors Association; in 2012, it recommended all states to re-examine their current SOP laws (National Governors Association, 2012). In 2014, the Federal Trade Commission also issued another report advocating the same viewpoint. Thus, a number of reasons that support the need for the expansion of the nursing role in the light of the national health system have emerged. Some of the most outstanding reasons include the following.

Increased pressure on the healthcare system. The healthcare system is currently experiencing a significant pressure due to the increased demand for the care that is a result of various changes that have been taking place in the recent period. Lathrop and Hodnicki (2014) identify the ACA as one of these changes that made a large number of Americans get insured. It is one of the reasons behind the increased demand for healthcare. According to the prediction of this rise in demand for healthcare services, by 2016, a total number of 30 million people will have access to healthcare as a result of the ACA (Lathrop & Hodnicki, 2014).

This rise has been brought about by the ACA’s role in easing the ability of many Americans to acquire such insurance. In the past, the lack of the same prevented many Americans from receiving adequate healthcare. According to Newhouse, White, Johantgen, Bass, and Zangaro (2011), despite the fact that each state has been granted the right to design the own expansion of the federal healthcare scheme, for example, Medicaid, the number is still expected to rise.

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The coverage will make more people eligible for obtaining healthcare as a result of new medical subsidies and insurance coverage prog. Similarly, the ACA contributes to this increased demand through its influence on creating a new inducement for the potential enrollment in the healthcare scheme. Hain and Fleck (2014) identify easing these enrollees’ chances of seeking preventive healthcare services by removing patient cost-sharing as one of such inducements.

This increased demand for healthcare and the subsequent pressure that it caused has led to reaching a compromise in care delivery. In this regard, it has negatively impacted the quality and speed of the service delivery. Therefore, it is an essential reason for expanding the role of NPs. When it is done, the current gap in primary care will easily be bridged. The same idea is supported by Iglehart (2013); he asserts that meeting the country’s increased demand for the care will require loosening the current restrictions on the practice of NPs.

The growing shortage of physicians. Today, the American healthcare system is facing a serious problem of shortage of physicians. According to Poghosyan et al. (2014), it is estimated that the US will have experienced a shortage of about 90,000 doctors by 2020. Similarly, Iglehart (2014) asserts that according to the Association of American Medical Colleges (AAMC), this number will have reached 130,000 physicians by 2025. This shortage will be split almost equally between the primary and specialty care. Despite this observation, the true nature of this shortage indicates that the majority of it will affect the field of the primary care, which is the most essential as it is the most demanded by people.

According to the Kaiser Family Foundation (2011), only 117,000 practitioners were delivering primary care in 2011. A non-profit group of the National Resident Matching Program pointed out that in 2012, only 1,916 medical graduates in the US joined primary care. Aleshire and Wheeler (2012) attribute this phenomenon to the fact that primary care physicians are paid less as compared with specialists. It has become a significant point of motivation for many physicians to venture into specialization.

Furthermore, this has been identified as one of the reasons as to why the majority of college students refuse to pursue medicine. Isaacs and Jellinek (2012) confirm this idea by asserting that a large part of the problem of the shortage of physicians is a consequence of a medical school culture that discourages students from pursuing primary care.

Policymakers that are concerned with this trend have tried to make the primary care appealing to physicians. In order to achieve this aim, they attempted to increase the pay in the primary care and develop loan forgiveness programs for physicians that venture into the primary care. However, Zand (2011) observes that it is not amounting to any tangible change since most of these policies will take a long time before they become effective. Furthermore, there is no definitive guarantee that physicians, who will accept and take advantage of this offer would continue their practice in the primary care.

In light of these predictions, it is clear that the healthcare system will be adversely affected by the potential lack of healthcare professionals that is created by the decreased number of physicians. Therefore, this reason is enough for expanding the role of nursing practitioners. NPs can be used to supplement the supply of physicians. By allowing NPs to perform some of the main roles of physicians, the healthcare system will be able to cope with the predicted future shortage of doctors especially given the fact that they make the largest number of healthcare professionals.

