The Nurse-Led Future of American Healthcare?

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The Nurse-Led Future of American Healthcare?

A substantial grant says yes

By Aaron Severson
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The passage of the Affordable Care Act is expected to highlight a serious national problem: an alarming shortage of primary care and general practice physicians.  As a result, there is growing interest in alternative approaches to healthcare delivery, including nurse-managed health centers (NMHCs).

Advanced Practice Nurses
Unlike traditional clinics, an NMHC is led not by a doctor, but by nurse practitioners and other advanced practice nurses. Physicians are typically available part-time, but most services are provided by nurses, who, according to the National Nursing Centers Consortium (NNCC), “are able to deliver high quality and cost-effective services to our most vulnerable populations, the poor and the uninsured.”  Many NMHCs are run by or in partnership with local nursing schools.

A Different Approach
According to Patricia Dennehy, director of San Francisco’s GLIDE Health Services, the West Coast’s largest NMHC,  nurse-led care is about more than just substituting nurse practitioners for doctors.

The NMHC model of care is community-based and patient-centric: Unlike emergency rooms — often the only recourse for poor patients — nurse-managed health centers focus on the whole person, rather than a specific illness or injury. Dennehy says this approach makes nurse-led clinics better able to promote overall health and disease prevention. There are currently at least 250 NMHCs in the U.S., seven of them in California. NNCC Chairman Kenneth Miller, RN, Ph.D., CFNP, FAAN, calls nurse practitioners, “the future of primary care in the United States,” and the Affordable Care Act includes a $50 million grant program to support NMHC development.   


It’s Political:California legislature may expand non-physician scope of practice

by Elizabeth Hanink, RN, BSN, PHN

State Senator Ed Hernandez (D-West Covina) has introduced a package of bills in the California Legislature, S.B. 491, 492 and 493, that would expand the scope of practice for qualified non-physicians, including nurse practitioners, optometrists and pharmacists.

The details of the bills, which were referred to the Standing Committee on Business, Professions and Economic Development on April 3, are not yet final, but the legislation would authorize nurse practitioners to establish independent practices, expand the practice of optometrists and allow “advanced practice” pharmacists the ability to assess patients, adjust medications and administer certain tests.

Another bill, S.B. 1069, introduced by Sen. Fran Pavley (D-Agora Hills), would similarly expand the role of physician assistants.

The bills are part of an effort to address California’s acute physician shortage. Only 16 of California’s 58 counties currently meet federal recommendations for primary care doctors per capita. With nearly 30 percent of the state’s physicians rapidly approaching retirement age, adequate coverage is becoming precarious.            

Furthermore, the Affordable Care Act, which will add many new patients to MediCal while requiring millions of Californians to purchase health insurance, is expected to further increase the demands on the state’s healthcare providers.

The California Medical Association has raised concerns about these bills, arguing that the proposed legislation could compromise patient safety. While acknowledging the importance of ancillary healthcare professions, the association maintains that physicians’ high level of education makes them the most qualified to diagnose and treat patients. 

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