Full Prescriptive Authority for Nurse Practitioners as Pediatric Health Care Providers

Based on their education, training, and skills the Nurse practitioner ought to be granted with full prescription authority to provide care for the pediatric patients. NPs care has been linked to improved satisfaction of the patients and quality care regarding patient communication, education, and documentation. 

Abstract

Nurses’ practitioners play a pivotal role in the provision of healthcare services. Many physicians depend on these professionals for assistance as well as providing direct care for the patients within their fields of competence, training, and state-specific rates act. Approximately 25% of the physicians employ nurses’ practitioners. Numerous studies have indicated the Nurses practitioners can provide care for approximately 60% to 90% of all patients in the primary care. Typically the nurses’ practitioners can diagnose and treat illnesses, perform medical histories, order x-rays, and laboratory tests, prescribe medications, offer patient education, and administer immunizations. 

Additionally, they can provide prevention services, care coordination as well as conduct case management. Their presence can assist to reduce the shortages of physicians’ by providing health care services and allowing the physicians to focus on serious illness and managing patients’ who have complex chronic illnesses. The cost-effective objectives of the Affordable Care Act can be attained when nurses are performing as providers in different services to the patients in the primary and acute care setting. The affordable act is meant to reduce incessant growth in spending concerning health care because the rapid rise in healthcare costs has become a huge threat to the economy. 

Problem Statement

Florida is facing a crisis in the health sector with 40% of Floridians lack adequate access to health care. 21% of all Floridians and 46% of low-income women lack health insurance. As a result, a large number of underinsured and uninsured pediatric patients in Florida receives services of healthcare in hospitals or emergency rooms which are much expensive compared to regular access to primary care and preventive setting. The Floridians ultimately bear provision of healthcare to the underserved and the uninsured through higher taxes and high health insurance premiums. Advanced Practice Nurses (APNs) consists of registered nurses with advanced certification, education and training in clinics and they act as health care providers in various ways such as the primary care, outpatients, and acute care setting.

In Florida, the APNs, are licensed as “Advanced Registered Nurse Practitioner (ARNPs).” ARPS was first acknowledged in 1975 under the Florida laws and today there are more than 13,000 ARNPs who are practicing in Florida. ARNP has three categories licensed in Florida namely Nurse Practitioner, Certified Registered Nurse Anesthetist and certified nurse midwife. Numerous studies have proven that quality care offered by the APNs is much better compared to care provided by physicians and other professionals in the healthcare sector. The nurse practitioners have been considered to be the best in providing healthcare services to the pediatric patients as well as the promotion of cost-effectiveness. Therefore they should be given full prescription authority to become pediatric health care providers. 

Literature Review

Primary Care

Allen et.al (2014), pinpoint that, based on the primary care setting of the nurse practitioners, cost- effectiveness was found to be of the same magnitude to that of the physicians. Interventions led by the by the nurse practitioner emphasizes the management of chronic disease and reduction of the risk factors which enhanced patients functions as well as reduce costly interventions. Goolsby, 2011 found proof indicating the economic value of the NPs in dealing with chronic care patients as well as the pediatric patients ( Allen et.al, 2014) . A substantial cost saving has been documented in many clinics where the nurses’ practitioners offer the majority of the care. Moreover, the NPS offer cost effective care to patients’ with high-risk illnesses by proactively pinpointing and minimizing the risk factors. The nurse practitioner provides economic value by reducing unnecessary usage of expensive inpatient and emergency care resources. 

When comparing the two groups of nurses and physicians operating in the primary care setting it has been noted that low rates of visits to the emergency department for the nurse practitioners. The decrease in the visits to the emergency department is credited to the management of early signs and symptoms by the nurse practitioners in the primary setting. The nurse practitioners examine whether the concerns of the patients are consistent with their regular recovery procedures and hence decreases unnecessary visit to the emergency room for minor complaints. The patient follows up conducted by the nurse practitioners established suitable future patterns of care regarding the unnecessary use of the emergency departments. Hence this suggests more cost effective results for the patients’ in the primary care setting.

Acute Care

The nurse practitioners care in the setting of acute was constantly attributed to low drug costs for the patients. Comparing the group controlled by the physicians with the nurse practitioners, it was indicated that the nurse practitioner management had significant reductions in drug utilization and costs. Huang (2015) established that the nurses’ practitioners who were managing the patients who had hypercholesterolemia the prescription drug costs were lowered because the patients were more likely to heed to the medication prescribed by the nurse practitioners. These finding further supports the idea that healthcare clinics managed by nurse practitioners are often cost-effective methodologies to improve the patients’ results. 

