Anne Vaillant: Explains role of advanced practice nurses

Thursday, January 11, 2018
Explains role of advanced practice nurses

As an advanced practice nurse (APRN) with 25 years of experience, I read Kaitlin Milliken’s article on the varied reactions to Sen. James Welch’s proposed health care legislation with great interest (“Senate health bill sparks debate over role of nurse practitioners,” Dec. 29).

The conversation around expanding the scope of practice for advanced practice nurses is long overdue in our state, particularly in western Massachusetts where there is a chronic shortage of primary care providers, and where timely access to quality care can be a real issue.

While I was struck by the reflexive, even tribal reactions of some physicians quoted in the article, on some level their reluctance is understandable. Physicians devote an immense amount of time and effort, and often take on substantial debt, to gain expertise in their fields. And yet they have seen their professional position erode significantly over the last 50 years — under siege from declining reimbursements, direct-to-consumer advertising, and a more empowered clientele, among many factors. But, as much I empathize with these challenges, the defensiveness and territoriality expressed in this article obscure some key priorities common to all health care providers.

First, as clinicians we have an obligation to practice based on evidence, and the data clearly indicates that in states with expanded scope of practice, health care costs go down, access to care expands, and outcomes improve.

Second, we need to remember that our job is not to consolidate power but to deliver compassionate, high quality, equitable health care to as many people as possible, and these struggles over turf and licensure do nothing to advance that goal.

Third, possibly the most essential component of good primary care is health education, and in the areas of communication and prevention APRNs have repeatedly proven themselves to be equal, if not superior, to most doctors.

Finally, I found the fears voiced in the article of rogue nurses who “could take on medical procedures and services which they are not qualified to perform” to be both offensive and baseless. I have had the opportunity to work with many nurse practitioners and certified nurse midwives in a wide variety of settings and find us to be responsible, collaborative, and attentive to the limits of our training. The implication that we are waiting in the wings to usurp power and run amok with it smacks of a cabalistic belief system that is outdated and unworthy of our physician colleagues as we enter a new era of more integrated health services.

It is worth remembering that as a nation the U.S. ranks dead last among high-income countries in key health indicators, including access, equity, efficiency, and outcomes, despite spending 50 percent more on health care than our nearest competitors.

In a country projected to have a shortfall of 45,000 primary care physicians by 2020, which lags shamefully in health promotion and disease prevention, and which leads the world in health expenditures, to resist using all the skilled and cost-effective resources available to us feels like the worst kind of malpractice.

Anne Vaillant