The increase in nurse practitioners, and the diploma mills that graduate ill-prepared nurses, should concern doctors and patient advocates, Rebekah Bernard writes on Medical Economics.
Changes in Practicing Unsupervised and the Consequences
The number of non-physician healthcare providers, such as physician assistants and nurse practitioners, has been increasing in part to counteract physician shortage, according to Bernard, a doctor at Gulf Coast Direct Primary Care, Fla.
Through political means—including $5.3 million on lobbying and $2.1 million contributed to congressional candidates in 2016—and a multi-media campaign, nursing organizations have increased the number and power of nursing practitioners, she writes. Nursing practitioners can now practice independently in the Veterans Administration, Washington, D.C., and 23 states, according to Bernard.
There has been a boom in nurse practitioner courses, with many being entirely online and lasting as little as 20 months with self-directed coursework, she writes. They boast 100% acceptance rates, with some accepting work hours as clinical training, she writes. Furthermore, there are programs that allow nurses who have never practiced to become nurse practitioners, according to Bernard. Moreover, some programs allow candidates with a non-nursing degree to become a registered nurse and nurse practitioner at the same time, meaning graduates are able to practice advanced nursing with no prior experience, she writes.
The courses often use an honor system for required clinic hours, which can involve simply shadowing a nurse practitioner, according to Bernard. This is because there are not enough clinical preceptors to accommodate the number of students, she writes.
Studies have found that removing physician supervision and a standardized curriculum has caused a drop in quality, according to Bernard. It has resulted in poorer referrals to specialists, more unnecessary skin biopsies, more diagnostic imaging and increased prescriptions, including in antibiotics and opiates in some states, she writes. There is also a rise in the number of malpractice and improper prescribing claims against nurse practitioners, according to Bernard.
This may be a growing trend, with 23,000 nurse practitioners trained per year compared to just 19,000 physicians, she writes. Doctors receive a minimum of 20,000 hours training whereas nurse practitioners receive a minimum of just 500 — and the difference in what is considered good practice should worry physicians, according to Bernard.