The need for quality improvement and efficiency. The necessity of improving both the quality and efficiency of the care provided by the healthcare system is another reason that necessitates a change in the role of NPs. According to Iglehart (2013), NPs possess enough competencies for providing the quality care to patients; results of the patient outcome is similar to that provided by physicians. In such a manner, it makes NPs just as qualified as physicians in providing the primary care. The changes, which are taking place in the healthcare system today, provide more patients with the ability to access various healthcare services easily as it is asserted by Ploeg et al. (2013).

This idea was mentioned in the previous discussion; today, it is causing momentous pressure on the healthcare system. It happens due to the fact that the number of physicians available to provide care services has significantly reduced while the number of patients in need of these services has been rising every waking moment. The resulting effect is the reduced quality of the care as physicians struggle to see as many patients as they can. Poghosyan et al. (2014) affirm that the quality of the care has been adversely impacted due to a large number of patients served by a single physician and the limited amount of time a patient receives.

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Moreover, the pressure placed on physicians to meet hospital demands such causes most physicians to spend less time on each visit of a patient. Lathrop and Hodnicki (2014) go on to add that the long hours, which a few available physicians work, make them sloppy in the service delivery. This problem can be overcome by expanding the role of NPs. Therefore, the quality of care will be improved when NPs are allowed to practice beyond their current scope. This step will ensure physicians have more time for patients with the view of dealing with serious health issues.

In line with this thinking, the need for improving efficiency in the healthcare service provider is another reason as to why it is necessary to expand the role of nurse practitioners. O'Grady and Brassard (2011) emphasize that an increased number of service seekers has impacted the efficiency of service providers. Accordingly, expanding the role of NPs should be taken into consideration since it will be essential in easing the workload of physicians. Therefore, it will improve the quality of the care that patients receive and facilitate the overall efficiency in healthcare.

The promotion of easy access to healthcare. The need for ensuring easy access to the healthcare service is another reason as to why it is necessary to expand the current role of NPs. According to the Robert Wood Johnson Foundation (2012), today, many Americans are not able to access the primary care. The statistics show that a large number of estimated 5,700 locations in the country have limited the public access to healthcare (Robert Wood Johnson Foundation, 2012). This phenomenon is attributed to the current shortage of healthcare professionals, in general, and doctors, in particular. It is asserted that this limited access to healthcare will require an addition of more than 15,000 healthcare practitioners as the only way of managing the problem. It is so because this strategy will improve the ratio of patients to physicians all over the country.

In addition, the current changes in the healthcare sector call for a timely delivery of the healthcare service to service seekers. The ACA, for instance, allows millions of Americans to get insured. For this reason, expanding the role of NPs is the only way to guarantee people that they will be able to access the care effectively. The pattern of the physician-centered care will not be sufficient in enabling the full healthcare access of numerous patients in the short-time perspective. The argument against the expansion of their role is only valid if the number of patients in need for healthcare was not as high as it is now.

The study by Kuo, Loresto, Rounds, and Goodwin (2013) assert that between 1998 and 2010, the increasing number of states relaxing their SOP laws has led to the number of patients receiving care by a factor of 15. Therefore, it is paramount to expand the role of NPs with the view to facilitating sufficient access to healthcare, especially in locations around the country that are recording either minimal or completely no access to the primary care.

Cost. Another reason for expanding the role of nurse practitioners in the wake of the current changes that are taking place in the healthcare sector is the need to save cost. The cost of healthcare provision is an issue that must be carefully taken into consideration. Liego (2013) affirms that as the nature of the healthcare sector transforms, it is evident that resources must be evenly allocated in order to meet the current rising demand for the primary care. Further, the modern trend predicts a significant jump in the cost of healthcare as more services are provided to an increased number of service seekers in the healthcare system. Therefore, it asserts the need for ensuring the cost-effectiveness of the service provision.

