The debate about who is qualified to provide primary care rages on this week, following the release of the report Primary Care for the 21st Century: Ensuring a Quality, Physician-led Team for Every Patient from the American Academy of Family Physicians (AAFP). In the document, the AAFP advocates for a team-based approach to primary care–in which a physician leads a groups of nurses, nurse practitioners (NP), physician assistants (PA), and other healthcare professionals to provide comprehensive and high quality care –while criticizing proposals to allow NPs to practice independently.
A national shortage of primary care physicians has led to efforts to substitute independently practicing NPs for physicians, but the AAFP points out that NPs “do not have the substance of doctor training or the length of clinical experience required to be doctors.” While it is an inarguable fact that physicians receive several years of training and clinical experience beyond that of NPs, the debate centers more around whether NPs and PAs can provide the necessary healthcare services that patients require while maintaining a high quality of care, without the direct supervision of or collaboration with a physician. Some states, such as Massachusetts, have already granted a greater degree of independence to advanced practice professionals.
While the AAFP’s argument for solving the primary care gap by instituting ideal ratios of NPs to physicians is compelling, and the model of physician-led healthcare teams does hold promise for improving the healthcare system, the report nonetheless seems to fan the flames when it comes to practitioner qualifications. NPs are referred to as “less-qualified health professionals” and “lesser-trained professionals” who are able to handle only patients with “basic,” “straightforward,” and
“uncomplicated” conditions. The language of the report does not seem to give NPs much credit when it comes to their training and education.
While the AAFP rules out the idea that two models of healthcare–physician-led teams and independently practicing NPs–could coexist harmoniously, one has to wonder whether ultimately the patient should be allowed to decide which model best meets his or her needs. Shouldn’t patients be trusted to make informed decisions about their healthcare? If a patient is aware of the amount of training an NP has received, is aware that it does not equal that of a primary care physician, and is comfortable with that concept, why shouldn’t a patient be able to seek those (potentially more convenient) services rather than hunt for a physician-led team model? The issue is complex, but a solution that allows all Americans to receive quality healthcare must be reached.
What are your thoughts on the AAFP report, and the debate about granting NPs autonomy? Share your comments with us!
Earlier this week, a language discrimination settlement–thought to be the largest of its kind in the healthcare industry–awarded $975,000 to immigrant Filipino healthcare workers in California who claimed they endured “harassment and humiliation” from coworkers and management, according to a recent article in the Los Angeles Times. Nurses involved in the case, which was filed in 2010 against Delano Regional Medical Center in Kern County, Calif., alleged that the hospital forbade them from speaking any language other than English in public spaces such as hallways and break rooms. The nurses also reported being followed by other employees, who would harass them and mock their accents. One employee claimed that a former hospital executive threatened the nurses with suspension or termination if they were caught speaking their native language.
According to the Los Angeles Times article, Delano Regional Medical Center employs healthcare workers who speak several other languages, including Spanish, Hindi, and Bengali, yet singled out Filipino employees. The terms of the settlement require the hospital to conduct anti-discrimination training and to enforce reporting and handling of discrimination complaints, which will be reviewed by an outside monitor. The hospital denies the claims and stated that it settled the lawsuit to avoid wasting financial resources.
Just a few weeks ago, The Leaders’ Lounge reported on an initiative at George Washington University to attract a more diverse group of students to the nursing profession. We followed up with a poll on StrategiesforNurseManagers.com asking readers how diverse they consider their organizations. Of those who responded, 34% said their staff is not very diverse and 40% replied that their staff is somewhat diverse. Only 26% of respondents consider their staff to be very diverse.
It seems that establishing a staff that reflects the diverse patient population is an issue that many organizations face, and the lawsuit in California shows that it is not enough to simply attract nurses from different ethnic and economic backgrounds. Employees and leaders alike must receive diversity training, and issues of discrimination / harassment should not be tolerated. A workforce that is divided by prejudice and hostility is a workforce that fails to work together to meet goals for patient safety and high quality healthcare.
Just a reminder that HCPro will present a live, 90-minute webcast on Tuesday, September 18, 2012 at 1:00-2:30 (Eastern) called Onboarding New Graduate Nurses: How to Overcome Hurdles and Retain New Nurses. The webcast demonstrates how the onboarding process for new graduate nurses will increase retention and speed up professional growth.
Nursing professional development experts Diana Swihart, PhD, DMin, MSN, APN CS, RN-BC, and Jim Hansen, MSN, RN-BC will discuss topics such as externships, internships, unit orientation, cultural and social integration, and nurse residency programs. They will also show how onboarding is key for moving new graduates beyond academic theory and technical skill to become competent, confident, professional nurses. Following the program, Diana Swihart and Jim Hansen will participate in a live question and answer session.
This webcast promises to be a great resource for nurse managers, assistant nurse managers, nurse leaders, charge nurses, directors of nursing, patient care managers, directors of patient care, directors of staff development, nursing professional development specialists, chief nursing officers, VPs of nursing, VPs of patient care services, and nurse residency coordinators. Sign up now and pay one price for your entire staff!
For more information or to sign up for the webcast, please visit www.hcmarketplace.com.
Editor’s note: This blog post originally appeared on the Patient Safety Monitor blog.
A physician in Massachusetts gained attention last week when she announced that she would no longer accept patients who weight over 200 pounds. According to Helen Carter, MD, two of her staff members have sustained injuries from treating obese patients. One suffered a neck strain when attempting to pull out an examination table foot rest while the 284-pound patient was lying on the table, and the other staff member herniated two lumbar spine disks while performing a physical examination. According to Dr. Carter, her exam tables are ill-equipped for heavy patients, and she cannot afford the estimated $7,000 electric exam table.
In an interview for CommonHealth, Dr. Carter stated that she is not dismissing any of her current patients who are obese, but instead is encouraging them to lose weight. She compared her policy to turn away new patients who are overweight to turning away people seeking treatment for addiction, since she is not an addiction medicine specialist. She recommends that obese patients instead seek treatment at facilities with equipment designed to safely handle patients’ extra weight and specific programs to assist with weight loss.
Dr. Carter’s policy has been met by mixed reviews. Some of the sources interviewed for the articles mentioned above see the policy as discrimination against obese patients, while others agree with the policy and note that obesity is contributing to rising healthcare costs and safety issues.
It’s a difficult argument from either side, however. Dr. Carter can justify her decision under the American Medical Association’s (AMA) Medical Code of Ethics, which states that physicians may choose whom to serve, and her argument for the safety of her staff and the lack of proper equipment is compelling. However, by refusing to treat patients she is arguably putting them at risk, and possibly violating another of the AMA’s principles: providing competent medical care, with compassion and respect for human dignity and rights.
Is Dr. Carter within her rights to refuse treatment for obese patients, or does this move beyond a safety issue to one of prejudice? Share your thoughts in the comments section!