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Are Nurses Becoming the New Doctors?

Nurses can help shoulder much of the burden that health care reform will place on doctors and should be given both the education and the authority to take on more medical duties, according to the Institute of Medicine (IOM).

In a report released Tuesday, IOM said that nurses should be fully engaged with other healthcare professionals and assume leadership roles in redesigning the fragmented and expensive US health care system. To facilitate this, the Institute is calling for the industry to institute residency training for nurses, increase the percentage of nurses who attain a bachelor’s degree to 80% by 2020, and double the number who pursue doctorates. Regulatory and institutional obstacles including limits on nurses' scope of practice should be removed so that the health system can reap the full benefit of nurses' training, skills, and knowledge in patient care, it said.

"Transforming the nursing profession is a crucial element to achieving the nation's vision of an effective, affordable health care system that is accessible and responsive to all," said Linda Burnes Bolten, vice president for nursing, chief nursing officer, and director of nursing research, Cedars-Sinai Medical Center, Los Angeles, CA.

With millions more patients expected to have access to coverage through the Affordable Care Act, the health care system needs to tap the capabilities of advanced practice registered nurses to meet the increased demand for primary care, said the IOM.

The four key messages from the report are as follows:
  • Nurses should practice to the full extent of their education and training.
  • Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
  • Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States.
  • Effective workforce planning and policy making require better data collection and information infrastructure.
Nurses, which number at more than 3 million, make up the single largest segment of the health care work force and spend the greatest amount of time in delivering patient care as a profession, according to IOM. Therefore, nurses “have valuable insights and unique abilities to contribute as partners with other health care professionals in improving the quality and safety of care as envisioned in the Affordable Care Act.”

The American Medical Association, however, has a different viewpoint. In a statement posted on the AMA website, Board Member Rebecca J. Patchin, MD, said that although nurses are critical to the health care team, “there is no substitute for education and training. Physicians have seven or more years of postgraduate education and more than 10,000 hours of clinical experience, most nurse practitioners have just two-to-three years of postgraduate education and less clinical experience than is obtained in the first year of a three year medical residency. These additional years of physician education and training are vital to optimal patient care, especially in the event of a complication or medical emergency, and patients agree.

Health care professionals, said the AMA, “will need to continue working together to meet the surge in demand for health care. A physician-led team approach to care—with each member of the team playing the role they are educated and trained to play—helps ensure patients get high quality care and value for their health care spending.”

Click here to access the report—Health Care Reform and Increased Patient Needs Require Transformation of Nursing Profession.
To read the AMA’s response to the report, click here.

As a physician, what do you think of the push to nurses to take on more responsibility and shoulder the burden of the expected increase in patient load as a result of health care reform? How will this impact you and your practice?

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