Potential Crisis in Nurse Practitioner Preparation in the United States.

The Doctor of Nursing Practice (DNP) degree was established to expand nurse practitioner education by adding new competencies. In 2004, the American Association of Colleges of Nursing released a position statement that redefined practice from only clinical care of patients to include nonclinical care. This policy position likely contributed to the rapid growth of DNP programs.

The ABCs of the doctor of nursing practice: assessing resources, building a culture of clinical scholarship, curricular models.

The Doctor of Nursing Practice (DNP) degree prepares nurses to provide comprehensive care across sites and over time. It is absolutely crucial-for both patient care and the nursing profession-that broadly recognized standards of competency for these new practitioners be established. The Council for the Advancement of Comprehensive Care has met since 2000 to build consensus on competency standards and a process for certifying these graduates.

Who's who in nursing: bringing clarity to the doctor of nursing practice.

Advanced practice nurses across the country are informally learning expanded skills and are assuming significant autonomy. The growing complexity and acuity of care, the aging of the US population, and the dwindling number of primary care physicians all contribute to the need for increased knowledge and practice competency. A formal and standardized educational process leading to a doctoral degree is essential for quality assurance, to clarify and validate authority/responsibility, and to recognize and identify these practitioners.

Context of care or provider training: the impact on preventive screening practices.

Background: While MD adherence to U.S. Preventive Services Task Force guidelines has been found to be uneven, nurse practitioners (NPs) and their adherence to guidelines have not been closely examined.

Essential health care: affordable for all?

Access to affordable health care has become a national crisis. The uninsured have many faces and many reasons for being uninsured. The nation cannot afford to sustain this broken system; not in terms of resources, nor in terms of the deteriorating health of the public.

Primary care outcomes in patients treated by nurse practitioners or physicians: two-year follow-up.

This study reports results of the 2-year follow-up phase of a randomized study comparing outcomes of patients assigned to a nurse practitioner or a physician primary care practice. In the sample of 406 adults, no differences were found between the groups in health status, disease-specific physiologic measures, satisfaction or use of specialist, emergency room or inpatient services. Physician patients averaged more primary care visits than nurse practitioner patients.

Diabetes care processes and outcomes in patients treated by nurse practitioners or physicians.

Purpose: The purpose of this study was to compare selected diabetes care processes and outcomes of nurse practitioners (NPs) and physicians (MDs) in the primary care of adults with type 2 diabetes.

Methods: Adults with type 2 diabetes and no regular source of primary care were enrolled from the emergency room and randomized to an NP or MD practice. Chart reviews were conducted to assess processes of care; patient interviews and hemoglobin A1C (A1C) testing were performed to measure patient outcomes.

Twenty-first-century primary care: new partnerships between nurses and doctors.

What role will advanced practice nurses (APNs) play in tomorrow's health care system? The author shares her answer to this question by first looking at the history of APNs and nurse practitioners (APNs whose focus is primary care), explaining what they do, and tracing their increasing success in overcoming long-standing barriers to full acceptance as providers of care. The author emphasizes that while APNs' advancement has usually been based on demonstrating sameness of practice processes and outcomes with those of physicians, in actuality, APNs-whose advanced primary care is delivered with full accountability and is indistinguishable from such care delivered by physicians-offer a different style of practice, which involves caring, nurturing, support, engagement with patients, attention to illness prevention and health promotion, and patient education. It is this difference on which APNs' survival rests.

Assuring quality and access in advanced practice nursing: a challenge to nurse educators.

In an environment characterized by a projected over-supply of primary care providers and a public seeking higher quality, cost-effective care, advanced practice nurses will be measured not only by their comparative value in delivering conventional primary care, but also by the uniqueness of their contributions to health outcomes. These value-added skills, distinctive to nursing practice at all levels, include health education, disease prevention, health promotion, community resource access, and partnerships with patients. Government, private payors, and national and state regulators all authorize increasingly independent practice by advanced practice nurses.

Primary care outcomes in patients treated by nurse practitioners or physicians: a randomized trial.

Context: Studies have suggested that the quality of primary care delivered by nurse practitioners is equal to that of physicians. However, these studies did not measure nurse practitioner practices that had the same degree of independence as the comparison physician practices, nor did previous studies provide direct comparison of outcomes for patients with nurse practitioner or physician providers.

Objective: To compare outcomes for patients randomly assigned to nurse practitioners or physicians for primary care follow-up and ongoing care after an emergency department or urgent care visit.

Health care trends, Part 2. The new health care team. Panel discussion.

In Part 2 of this third annual panel discussion, six experts talk about the growing diversity of health care providers and what it means for consumers and physicians. Americans are getting their wellness and health care services from a wider variety of non-physician practitioners than ever before. The number of allied health and alternative providers with direct patient access is likely to continue growing.

Can advanced practice nurses succeed in the primary care market?

In the mid-1980s the Columbia University School of Nursing (CUSN) reconfigured its mission to once again become the premier training ground for clinical experts in nursing. Its APN faculty members were expected to function as APN primary care providers in some of its affiliated clinics. Extensive studies at CUSN have validated the high quality and effectiveness of comprehensive APN-managed patient care when compared to a randomly selected group of patients managed by primary care MDs.

Differentiated primary care and evidence-based practice: the Columbia nursing experiment.

Changes in our health care system and the growth of managed care have turned the spotlight on primary care and are driving sweeping reforms in health professions education, patient care, and research. The Columbia University School of Nursing has responded to this challenge by establishing a community primary care clinic managed by nurse practitioners. This article describes this clinic, an evaluation study of this practice, and their relevance to pending policy discussions on primary care provider designation and payment and the regulation of scope of professional practice.

New alliances: nursing's bright future.

The health care system is undergoing tremendous change. Managed care and its several incentives probably represent only an intermediate step in an unstable evolution. Equilibrium will no doubt appear with new alliances, particularly between medicine and nursing.