Institute of Medicine recommends expanding duties of nurse practitioners

In some ways, graduates of the School of Nursing’s nurse practitioner programs are going to hold the future of health care in their hands.

As the push for health care reform continues, nurse practioners’ special approach to health is being increasingly looked at as part of an improved care system, especially in addressing the mounting shortage of primary care providers.

The Future of Nursing report published by the Institute of Medicine — which held its Pennsylvania report launch at Claire Fagin Hall on Oct. 14 — made a number of recommendations emphasizing an expanded role for NPs in managing patient care.

NPs are registered nurses who have obtained a masters or doctorate degree and are licensed to practice largely autonomously with patients, according to Sue Schrand, executive director of the Pennsylvania Coalition of Nurse Practitioners.

Their responsibilities include conducting physical examinations, giving diagnoses, managing primary care and prescribing medicine for patients.

When scheduling an appointment with Penn’s Student Health Service, students can choose to see a physician, physician’s assistant or nurse practitioner, according to SHS Director Evelyn Wiener.

In addition to handling primary care, NPs also emphasize illness prevention among their patients, said Nursing professor Rebecca Bryan, who teaches in the Family Health Nurse Practitioner Program.

“Even if we combine everyone from all the [health] professions, we still don’t have enough providers,” Schrand said, referring to the combined population of physicians, dentists, NPs and other professionals who provide primary care.

However, this expanded role faces obstacles in the form of legal barriers that require physician oversight for aspects of care that NPs have been sufficiently trained to implement, Schrand said.

In accordance with Pennsylvania law, all NPs working for SHS must have a collaborating agreement with a physician on the staff, Wiener wrote in an e-mail.

Bryan, who works at a family practice run by a physician in Cherry Hill, N.J., said that federal Medicare laws specifically bar NPs from ordering home care for patients and also require a physician’s signature on certain disability forms.

Some NPs also encounter resistance from patients who would prefer to see a physician, although this is becoming less common, according to Victoria Weill, who teaches in Penn’s Pediatric and Family Health Nurse Practitioner programs and also works for a nurse-managed clinic in Lansdale, Pa.

Wiener wrote that although some students specifically request to see a SHS physician, “this appears to be an increasingly rare occurrence.”

Pointing to studies conducted by the Journal of the American Medicine Association and other medical organizations in support of NP care, Schrand said that NPs will step up to the challenge of addressing the primary care shortage from a holistic perspective, which looks beyond some of the more obvious physiological factors that affect health.

Weill — who lectured to Nursing students last week on the importance of considering patients’ health literacy in providing them with care — said that she has seen “fabulous” work from the Nursing students she has examined at clinical site visits across Delaware, New Jersey and Pennsylvania.

Nursing sophomore Jenny Wang, who is leaning toward sub-matriculating into one of Penn’s nurse practitioner programs, said that the field appeals to her as a way to help people while balancing the responsibilities of a physician and a registered nurse. “It’s like the best of both worlds,” she said.

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