National Governors Association 2012 revealed that, nurse practitioners provided superior/equal quality care to the patients’ at lower costs with greater consistency and continuity. In a study that contrasted the neonatal care offered by the physician s and nurse practitioners in the NICU, the costs incurred through the nurse practitioners’ was reported to be $18,240 less for every infant than those administered by the physicians (NGA, 2012). The differences in costs were associated with nurse practitioners blend of knowledge, good communication skills, constant visits and early detection of service coordination needs. Evidence also showed that admission costs decreased as well as the length of stays for asthmatic patients who were handled by the pediatric nurse practitioners contrasted to the medical residents. Therefore the cost-effectiveness linked to the nurse practitioners care is associated with their communication skills, concerning patient education as well as the consistency in providing the best approach to care. 

Societal Perspective

The societal perspective while analyzing the cost effectiveness of the nurse practitioners is not only directed to the patients gaining health but also to those who pay for it. While analyzing the cost-effectiveness from the perceptions of the society the analysis considers every person who is affected by the involvement and counts all the health results and costs. The resources provided by the society are limited and hence those devoted to healthcare ought to be invested wisely. Of principal concern to the society are the healthcare providers’ education and training as well as the costs and benefits that are accepted by the society at large. 

Conferring to the Huang (2015), the training costs for the nurse practitioners is only 20-25% of the physicians’ training. In fact, the total amount of tuition for the education of the nurse practitioners is less than one year for the costs of medical education (AANP 2010). Three to seven nurses can be educated using the costs of education a single physician. The cost effectiveness of the training programs of the nurses’ practitioners is the fastest as well as the least expensive method of addressing the shortage of providers in the healthcare amid the increase of patients demand. 

Hospital and Employer Perspective 

Naylor& Kurtzman (2010), express that employers in the healthcare fraternity are increasingly troubled with the stretched limited financial resources that are caused by restrictive budgets, compensation of salary, and costs containment policies and hence a key consideration for employers and hospitals. However, by employing the nurse practitioners, the yields savings experienced by the hospital and employers are much better compared to hiring the physicians ( Naylor& Kurtzman, 2010) . Huang (2015) study indicate that, in 2010 the mean full-time salary for nurse practitioners in the primary care setting ranged from $87, 220 (Pediatric) and $90, 710(adults). Conversely, the median salary for the physicians in the primary care setting ranged from $208,658 (family) and $219, 500 for internal medicine (Huang, 2015).

The mean salary for full-time nurse practitioners in the specialty care was $95,770 for acute care and $01, 540 for neonatal whereas for the physicians in the specialty care ranged from $233,500 for Endocrinology and $532,567 for cardiac and thoracic surgeons. The average total salary for the nurse practitioner is approximate $92,000. Hence the low amounts needed to compensate the nurse practitioners working in both primary and specialty departments ay enable the hospital and employers to distribute limited resources more efficiently. 

Even though the nurse practitioners can decrease the overall healthcare expenses as indicated n the literature, full exploitation of the nurse practitioner by employers and hospitals has not been realized due to several reasons. The scope of the regulations in practices does not grant the nurse practitioner full autonomy, and hence the physicians continue supervising them. The supervision severely affects the cost-effectiveness of hiring nurse practitioners and consequently decreases productivity because the physicians are required to spend time in supervising the nurse practitioners. Furthermore, the physicians continue conducting various functions that could else be transferred to the nurse practitioners. Huang (2015) realized employing a nurse practitioner is cost-effective if only the nurse practitioner will autonomously manage at least 30% of the patient workload. 

Nurse practitioner perspective

In a sample of ten, the majority of the respondents 80% were nurse practitioners in the primary care setting while the 20% were nurse practitioners in the acute care setting. The respondents had an average of 20 years of experience either as part-time of full-time nurse practitioners which do not comprise of prior work experiences .four of the participants interviewed held a doctorate of nursing practice (DNP). 