According to Walsh, Moore, Barber, and Opsteen (2014), one area where the cost of healthcare has come to matter the most is the training of healthcare professionals. This cost is much higher than that of NPs. To an extent, this trend can be attributed to the fact that the training of physicians takes a longer time as compared with the training of NPs. Hain and Fleck (2014) are of the view that three to twelve NPs can be prepared for the price of preparing one doctor. The employment of NPs is also cost-effective for the healthcare system because they earn less than physicians. Current changes in the healthcare sector have made it impossible for money to be channeled for training more NPs.

In addition, the employment of NPs in primary care will also be less costly to the healthcare system. It is true because unlike physicians, NPs results in less costly healthcare service provision, in general. This idea can be attributed to the fact that unlike physicians, NPs carry out fewer clinical procedures, including laboratory tests. It is also essential to note that the expansion of the role of NPs will be effective in cutting costs due to the fact that NPs are cheaper as compared with physicians. According to Isaacs and Jellinek (2012), Medicare pays NPs about 85 percent of what doctors make while private insurance payments can be as low as 50 percent of what physicians make for similar services.

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Therefore, expanding the role of NPs is necessary as, in the end, it will allow for effective cost management. It will be an effective way of fostering the survival of the healthcare system during this time of its transformation. Furthermore, it is essential as healthcare providers struggle to lower the cost, which has been heightened as a result of inflation and overall poor economic performance. Moreover, the evidence that nurse practitioners perform just as well as physicians with respect to the primary care and the fact that patients actually appraise more than physicians further indicate the need to expand their role.

Need for the improved performance and patient experience. It is another relevant reason as to why it is crucial to expand the role of nurse practitioners. In the face of the current changes in the healthcare system, it is clear that the provision of primary care will be neither as smooth as expected nor needed. Dill, Pankow, Erikson, and Shipman (2013) assert that the high number of patients flocking various healthcare facilities will lead to a reduced performance of the service provision. Moreover, it may mean less time being spent with physicians, less time for treatment as the healthcare facilities will struggle to deal with numerous people, and worse quality.

Additionally, the increased number of the elderly will also impact the ability of healthcare facilities to provide maximum service. According to Kleinpell, Hudspeth, Scordo, and Magdic (2011), it is so due to the specialized level of treatment that these segment of patients require given that many of them suffer from a number of chronic diseases. Inline, chronic diseases are transforming the entire healthcare system, as well. It is so because, over time, these illnesses have come to change their attack angle. It means that today, chronic diseases are no longer limited to the elderly. Currently, they are attacking younger people in huge numbers as is asserted by Aleshire and Wheeler (2012). Today, many young people are suffering from cancer and diabetes.

Moreover, infants have not been protected as a large number of them are found to suffer from such chronic conditions. Epstein and Street (2011) also take note that the patient experience has been adversely affected by the long waits that most healthcare facilities are now experiencing. In the face of this fact, it is urgent for the healthcare facilities to maximize the contributions of NPs in order to ensure there is improved clinical performance. Ultimately, it will ensure these patients receive a better experience that will be sufficient for helping them go through their conditions.

The need to maintain the patient-centered care. It is another relevant reason as to why it is critical to expand the current role of nurse practitioners. According to Epstein and Street (2011), patient-centered care is a way of providing care in a manner that is respectful and responsive to every patient, as well as his or her preferences, needs, and values. Furthermore, it is a way of providing patients with the chance to guide all the clinical decisions that will be made about them. Thus, the patient-centered care supports the active involvement of patients and their families in deciding on the treatment options that are available to a patient. According to Kuo, Loresto, Rounds, and Goodwin (2013), it is essential in helping patients feel that they are receiving the best possible care from healthcare professionals.

However, with the current transformation of the healthcare system, this kind of care is slowly being threatened. It can be illustrated by the impact of the ACA on increasing the extent of demand for healthcare. Therefore, it becomes almost impossible for the patient-centered care to be implemented in many healthcare facilities. This trend can be attributed to the fact that today, physicians lack enough time to focus on a single patient. Dill, Pankow, Erikson, and Shipman (2013) suggest that the increased demand for healthcare has meant that a physician spends less time with patients. Further, in an effort to save time further, as well as to ensure that care is provided to all patients, physicians provide the type of care that they see appropriate to a patient.

