I am writing in response to Rauda Tellawi's Oct. 27 column, "Should nurses be the new doctors in town?". As a fourth-year Nursing student who will finish roughly 650 hours of hospital clinical experience in May as an undergraduate, I find Tellawi's suggestion that care provided by an advanced practice nurse is "settl[ing] ... for less" very disappointing.
An undergraduate nursing degree is required for admission to an advanced degree program. The majority of advanced practice nurses have several years of experience in the field between their undergraduate and masters studies. Masters of Science in Nursing (MSN) programs are usually two years, in addition to the four years of undergraduate schooling focused on nursing. I will not argue that two years in an MSN program is more substantial than four in medical school, but one must take into account the undergraduate experience as well as the field experience nurses gain between degrees. Saying that advanced practice nurses have "some work experience" is an understatement; many have several to dozens of years between degrees. It is rare for an undergraduate nursing student to enroll directly in a master's program, and admissions departments for advanced nursing degrees heavily value nursing experience. How could I be a great advanced practice nurse without first having "real-life" experiences as an registered nurse (RN)?
It is important, however, to consider the differences in focus of care between the two professions. Yes, both doctors and nurses want to "help the patient get better." This can be accomplished in a variety of ways, including surgical and pharmaceutical interventions provided by those with advanced degrees. The focus of Tellawi's article is on the rural regions of Virginia, where health care issues like heart disease, obesity, and sexually transmitted illnesses occur at comparatively higher rates. Especially in these settings, patient education is key for disease prevention.
A medical degree is not necessary to provide a patient with the skills to successfully achieve smoking cessation or use contraceptives appropriately. Nurses are charged with the specific obligation of educating patients and their families. In a time when health costs are rising, does it not make sense to provide resources to prevent illnesses from happening in the first place? When funding resources are limited, we should be focusing our efforts to care for the whole patient - not only the diagnosis.
Apart from the misconception in the amount of schooling, what I find most disturbing is Tellawi's allegation that care provided by a nurse practitioner would be less satisfactory than that provided by a physician. According to a 2002 systematic review of the literature published by the British Medical Journal, "patients were more satisfied with care by a nurse practitioner ... No differences in health status were found ... Nurse practitioners had longer consultations and made more investigations than did doctors ... No differences were found in prescriptions, return consultations, or referrals. Quality of care was in some ways better for nurse practitioner consultations" (Horrocks, Anderson & Salisbury, 2002).
Nurse practitioners in Virginia have a scope of practice under a physician. These scopes vary from state to state, but all ensure nurse practitioners collaborate with physicians consistently. The evidence provided demonstrates that "no differences in health status were found" between care provided by either a physician or nurse practitioner. Care provided by an advanced practice nurse is not only equivalent (sometimes better, depending on what category is valued) but also more cost-effective. When healthcare costs are soaring, I see no cost in expanding the nurse practitioner scope of practice to provide thorough, affordable and satisfactory care to all patient populations - especially those in rural settings. For more complex or surgical patients, the option to consult the physician is clearly an option. Expanding the role of the advanced practice nurse has several benefits without serious cost to patient care, and should be seriously considered by the legislature.
In an age when interdisciplinary cooperation is necessary not just in clinical care but also is being integrated into curricula by the Nursing and Medical Schools, I am disappointed by Tellawi's apparent lack of respect of the nursing profession. As a new graduate nurse come spring, I hoped that these outdated views on the nursing profession were behind us. Suggesting that seeing an advanced practice nurse would be compromising care is dangerous and disrespectful to the profession. For nurses and doctors to work together in a cohesive and mutually beneficial manner, we must trust and respect each other. I hope Tellawi is able to experience what a wonderful resource RN's will be to her as a medical school student and intern rotating units monthly and will cooperate with advanced practice nurses as peers rather than subordinates.
Page Dunbar is a fourth-year Nursing student.
Read More
EDITORIAL: U.Va. needs to promote better artificial intelligence policies
By Editorial Board | YesterdayA better method of controlling AI use in classrooms comes with collaboration and communication — the University should set a clear policy-making process for professors.
PAYNE: U.Va.’s acquisition of the FEI directly harms the children of Charlottesville
By Michael Payne | 3 days agoThe Department of Education rescinded its award to CCS and gave the FEI property to the University instead.
COHEN: Charlottesville must embrace a comprehensive solution to homelessness
By Ryan Cohen | 5 days agoThe city has made several past efforts to reduce homelessness, but the growing number of unhoused people suggests that these temporary solutions are simply not enough.
