Advance Practice Nurses

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Advance Practice Nurses

Nurse-midwives get high marks

By Elizabeth Hanink
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The care given by advance practice nurses can be as good as or even better than that provided by physicians. A recent literature review by Associate Professor of Nursing Julie Stanik-Hutt showed that nurses provide effective and safe primary care, and could be the key to the expansion of access to care in the United States.

The study, which included 107 reports, also showed patient satisfaction for three advance practice categories: midwifery, clinical nurse specialists and nurse practitioners.

Justification for Expanding Nursing Care

Published in Nursing Economic$, the study should help the argument that advance practice nurses be allowed to expand their practice into new settings and populations, that they be allowed to practice to the full extent of their education, and that the reimbursement from third-party payers acknowledge these expanded roles. (Proponents also argue that billing data should reflect who actually provided the service, whether CNS, NP, CRNA or midwife.)

Researchers found that several studies showed that control of glucose and lipids were comparable to care provided by physicians. In other studies, the rate of caesarean sections and low Apgar scores were the same for physicians and certified nurse midwives. Several other studies showed like outcomes for emergency visits, urgent care, hospital and nursing home readmissions.

Oddly enough, in one of the few studies to show only moderate rates of comparable care, researchers found that in the initiation of breast feeding advance practice nurses did not do better than physicians.

The literature review supported many of the findings of the Institute of Medicine, that in October of last year, called on nursing to expand the access to and quality of care.

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