This strategy prevents these patients and their families from making any contributing and influencing their treatment process. It can be prevented by an expansion of the role of NPs. Doing so will be essential in ensuring that physicians have sufficient time to spend on patients. In such a manner, patient-centered care will be ensured. In addition, it is essential to take note of the fact that NPs have all the necessary competencies and skills for managing the developing the needs of care; thus, they can significantly contribute to patient-centered care.

Reasons against Expanding the Role of Nursing Practitioners

While the calls for expanding the role of NPs continue, similar appeals against doing the same follow, as well. There are those who are strongly against such changes. The majority of those opposing this shift in the role of NPs are physician-related healthcare groups such as the American Medical Association (AMA) and the American Academy of Family Physicians. They assert that NPs should only be allowed to practice care in the paradigm of a physician-supervised team. They put forth a number of arguments against the expansion of the role of NPs. Some of the most outstanding points against implementing this initiative are outlined below.

Being not qualified enough. It one of the most frequently and widely used reasons for opposing the expansion of the role of NPs. It is asserted that NPs’ training and education background makes it impossible for them to provide the same kind of care as physicians do. The one thing that is most quoted to support this idea is the difference in training. NPs undergo a shorter training as compared with physicians. With the view to exploring this thinking further and demonstrating the difference in training, Dill, Pankow, Erikson, and Shipman (2013) points out that NPs are trained for a maximum of six years while physicians require a maximum of eleven to twelve years. It is claimed that this gap in training is an indicator that NPs cannot provide the same quality of care as physicians can, which are considered to be more superior in nature.

This viewpoint is supported by the AMA, which is the strongest opposer of the expansion of the role of NPs. The organization further reinforces this argument by claiming that NPs lack proper training and education for being independent practitioners. Thus, they are unable to meet the needs of patients. This physicians-affiliated association adds that the education received by NPs does not prepare them to serve patients adequately at the initial point of contact with the healthcare system. It is also asserted that physician care is preferred by people as compared with that of NPs.

It is essential to counter this assertion at this point. The in-situ investigation has reported that patients have shown more satisfaction with the care of nurses versus the one provided by physicians. Another significant point that is employed in support of this idea is provided by Isaacs and Jellinek (2012). They assert that the Master’s degree cannot be equated to a medical degree. It implies that despite the high educational qualifications that NPs possess due to enhancing their skills by pursuing a higher level of training, the truth is that their training will never be equal to that received by physicians. Overall, they will always be less qualified as compared with physicians no matter their training.

Nevertheless, it is not the reality of the situation. Many studies have clearly demonstrated that NPs are able to administer care within their level of training effectively. The same idea is supported by Iglehart (2013), who affirms that the training of NPs is more advanced as compared with that of registered nurses (RNs). Their training presupposes the acquisition of various types of graduate degrees such as the Master of Nursing, for example. This fact allows them to provide care effectively and be as competent as physicians are.

Therefore, the argument of longer training of physicians is purely supported. It is also essential to note that at the end of the day, education has nothing to do with care services. What really counts is the very process of the service provision, in which NPs have more experience, since they spend more time with patients as compared with physicians. It is also reasonable to take note of the fact that physicians do not have a monopoly on healthcare knowledge. Further, they are not the only qualified independent healthcare providers.

According to Walsh, Moore, Barber, and Opsteen (2014), as much as they have longer training, the fact remains that it does not take 11 years of training to perform a healthcare act such as immunizing a child competently or treating a sore throat infection effectively. Therefore, providing such a weak argument of NPs being not qualified enough as the basis for not expanding their role in the light of the current changes that are taking place in the healthcare system today is wrong since this reason has no valid basis.

Concern for the patient safety. The concern for patient safety has also been a reason for the rejection of the expansion of the role of NPs. Keeling (2015) makes a claim that this viewpoint is a consequence of the claim that NPs cannot measure up to physicians. For this reason, the care they provide to patients is not as good as the one that is provided by physicians. Therefore, it warrants the need for supervision by physicians. This idea is emphasized by statements that assert that NPs are only good in treating common acute ailments and managing minor chronic conditions (Hain & Fleck, 2014).

