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Clinical Systems Leadership

Study: Independent Nurses Could Lead to Better Health Outcomes

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Independent NPs deliver superior care

Published in the November-December issue of Nursing Outlook, the MU research analyzed health care quality in states where advanced practice registered nurses are allowed to practice primary care services independently of an overseeing physician and compared it to more restrictive states. The quality was found to be better in the states with independent NPs.

The researchers used Medicare and Medicaid studies analyzing health care outcomes among different states. States with fewer restrictions and more independent NPs saw better care, lower hospitalization rates and lower health care costs. For the study authors, these results made sense because APRNs are qualified to give care.

“APRNs have graduate-level educations; when you get APRNs into nursing homes, they help improve the overall quality of care because they have advanced knowledge of the best evidence-based practice,” Marilyn Rantz, a study researcher and professor in the MU Sinclair School of Nursing, said in a statement. “In states where APRNs practice independently, health outcomes are better, Medicare and Medicaid outcomes for older adults are better, and costs are lower. Hospitalizations also decrease.”

Independent NPs are able to perform duties similarly to primary care physicians, having their own patients whom they are able to care for in full capacities. These NPs are still able to consult physicians, but aren’t required to report to a doctor by law. In more restrictive states, like Missouri, where the researchers worked, physicians directly oversee NPs and APRNs.

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Impact on care in the US
This study is significant, not just because better health outcomes and lower costs are important to everyone in health care, but because these findings bolster the suggestions that NPs could help meet the health care shortfalls expected in the next few years. As the population grows larger and older, and more people are covered by health insurance, the need for health care professionals is expected to grow significantly.

The U.S. Department of Health and Human Services explained that the rise in health care demand is expected to exceed the rate of growth of physicians, with the number of doctors only increasing about 8 percent between 2010 and 2020, compared to demand which is expected to rise by more than 14 percent over the same time period.

NPs can help address this projected shortfall. The DHS report, “Projecting the Supply and Demand for Primary Care Practitioners Through 2020” explained that between 2010 and 2020, the number of NPs is expected to jump 30 percent from about 55,000 to more than 72,000.

With this expected growth, NPs, as well as physician assistants, can help drastically cut the number of primary care physicians that the U.S. would need to meet expected demand.

“Given the rapid growth in the NP and PA workforce, as well as ongoing efforts to effectively integrate these providers into the primary care delivery system, the projected physician shortage could be somewhat alleviated. Efficient use of NPs and PAs will require patient and health system acceptance and the continued dissemination of more effective models of workforce deployment,” the DHS report concluded.

While having more NPs working in a similar role to doctors may prove better for health outcomes and help address predicted shortfalls, many states still have restrictions in place to prevent independent operation.

California, Texas, Oklahoma, Missouri, Tennessee, Florida, Georgia, South Carolina, North Caroline, Virginia, Michigan and Massachusetts are the most restricted, requiring doctors to over NPS when they diagnose patients, write prescriptions and treat patients, according to Simons University.

However laws are changing. New York recently passed legislation that allowed some NPs to practice without doctors starting Jan. 1, 2015.


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