Nurses push for independent practice

- Would you be comfortable going to a nurse practitioner instead of a doctor for your medical needs?

Some nurses have been pushing legislation for years to run their own practice, and now, it could happen soon in the VA hospital system.

“What we have going on at a national level that's been going on for about ten years is a big push to utilize nurses in the role of physicians,” Dr. Jeff Plagenhoef, the President-Elect of the American Society of Anesthesiologists.

Several national nurses organizations, including the American Nurses Association, are pushing for a new law that would allow highly-trained nurses to open up their own practice.

But some doctors take issue with that.

"Nurses don’t have the same training as physicians do as far as intensity, number of hours,” said Dr. Elizabeth Torres, a doctor of internal medicine in Sugar Land.

But some nurses say they already provide quality primary care in their current role and that patient satisfaction is the same as with a doctor.

“We do come, first of all, with a nursing background so many nurse practitioners have many years in healthcare before they become nurse practitioners, so we bring that to the table. But we do have clinical education and training during our programs. Preparation is at a minimum of a Master's degree and in many areas across the U.S., that's gone to entry level at a doctoral level,” said Dr. Susan Ruppert, an R.N. and Ph.D.

There is no question that the nation has a severe need for more healthcare providers.

“It increases access for patients and helps fill the gaps where there are primary care shortages. We have many counties here in Texas that have very few providers and some that have no providers at all. Some of those areas are less attractive for providers to go practice in, especially physicians, so those are areas where nurse practitioners can really fill those gaps and provide more access to healthcare for patients,” said Dr. Ruppert.

Waller County, for instance, has just four primary care doctors serving the entire area. As it stands now, highly-trained nurses cannot serve in an area if a physician does not want to be in the same area.

“When you have a supervising physician, they either need to be on-site or within so many miles distance for it, so that can be restrictive especially in areas that don't have  a lot of providers in them or rural areas where there’s long distances between health care facilities,” said Dr. Ruppert.

While doctors are aware of this problem, they say there is a better solution out there.

“With the population expanding, and the number of doctors not keeping up with that, concern arises about how do we provide healthcare in this country -- very valid question. And the American Society of Anesthesiologists totally agrees we need to redesign the system,  but what we see happening is people throwing the baby out with the bathwater,” said Dr. Plagenhoef.

If this proposal, which uses the APRN consensus model, is established nationally, four types of nurses could practice on their own authority -- nurse practitioners, clinical nurse specialists, nurse midwives and nurse anesthetists.

Doctors say nurses are deeply appreciated but that it's better if nurses are a part of a team.

“I think they're very capable as part of a physician-led team to meet those standards, provide medical care in that fashion,” said Dr. Torres.

“We should expand nursing scope of practice to utilize them where it's safe for patient care where quality can be maintained possibly even increased, possibly. But we don’t agree with saying full independent practice because we don't have people. That's like saying we don't have enough pilots so we'll let the flight attendant fly the plane. Would you want your pilot to have seven to eight hundred percent less hours of training? I think not. Experience does matter,” said Dr. Plagenhoef.

Nurse practitioners can practice independently in other states but currently not in Texas.

However, at VA hospitals across the country, that might change soon. Those four types of nurses could soon have full authority, even administering anesthesia, which does carry a risk of death, for our nation's veterans.

Ruppert also said your medical bill would likely stay the same if you saw a nurse practitioner versus a doctor because the quality of care would be the same.

But doctors firmly stand by it – and say it's the moments of utter chaos that prove why those with the most experience should be the ones in charge.

“If somebody's having a cardiac arrest or anaphylactic reaction or hemorrhaging to death, you've got seconds to make a difference. You don't have time to look something up,” said Dr. Plagenhoef.

The United States Department of Veteran Affairs' proposal to give nurses full authority is not in place yet.

That plan is still being finalized, but many nurses say they expect it to begin next year.

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