Another statement proving the same is provided by the AMA; it asserts that it is quite irrational to endanger the safety of patients by allowing unsupervised NPs to practice healthcare. With such statements, it is confirmed that only physicians can handle difficult medical cases in healthcare. Therefore, this concern for patient safety makes the focus on the capabilities of NPs to provide an efficient service to patients in a manner that will neither endanger their lives nor lead to subsequent death. Different physician-affiliated groups that are rejecting the broadening of the role of NPs affirm that patient safety is threatened given that NPs lack the ability to diagnose complex illnesses and conditions such as broken bones and concussions. As a result, the timely treatment of a patient and the chances of recovery becomes imperiled in such cases.

However, it not entirely true, as well. A number of conducted studies report a completely different story. NPs can provide the care service just as well as physicians do; thus, the patient safety is not compromised at all. This idea is backed by Hain and Fleck (2014); they assert that the primary care provided by nurse practitioners has been found to be safe and effective just as that provided by doctors. In addition, according to Keeling (2015), NPs measure up against physicians very well especially in the case things get complicated. For instance, when the condition of a patient worsens, a diagnosis is unclear, or a patient has multiple chronic illnesses, NPs are able to cope well and usually even better than physicians since their SOP entails spending a significantly large amount of time with patients with various complex health issues. This trend is unlike in physicians, who only diagnose and administer the treatment; thus, they are not involved in the after-treatment activities.

The maintenance of healthcare quality. Just as those supporting the expansion of the role of NPs cite the need to improve the quality of healthcare so do those who oppose this expansion. It is claimed that NPs provide inferior care to patients; therefore, they are affecting the quality of the administered care. According to Kuo, Loresto, Rounds, and Goodwin (2013), this issue is critical given the fact that healthcare is a service that must be maintained within the highest sense of quality as the preservation of life depends on it. In addition, it is asserted that the quality of care is endangered since NPs lack the ability to discover serious conditions; therefore, they are more likely to administer incorrect treatment. For this reason, expanding their role can be detrimental.

Nevertheless, it is not necessarily true. Many studies have shown that the quality of care is maintained by NPs, and more so when this is compared with the one provided by physicians. According to Barbarito (2015), nurse midwives are able to manage normal pregnancies more safely and better than physicians. Furthermore, low-risk women with CNMs tend to deliver fewer babies with low birth weight. In addition, they had less inpatient stay for labor as compared with similar patients attended by obstetricians. Therefore, this reason provided in the opposition to the expansion of the role of NPs has no validity. The fact that it is not possible to measure the quality of care further discredits this argument since the aspect of quality entails both tangible and intangible components. For this reason, these groups that oppose this change in the nature of NPs’ cannot claim with exactness any form of higher quality that is provided by healthcare professionals.

Cost. It represents another common reason that is employed by those who oppose and those who support the expansion of the role of NPs. Those, who oppose this expansion, cite cost as a significant reason because of the following. It is argued that expanding the role of NPs will lead to an increased level of spending. In particular, it is claimed that expanding the role of NPs will increase the delivery of low-value care in healthcare facilities as it is asserted by Letz (2014). Low-value care is the type of care that raises costs but does not positively contribute to the health and well-being of patients. It is further argued that the cost of healthcare as a result of expanding the role of NPs will increase because of the fact that the nature of treatment offered by these health practitioners is costly.

Isaacs and Jellinek (2012) add that patients cared for by NPs tend to pass a larger number of radiology and laboratory tests; thus, they are more likely to be hospitalized and require specialist visits. In such a manner, they are raising the cost of care that is negatively impacting the healthcare system, in general. This claim is supported by supposed evidence such as the report that NPs working independently tend to use more medical services as compared with those working in a collaborative framework (Isaacs & Jellinek, 2012). In addition, they also prefer administering more medical procedures such as tests and prescriptions, as well as using more medical supplies. This practice causes an increase in the overall cost of healthcare.

