The advent of nurse practitioners
and physician's assistants
Both nurse
practitioners (NPs) and physicians assistants (PAs) came into being because of
the marked shortage of professional, medical personnel, during the 1960's. With
the advent of NPs and PAs, medical care changed in a positive direction. Note that the health care system still remains
in a state of flux and will continue to experience ongoing changes, in the
future.
With
the introduction of the two new levels of medical training and practice, during
that time, there was initially strong resistance to these changes in
medical care and the health care system, both on the part of some physicians
and other health care professionals. But, it soon became evident that other
physicians and health care professionals were gradually beginning to
acknowledge the reality that health care needs were growing in leaps and
bounds. There were those who could see that physicians would not be able to
meet all of these demands; they would need professionally trained medical
assistants.
Historically,
registered nurses have always worked closely with physicians, assisting
them however possible. Many physicians and health care professionals were
appreciative of the assistance that they received from registered nurses,
whereas others chose to fight against what appeared to be a growing trend in
health care, insisting that the doctors' roles and responsibilities were theirs
and theirs alone. Many people, professional and non-professional, were quite
reluctant to allow registered nurses to assume any of the doctor's tasks, even
though they were trained.
In
the military, many physicians worked closely with medical assistants, who were
not fully trained as physicians, as well as with registered nurses. The medical
assistants also met with strong resistance. Neither registered nurses nor
medical assistants were officially recognized, in spite of the fact that many of
them had already attained high levels of advanced skills and training, as the
direct result of working directly with physicians. Many of these people had
been trained on a one-to-one basis, by physicians.
The
establishment of a nurse practitioner program appeared to be a feasible
solution. It met with a great deal of resistance. ‘Nurses are nurses’ was the
attitude that many took towards NPs. Medical assistants were either forced to
work as orderlies, or to train as registered nurses or physicians.
In
1965, the profession of nurse practitioner was instituted and required a
master's degree. In the late 1960s into the 1970s, predictions of a physician
shortage increased funding and attendance in nurse practitioner programs. (1)
It
soon became apparent that NPs, who had advanced training, were able to function
in a capacity that would be of benefit to physicians, patients and the health
care system. NPs began to be perceived in a different light. During the 1970s,
the NP requirements relaxed to include continuing education programs which
helped accommodate the demand for NPs. (2)
During
the Vietnam War, many physicians worked closely with medical assistants. The
growing need for their skills and training was becoming increasingly evident. Gradually, military medical assistants came to be acknowledged as a
possible source of assistance for overburdened physicians.
The
PA profession came into existence in the mid-1960s due to the shortage and
uneven geographic distribution of primary care physicians in the United States
It
was not long before a training program was established.
Dr.
Eugene A. Stead of the Duke University Medical
Center in North Carolina
Since
that time, the NP and the PA horizons, roles and responsibilities have
continued to expand dramatically.
There
is still resistance to the medical system that allows NPs and PAs, but
gradually, people are beginning to accept the reality that in order to obtain
adequate health care, they have to accept both NPs and PAs, who are working in
conjunction with physicians. Many people now welcome the care that the NPs and
PAs are able to provide for them.
Has
the role of NPs and PAs changed with regard to their assumed responsibility?
Nurse
practitioners, along with other advanced practice nurses, function within the
scope of their state's nurse practice act and have varying levels of physician
collaboration or supervision. In some states, nurse practitioners function
independent of physician involvement. (5)
A
physician assistant (PA) is a healthcare professional licensed to practice
medicine with supervision of a licensed physician. (6)
The
roles of both NPs and PAs have changed in such a way that with proper training,
practice and licensure, under the guidance of physicians, they now function on
a far higher level than they were allowed to assume as health care providers.
In a health care system that still needs more physicians, they provide a wide
range of professional health care services.
The
physician's role has not and will not be replaced in total. If anything, there
is growing evidence to show that the physician's role has been enhanced, by
those who have been trained to assume some of the physician's previous roles
and responsibilities. For instance, the introduction and acceptance of NPs and
PAs, makes it possible for physicians to give medical care to more people.
It is
also possible for patients to obtain more advanced medical care, because
physicians are able to pursue higher levels of medical knowledge. Because
medical technology is increasing so rapidly, it is important that physicians
stay informed. They continue to learn, even while they train NPs and PAs.
Allowing NPs and PAs to take responsibility for some of their lesser tasks,
gives physicians more time with their patients. Thus, a higher level and better
quality of medical care is possible for everyone.
Ultimately,
physicians still bear responsibility with respect to the medical care given by
NPs and PAs, but it is proving to be win-win situation for everyone, even those
who still resist being diagnosed or treated by NPs and PAs. Resistance to
change is to be expected. Change invariably brings about solutions to problems
that might otherwise remain unsolved. The advent of NPs and PAs should be
regarded as a good thing.
With
an eye to the future, in the light of the global economy, there is also the
cost factor that must be taken into consideration. NPs and PAs are proving to
be cost effective. In fact, it is becoming increasingly evident that more NPs
and PAs could and should be trained.
One
of the difficulties in the health care system, as it stands today, is the fact
that there are large numbers of senior citizens. There are also relatively few
post baby boomers being born, compared to the large numbers of baby boomers.
Over time, this may mean that there will be fewer physicians trained. More NPs
or PAs may have to be trained in order to meet the growing health care needs of
the global community.
As
for their current status, both NPs and PAs are now regarded as Mid-level
Providers/Practitioners. (7)
Should
all registered nurses become NPs?
There
may need to be other different levels of health care providers introduced into
the health care system of the future, as a way to meet the burgeoning health
care needs of people everywhere.
Will
there still be resistance? Resistance to change is normal. Further transitions
will always meet with resistance on the part of physicians and health care
professionals, but transitions will continue to bring about continuing progress
and improvement in medical care and in the global health care system.
(1)
http://en.wikipedia.org/wiki/Nurse_practitioner
(2)
Ibid.
(3)
http://en.wikipedia.org/wiki/Physician_Assistant
(4)
Ibid.
(5)
Op cit., Nurse_practitioner
(6)
Op cit., Physician_Assistant
(7)
Op cit., Nurse_practitioner
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