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The Great Debate: Should Nurse Practitioners Have More Independence?

Updated: Jul 5

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Many nurse practitioners (NPs) feel that they’re hopelessly tethered to their physician counterparts despite, in many cases a much deeper patient relationship. On the other hand, physicians realize the critical importance of this role given the workload and record-keeping demands. But in some quarters there are frustrations about just how much authority nurse practitioners should have.

In addition, some nurses have also expressed frustration about the amount of real-life clinical experience a NP has even when compared to some more rigorous nursing credentials. The debate has been magnified by the fact that many states allow NPs to practice independently. The rigor of state requirements for NP certification has yet to be standardized.

As a result, some physicians are worried that NPs are not adequately prepared. This has also led to concerns that patients don’t understand the differences between NPs and a physician, but are hesitant to challenge an NP-only appointment for fear of insulting the practice they are dependent upon for a pleasant patient experience.

The Credentialing Landscape

Currently, 26 states allow NPs to practice without physician supervision.

To further complicate the mix for patients consider the Physician Associate (PA) who arguably has more rigorous medical training across a number of aspects of patient care versus the NP who tends to focus on a specialty. Only two states permit these physician associates (PAs) to provide care independent of the physician, despite PAs having more training than NPs in both didactic and clinical hours.

While the debate about qualifications and credentialing ensues, the fact is that there is no surplus of trained professionals who can administer high-quality care whether independently or in tandem with a physician.

The Patient Lens - Expectations

As always in healthcare we should ignore the patients' perspective at our own peril.

To that point, having spent a very perilous period in 2020 with a near-death bout with COVID, which provided the opportunity for me to meet literally dozens of caretakers with PA, NP, RN and MD credentials. I also did so as one who teaches a graduate class in personal branding which requires the study of subtle differences in professional roles.

I would argue that the major hesitation with a call with an NP versus the doctor has little to do with the credentials. For me, it was mostly related to whether I knew I was going to see an NP as opposed to an MD. In many cases, there was a “bait and switch” of sorts after I got to the live or virtual appointment.

Let me be clear, my experiences with NPs have been no more or less dissatisfying than those I’ve had with many of the luminaries with medical degrees. I simply felt I should have been told in advance that I would not be seeing my doctor!

The Patients Lens – Reality

Quite frankly with only a few exceptions, I’ve had many NPs (and RNs for that matter) who had a much better grasp of the nuances of my ailments than MDs. But the less-than-satisfying experiences were related to the NP being the equivalent of a screener for job interviews. I knew that I would need to schedule yet another appointment, this time with the physician to get a final opinion and course of action.

This goes back to the issue of NP empowerment and how it relates to the patient experience. One could arguably cross a state line and have a completely different NP experience given the greater independence the NP has in one state versus the other.

Needless to say, if there were enough physicians, and if they had the time to spend with patients rather than doing mundane documentation tasks, many of these NP independence issues would not be as controversial.

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