Nevertheless, this argument does not really have much validity. This assumption is supported by the fact that only one study is cited in support of such a viewpoint. In addition, the study was conducted almost two decades ago in 1999; since then, much has changed in the nature of the care provided by NPs (Hain & Fleck, 2014). This study was also limited as it was carried out in a single clinic. The same research is further discredited by the fact that it failed to determine the impact of the SOP of NPs that were working there. What it did was to make a mere comparison between NPs and physicians working in this facility.

Therefore, this study does not provide any substantial evidence with regard to the claim that expanding the role of NPs will cause the escalation of low-value care and, thereby, will increase the overall cost of healthcare. The use of the concept of physician extenders is also applied for illustrating the extent, to which NPs are expensive. When NPs are used as physician extenders in the case of shortage of the same, they result in a higher cost. The high cost is defined by paying each NP considerably higher wages bringing the total to be higher than what would have been paid to the doctor.

NPs are not physicians. It is a straightforward argument. It asserts that the expansion of the role of nurse practitioners is not necessary as they cannot deliver the services that are given by physicians. However, the groups rejecting this change acknowledge the fact that the healthcare system is facing a challenge of shortage of physicians. Despite this pattern, they make it clear that the use of NPs to overcome this challenge is not a way out. This standpoint is confirmed by the following statement, “Substituting NPs for doctors is not the answer. NPs are not doctors” (Dill, Pankow, Erikson, & Shipman, 2013).

In such a manner, it is affirmed that the best type of care is provided by teams of health professionals that are led by physicians and not by independently practicing non-physicians. In order to further demonstrate the insignificance of enhancing the SOP of NPs in order to counter the problem of shortage of physicians, these groups explain that the best thing to do is to fill this gap that has been created by the continued transition to the team-based care.

It is a great argument. However, these groups should essentially realize that the problem of the shortage is currently in existence. It is not an issue that is expected to happen in the near future. Thus, their argument that NPs are not doctors has no merit at this particular point. It is so because the nature of the current problem, which is not limited to the shortage of physicians in the healthcare system, warrants some urgent actions. For the moment, the expansion of the role of NPs is the best option that is available in the current healthcare system if it is to survive the rapid changes that are taking place in it today.

Accountability. It is another reason that is provided by those opposing the expansion of the role of NPs. They assert that expanding this role and, thus, providing NPs with autonomy in practicing their roles without any supervision from a physician will take away any sense of accountability in the healthcare provision. O'Grady and Brassard (2011) further assert that despite the fact that NPs have higher training as compared with RNs, it should not be taken as a reason to assume that these health professionals can easily accomplish the work that physicians do in the healthcare provision. As it is almost impossible to determine with certainty the competency of healthcare professionals, it will equally be difficult to determine the extent of the accountability of NPs if they are allowed to practice independently.

Thus, with no way of ensuring accountability in the independent practice of an NP, it is risky to expand their role. It further translates into the higher cost for the healthcare system because of the increased burden for additional care and due to the legal action that is taken by patients and their families as it is asserted by Iglehart (2013). While some of the ideas may have a point to a certain extent, the argument fails to reach home base. Firstly, the fact that these arguments do not produce any data to support their validity confirms that they are nothing but expressions of fear. It is critical due to the fact that the wellbeing of patients and effective operations of the healthcare system, in general, should not be determined on the basis of the possible future outcome but should be rather determined by the current situation and facts. The truth of the matter is that there is a plenty of accountability in the nursing profession. It is confirmed by the fact that malpractice claims have been dramatically low.

Position Taken

The official position that this paper takes asserts the role of NPs should be expanded. The current state of the healthcare system warrants this change. One thing that is characteristic of the arguments presented by the parties that are opposing the expansion of the role of NPs is that much of their reasoning is not supported by any empirical evidence. Therefore, this fact goes on to prove these opposing arguments as being invalid. For instance, Letz (2014) makes an assertion that none of these parties that preach down the expansion of the role of NPs has actually cited any research to support their position. In fact, studies backing it reflect the need for expanding the current role of NPs. An in-depth analysis of those opposing this change, who have already been identified as physicians, shows that the financial incentives are the basis for this opposition.

