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Nurse Practitioners As A Solution For The Physician Shortage Problem

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In light of the aging population in North America, healthcare professionals are seeking solutions for the impeding physician shortage. Numerous policymakers have begun advocating for nurse practitioners (NPs) and suggesting they could fill this gap. Policymakers have argued NPs provide a cheaper and faster solution for the physician shortage problem, as they have lower reimbursement rates and complete their training an average of five years faster than a physician (Cabbabe, 2016).

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Within the Canadian healthcare system, NPs have started to extend services provided by physicians and complement their role in speciality medicine and primary care. However, NPs face many barriers, including lack of clinical training and practicums, lack of an appropriate funding model, and physician’s resistance against their expanded role. In both Canada and the United Stated, physicians have begun to speak out against the independent and unsupervised practice of NPs. The available scientific and media articles have mainly focused either on how NPs may be a solution to the primary healthcare gap present today, or the lack of sufficient clinical training that may lead to more harm from the autonomous practice of NPs. As healthcare professionals, it is important to asses the credibility of each of these sources and extract accurate information. In this paper, the credibility of three online sources will be analyzed for accuracy and validity of data and claims using the example of nurse practitioners.

Nurse Practitioners and Their Role in Healthcare

Currently, nurse practitioners are “experienced registered nurses with additional education” who use “an evidence-based, holistic approach that emphasizes health promotion and partnership development” and “blend their in-depth knowledge of nursing theory and practice with their legal authority and autonomy to order and interpret diagnostic tests, prescribe pharmaceuticals, medical devices and other therapies, and perform procedures” (CNPI, 2006). The expanded autonomy of NPs in North America has initiated numerous debates and controversies among healthcare professionals. The role of NPs in healthcare has been widely discussed through online news outlets, academic journals, and blog posts. While studies published in academic articles have shown the integration of NPs within the primary healthcare system can improve patient outcomes and satisfaction, many healthcare professionals have expressed their concern about the autonomous practice of NPs through blog posts and articles in news outlet websites.

Nurse Practitioners in Academic Journals

In the context of the globally ageing population and the epidemic of chronic diseases that will follow, the need for primary healthcare is on the rise. A systematic review of the impact of nurse practitioners in a clinical setting performed by Woo, Lee, and San Tam (2017) and published in the Journal of Human Resources for Health demonstrated NPs can aid by strengthening the healthcare team. By reviewing fifteen studies selected from eleven electronic and paper journals over a ten year period, Woo et al. claimed the integration of NPs in emergency and critical settings has a positive impact that could be capitalized on to increase patient access and alleviate the increasing demand for primary healthcare. Based on their findings, NPs were also shown to provide more effective coordination of care for multidisciplinary teams as they were the consistent point of contact and were more familiar with the environment and patient demands. In addition to positive clinical outcomes, patients interacting with NPs were reported to have higher satisfaction levels than patients interacting with physicians. In accordance with the goals of a nurse practitioner, they were better at educating patients, answering questions, listening, and pain management when compared to physicians.

Nurse Practitioners in News Outlet Websites and Blog Posts

Despite the positive results indicated by scientific studies, many physicians argue NPs do not receive sufficient training for independent practice. In McCaughey’s article “When a nurse is your health-care provider, you’re at risk” (2015), published on the New York Post website, the difference in the length of education received by an NP and physician is brought to light to demonstrate the inability of NPs to diagnose and treat an uncommon disease or complex problem. Drawing on examples provided by a limited number of physicians, McCaughey (2015) argues that NPs are trained to treat symptoms, not diseases, which can lead to misdiagnosis and harmful outcomes.

Physician bloggers, including David Lui, have also stated their opposition regarding the independent practice of NPs. In his blog post, “Why Nurse Practitioners Should Not Do Primary Care Without Physician Oversight” (2014), published on his personal blog page, Lui emphasizes the significant difference in the required training and clinical hours that a primary care physician and nurse practitioner must complete along with the complexity of primary care. As the first line of healthcare, correct diagnosis and disease management for complicated cases is essential at the primary care level. Using other news outlet articles and blog posts as his reference, Lui argues that the training received by NPs lacks the in-depth multidisciplinary problem-solving processes that physicians obtain through extensive clinical experience. He concludes that NPs may be a solution to the primary healthcare crisis but should not be allowed to practice independently unless they are held to the same certification standards as a physician.

Analysis of the Resources

While the arguments laid out by McCaughey and Lui regarding the difference in the clinical and theoretical education received by NPs and physicians may be factual, they don’t include any valid sources for their claims. Additionally, the claims they make about NPs inability to treat complex cases is not supported by scientific data. In his blog post, Lui makes claims using the personal experience of two physicians who encountered an NP that made a mistake. Similarly, McCaughey supports her argument using quotes and opinions of three physicians who have worked with NPs. Lui and McCaughey also fail to mention the studies that have found NPs to be valuable in healthcare settings. Their articles don’t provide a well-rounded argument with proper statistical data or scientific results. The arguments they present may seem compelling but without proper data collection, Lui and McCaughey have written biased articles based on their personal opinion.

On the other hand, the systemic review of the impact of NPs in healthcare settings performed by Woo et al. (2017) reached a conclusion based on scientific data and results gathered from fifteen articles in three journals. The impact of the integration of NPs in emergency and critical settings was analyzed using multiple factors, including patient satisfaction and efficiency of treatment, through unbiased comparison of relevant studies. Therefore, the claims made in the article by Woo and his colleagues are more accurate and fact-based than those in Lui and McCaughey’s articles. Using the controversy around NPs, it’s clear that not all science related articles have the same quality of results. While papers in academic journals are required to meet certain standards before they are published, the same can not be said about blog posts and news outlet websites. There are numerous examples of good scientific journalism in blogs or news outlet websites, where the author has valid claims and strong citations, however, many articles on these platforms aim to grab the attention of the public with personal opinions formatted in a scientific manner or at the expense of accuracy in the relayed information.

Conclusion

With the excess of scientific articles available online it’s becoming increasingly important for the general public and healthcare professionals to use credible sources of information and distinguish scientific evidence from personal opinions in writing. As with the example of NPs, scientific data has shown they are valuable as independent practitioners in various healthcare settings, however articles in the media and blog posts express concerns based on the personal opinions of a limited number of physicians. In light of the physician shortage and increased wait times for emergency and primary care, I believe nurse practitioners could play an integral role in provided high quality and efficient healthcare. Furthermore, in analyzing the resources we use, I think we should dedicate time to learn about the different forms of writing and how to asses the credibility of an article, then move to expand our general and field-specific knowledge through them.

14 May 2021

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