Establishing New Care Methods for Physician Assistants and Nurse Practitioners

Bridget McGrath, PA-C, FHM

Investigators based primarily in Chicago detailed the implications of the COVID-19 pandemic on the nursing workforce in the United States and found several strengths and weaknesses in physician assistant (PA) and nurse practitioner (NP) use and optimization.

The authors, lead by Bridget McGrath, PA-C, FHM, intended to expose limitations within the healthcare system and improve upon patient care through new methods.

During the pandemic, the continuous waves of COVID-19 throughout the country resulted in everything from mass cancellations of clinics and elective procedures to forced transitions to telehealth platforms and rationing of limited resources.

Physician assistants and nurse practitioners always remained readily available. However, several outdated practice laws had kept these clinicians from being appropriately used during a national crisis, according to the authors.

In their research, McGrath and colleagues discussed the practice laws, the importance of having an institutional PA and NP structure that can be easily reached and deployed during a crisis, and what the future of healthcare delivery could look like for PAs and NPs with expanded scope of practice leading to creative and innovative practice models.

Outdated Practice Laws and Hospital Bylaws

In the past decade, the PA and NP professions have grown around 54%-65%.

To evenly distribute work and responsibilities, a new practice philosophy called optimal team practice (OTP) was developed.

According to the American Academy of PAs (AAPA), OTP occurs when PAs, physicians, and other healthcare professionals work together to provide quality care without burdensome administrative constraints.

Professional organizations for NPs advocated for similar practice agreements.

However, organizations, such as the American Medical Association (AMA), have held opposing viewpoints to such modernization, feeling proposals such as OTP and full-practice authority raise safety concerns.

Despite this, many states allowed for the deployment of new practice settings, which in turn meant NPs and PAs could practice to the full extent of their license beyond the current COVID-19 pandemic.

Another stumbling block for PAs and NPs are hospital bylaws, which the authors considered “frequent and inconsistent”.

If a state law lets PAs and NPs independently care for their own patients but the hospital bylaws require an attending to round on all of the patients seen by a PA or NP, this could result in double the use of personal protective equipment, exposure risk of healthcare providers, and limitations to the number of patients who can effectively be treated by 2 capable clinicians.

New Models of Care

McGrath and colleagues suggested that new partnerships, less restrictive policies, and stronger leadership could be mutually beneficial to PAs and NPs as well as patients.

They also noted the importance of advocating for clinicians during the ever-changing COVID-19 pandemic, a practice that is best approached through stronger leadership.

Allowing for PA and NP leaders to collaborate with hospital and service leader could aid in staffing issues, expand on admitting criteria, and increase care for patients admitted for COVID-19.

“By addressing the barriers to full use of PAs and NPs, healthcare systems can leverage lessons learned during this time to create novel models of care to meet the needs of patients,” the team wrote. “Teams of PAs, NPs, and physicians can then gracefully navigate changing workforce needs due to COVID-19 surges, future pandemics, and other disruptions such as duty hour restrictions.”

The study,“Modernizing the PA and NP workforce: Lessons learned from the COVID-19 pandemic,” was published in the Journal of the American Academy of Physician Assistants.