According to Hain and Fleck (2014), there is a strong objection to this shift due to the fact that the expansion of the role of NPs will allow them to receive the payment that might be close or in some instances even better than that of some physicians. Furthermore, there is a fear that even such national insurance systems as Medicaid might come to favor NPs and boost their earnings at the expense of doctors. Another significant reason for this vehement opposition is turf-related. Granting the independence to NPs will threaten the position of physicians since they consider themselves as being at the top of the healthcare structure. In the case of implementing this change, physicians fear that their position may be threatened.

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There is a need to forget all the pettiness that comes with the opposition of the expansion of the role of NPs. Today, NPs play significant roles in the coordination of healthcare and making it available for multiple service seekers. In addition, most NPs have an ability to oversee need of various patients in having intense care. They are able to help them receive the best care and help them in the transition from hospital care. It is also significant to add that NPs are working to becoming what can be named as coaches who strive to prevent various forms of illnesses and oversee the general wellbeing of people. NPs are also very active in implementing new ways of care delivery such as Telehealth, informatics, and genetics. All these facts confirm the competence of NPs in the healthcare provision.

Therefore, nurse practitioners are playing a significant role in meeting the ever-evolving needs of patients. Therefore, they should not be considered subservient and subordinate employees. Instead, it is about the time when they are given the chance to practice in the full scope of their training and education capacities. The fact that they are essential partners in the healthcare system should be the reason that is enough to initiate this change. A number of states that have removed their restrictive practice laws can report the benefits of NPs who are working autonomously. These states are demonstrating a better clinical performance, as well as better patient experience. For patients, it means that their health is in good hands.

Conclusion

It is evident that the debate over the sustainability of NPs to practice an independent care will continue for quite a long time. This scenario is unfortunate given the fact that the changes taking place in the healthcare sector today are require a much faster response in the nature of care that is provided to patients. It is clear that this issue has resulted in the emergence of two opposing groups: those supporting the expansion and those who oppose it. Each side has gone ahead to develop and provide arguments with the view to supporting their position. Those, who advocate the expansion of the role of the nurse practitioners, have provided the following reasons that are outlined in this paper. There is a significant increase in the pressure on the whole healthcare system due to the higher demand for healthcare that what brought about by the ACA. Therefore, the expansion of the role of NPs is the only way of relieving this pressure in a timely and effective manner.

The second reason is the shortage of physicians. Expanding the role of NPs will be essential in filling the gap that is created by this shortage of physicians. Thirdly, the need for quality improvement in the provision of healthcare and maintenance of efficiency further warrants this expansion. Inline, expanding the role of NPs will improve the efficiency and quality of care by overcoming the challenges that will be caused by the increased number of patients. Fourthly, the need to promote easy access to healthcare is another reason for the demand for expanding the role of NPs. When they are able to provide care that is comparable to that of physicians, the maximum number of patients will be able to receive care. The fifth reason that is named is the cost-effectiveness of the solution.

Expanding the role of NPs will be essential in reducing the overall cost of healthcare in a number of areas that range from training, payment, and service provision. The sixth reason why expanding the role of NPs has become so critical is there is a need to ensure better clinical performance and improve the patient experience in the service provision. The final reason that is given with the view to supporting this viewpoint is the need to maintain patient-centered care.

On the other hand, those opposing the expansion of the role of NPs provide the following arguments to support this change as it is discussed in the paper. The first is the assumption that NPs are not qualified enough; thus, they cannot provide care, as well as physicians, do. The second argument for the rejection of the expansion of the role of NPs is the idea that they will threaten patient safety.

Once again the issue of their competencies is cited, and physicians are named the better service providers once again. The third and fourth reasons that are given are similar to those given by supporters of this expansion. They are cost and the need to maintain the quality of care. Accountability is another reason that is named as the point for not expanding the role of NPs. The final reason is straightforward and clear; NPs are not doctors. In the face of all this debate what remains to be true is that challenges attacking the healthcare system due to its transformation need to be addressed. If expanding the role of NPs facilitates this improvement, this change should be implemented as soon as possible.

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