A Nurse Practitioner (NP) is a Registered Nurse who has obtained advanced academic and clinical education. Most hold a Master’s Degree or higher and a number are nationally certified with requirements for a certain number of hours of retraining yearly. In New York State, NPs practice under the regulation of the Nurse Practice Act and are licensed as NPs in addition to their Registered Nursing licenses. Nurse Practitioners have been in existence over 30 years. There are currently about eight thousand NPs in New York State in 1999. Research since 1965 has documented that NPs provide (1) high quality, (2) cost-effective health care with (3) a high degree of patient satisfaction.****
Since 1989, New York NPs have been authorized to diagnose, treat, and prescribe in collaboration with a physician in accordance with a written practice agreement and written practice protocols. Registered Nurses are authorized to implement NP prescribed regimens. OTs and PTs are authorized to accept NP referrals. NPs may be granted hospital admitting privileges. “Advanced Practice Nurses (which include NPs) can be credentialed for hospital privileges. However, the credentialing process is through the medical staff bylaws, so barriers do appear.” ** In addition, federal law supports full hospital privileges for NPs for all people covered under Medicare.*** Since NPs are considered independent practitioners, their orders, prescriptions, and medical notes do not require a cosignature.
| Nurse Practitioners: | Physicians: |
|---|---|
| Spectrum of interventions aimed at environmental, human behavior, lifestyle and medical care | Predominantly Medical Care |
| Population groups - public service tempered by the individual | Individual care with awareness of social group responsibility |
| Emphasize prevention and health promotion for the community | Diagnosis and treatment for the whole patient |
| Multitude of professional entities with diffuse public image | Well established and sharp image in any branch of the profession |
| Social sciences are integral in training | Social sciences are elective in training |
| Clinical sciences are peripheral | Clinical sciences are essential |
| · Acute Care Facilities | · Emergency Rooms |
|---|---|
| · Family Health Centers | · Ambulatory Care Centers |
| · Schools/Colleges | · Women’s Health |
| · Psychiatric/Mental Health | · Pediatric/Child/Neonatal Health |
| · Public Health Departments | · Health Maintenance Organizations |
| · Home Health Care Agencies | · Nursing Homes/Hospices/Gerontological Health |
| · Business/Industry/Occupational Employee Health | · Private Office Practice |
A number of studies have shown that NPs are as effective as physicians in patient diagnosis and management of particular diseases, and for quality of care and outcomes at lower cost. NPs are well aware of the need to refer patients to MDs for very complex and unstable situations and often work closely with MDs to care for patients in those difficult situations.
NPs in any specialty may register as Medicaid providers and be reimbursed at 100% of the physician rate. In 1996 the Medicaid law was changed and NPs are specifically mentioned as qualified primary care gatekeepers. In addition, New York has a law on the books that regulates the practice of HMOs and which also specifically mentions NPs as qualified primary care gatekeepers for managed care. Numbers of other insurances are beginning to cover NPs as primary care providers under their health plans as an effective and cost-reducing alternative. Further, NPs are designated as covered providers via delegation for all hospitalized Medicare patients.***
| · Diagnose and treat acute health problems | · Prescribe medications, tests and medical devices |
| · Perform histories and physicals on any patient population | · Teach patients and families to administer medications and in self-care skills |
| · Promote and teach health seeking behaviors. | · Build upon wellness needs of patients and families |
| · Listen to patient and family needs and concerns | · Provide preventive care that includes immunizations, well check-ups and screenings |
| · Collaborate with physicians and other health professionals and refer to them when needed | · Order, perform and interpret diagnostic studies and lab work |
| · Treat, monitor and help the patient and family adapt to chronic illness | · Provide prenatal/perinatal and family planning services* |
Nurse Practitioners (NPs)
pride themselves in their skills as first-line or gateway
health care providers. They can diagnose, treat, and
help people adapt to a variety of health care needs.
NPs have an extensive network of skilled fellow health
professionals, including physicians, for those more
complex or unusual and more technical health care needs.
As one part of their daily practice, Nurse Practitioners
promote optimum health in the population by:
· Helping people to help themselves-across the life span and across the acute and chronic health care spectrum of needs--Holistically.
· Emphasizing individualized care, taking into account health problems in a social and cultural context and account of the impact of those health problems on the person and his or her family.
· Informing people of the range of health care options available so that they can make their own more fully-informed choices.
· Explaining the specifics of health problems, medications and other physical and mental health, social and welfare issues in a manner more readily understandable to the patient and his or her family.
· Diagnoses and treats common physical and mental health care problems.
· Emphasizes health, wellness, and self-efficacy.
· Teaches cost-effective ways to manage your personal and family health care needs.
· Practices primary family and mental health care across the life span with emphasis on children and adolescents, chronic and home care.
· Utilizes a transcultural approach to all health care needs of families and clients.
· Performs public speaking engagements regarding health education for your group or community on many health issues of the day such as:
· Is a resource for health care topic electronic searches and networking.
· Provides administrative and community health consultations and advising.
· Provides hypnosis for medical and health conditions; teaches condition specific self-hypnosis.
· Provides services in your home under some circumstances as well as the more traditional office-based care.
· Vaccination
· Motor Vehicle safety
· Safer workplaces
· Control of infectious diseases
· Decline in deaths from coronary heart disease and stroke
· Safer and healthier foods
· Healthier mothers and babies
· Family planning
· Fluoridation of drinking water
· Recognition of tobacco use as a health hazard
* NYSCONP Nurse Practitioners...A Healthy Choice;
Preventing, Caring, Healing. (Pamphlet) 113 Great
Oaks Blvd., Albany, NY 12203
** The Nurse Practitioner, January 2000, vol.
25, #1.
*** Nurse Practitioner’s Business Practice & Legal
Guide. Carolyn Buppert, 1999, page 213.
****http://www.aanp.org accessed 01/00.