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Nurse Practitioners Expand Role in US Health Care

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Deborah Block

The new health care reform law in the United States will require everyone to have health insurance.  People who avoided going to the doctor because they had no insurance will be more likely to visit primary care physicians for minor illnesses.  But there's a shortage of primary care doctors, and nurse practitioners, who have advanced nursing training, are hoping to fill the gap.

Leslie Henry and Maura Constance are nurse practitioners at the Arlington Free Clinic in Arlington, Virginia.   

Henry is examining a woman who has allergies. "Well, you definitely look like you have allergies," she says.

A nurse practitioner is a registered nurse who has completed advanced nursing education. "Nurse practitioners have a lot of the same functions as doctors.  We take classes that look at different systems in the body.  The same thing a doctor would take," says Constance.

They learn how to diagnose and manage common illnesses like colds, or chronic problems such as diabetes and heart disease.  "We assess their medical problems and we come up with a treatment plan. We write prescriptions," says Henry.

For years, nurse practitioners have been playing a larger role in the nation's health care, especially in regions with few doctors.  

Jan Towers is Director of Policy for the American Academy of Nurse Practitioners. "There are also shortages in terms of having providers who will work with the elderly.  Nurse practitioners are particularly prepared to work with those kinds of people and in those kinds of settings because of community health preparation that we get in our nursing programs," she says.

States regulate nurse practitioners and laws vary on what they are permitted to do. Most nurse practitioners are overseen by a physician.

With the shortage of primary care physicians, 28 states are considering expanding the authority of nurse practitioners.  This includes practicing without a doctor's supervision and prescribing narcotics such as morphine for pain. "Given that there is going to be a need for primary care providers, and nurse practitioners are highly qualified primary providers who have been underutilized to date.  And they will be able to be part of what we think is a solution to getting primary care providers to everybody," she says.

The American Medical Association (the largest association of U.S. physicians) argues that the shortage of doctors is no reason to put nurses in charge. The group says the quality of medical care will drop if nurse practitioners are given more authority.  Instead, it says, more primary care doctors should be trained.  

But that may be hard to do since primary care physicians earn much less than specialists.  

Dr. Winston Liaw, is a primary care physician in Fairfax, Virginia. He says studies on the effectiveness of nurse practitioners have been too small to be conclusive.  "I think we still need to do more evaluation. It's obviously a very important skill, but I think it doesn't really encompass what primary care physicians do," he says.

Studies have shown nurse practitioners are better at listening to patients than doctors, and they make good decisions about when to refer patients for specialized care.  

Leslie Henry says she'd like to see nurse practitioners have more independence. "Nurse practitioners provide good care and certainly the studies have supported that.  Also, nurse practitioners get paid a lot less than a medical doctor and that means maybe we can provide affordable care," she says.

She says she enjoys helping people.  Her frustration is that -- like for doctors -- there are too many patients and not enough time to spend with them.

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