Table 1: Positive indicators of cost-effectiveness of the nurse practitioner

(n=10, % of the nurse practitioners mentioned)

Holistic Care Nursing Model	100%
Patient education	100%
Patient partnership	100%
Teamwork among health care providers	80%
Patient follow up after discharge	80%
Resource utilization	70%
Scope of Practice Regulations	100%
Restrictive Reimbursement Policies	100%
Physician Lobbying	90%
Physician Network Referral Policies	60%
Lack of Nursing Professional Advocacy	60%
Lack of Standardized Nursing Education	50%
Lack of Nurse Representation on Hospital Boards	30%
Hospital Bylaws (Acute Care NPs)	20%

Education

According to Stanik-Hutt et.al, (2013), a ll the nurses who were interviewed stated that the differences in training education and styles between the physicians and the nurse practitioners have a huge impact on the practice patterns. Since the nurse practitioners are obligated to acquire experience in work as registered nurses before enrolling for a master of science in Nursing, they incorporated the holistic care model which is highly stressed in nursing into practice. Promotion of health, prevention of disease and patient education are crucial to the nursing model of care. The nurse practitioners make contact with the patients’ though components of the physicians medical model as well as the holistic healthcare model for the nurses ( Stanik-Hutt et.al, 2013) . 

Nonetheless, the nurse practitioners are not midlevel providers or junior doctors. When establishing an optimum treatment procedure, the nurse practitioners incorporate pharmaceutical and non-pharmaceutical interceptions, primary prevention as well as lifestyle adjustments. Medication and the possible side effects are critical, but the psychological state of the patient, the social support system, and the physical environment are significant to the planned care. Nurse practitioners establish a connection with the patient to attain the healthcare goals of the patients. Contrastingly, the physicians observe the medical approach to care which concentrates more on surgical and other interventions which are short term so as to attain healthcare outcomes. In medical schools, they focus more on symptoms, and hence physicians learn to treat people and move on ( Jennings et.al, 2015) . 

The nurses interviewed noted that the NPs are more proficient in dealing with the wellness and prevention of illnesses because they utilize an inclusive approach to care for the health of the patients. Jennings et.al, (2015) indicate that nurse practitioners extend their concern beyond immediate injury and disease to comprehend the implications of the daily functioning of the patients, family role, finances, support system and home transition. The nurse practitioners play a pivotal role as the gatekeeper to the patient regarding the healthcare particularly in primary care setting because there is a 15 to 30-minute visits for the healthy patients ( NGA, 2012). At the entry point of the healthcare facility or clinic, the nurse practitioner can guide the patients to the physicians if the need arises and if the patient’s care is more complex to be handled by NPs. As health coaches, the nurse practitioners engage in education to the patient’s so as to teach them about the risks involves and the objective of the treatment as well as lifestyle modifications. 

Proposal for Change

To enhance more effective utilization of the nurse practitioner the federal and state policies that control the healthcare partners should mirror the knowledge, experience and skills of each profession rather than being reserved for a command and control kind of relationships. The policies should focus on strengthening the responsibility of the healthcare providers and their professional standards ( Pohl et.al, 2010) . Moreover the policies should also highlight inter professional collaboration, promote accessibility of superior quality care and foster innovative practice. 

Remove unwarranted restrictions

In light of the proof provided illustrating the equivalence and in other cases the significance of the Nurse Practitioner in offering primary care, considerable efforts ought to be made to remove unwarranted restrictions as well as standardize the practice acts of the nurses ( Pohl et.al, 2010) . Policies that promote collaborate, innovation, cost-effectiveness and high quality care to the patients should be implemented. The nurse practitioners should also be granted with the prescription authority to deal with pediatric patients’. 

Equalize payments

The discrepancies in the reimbursement of the Medicare nurse practitioner are baseless and hence they should be evaluated with an objective of attaining pay parity for the services. The literature review has revealed the differences in amounts that the nurse practitioner and physicians get and they are worrying. The nurse practitioners are quite important in the healthcare fraternity through provision of quality care to the patients and comprehensive knowledge and skills about their field of specialty. The current payment methods should be structured so as to acknowledge the nurse practitioners as eligible providers. 

Increase nurses’ accountability

Nurse practitioners’ should be held responsible for their assistance in providing high quality primary care ( Pohl et.al, 2010) . A growing number of studies reported by the state and federals government, employers, states, payers, and other stakeholders indicate that the most of the nurse practitioners’ performance towards the patients’ is excellent. Therefore the performance of the nurse practitioners should also be made publicly available so as to fuel quality improvements and enables consumers to select the high quality providers. 

Cost-Benefit Analysis

As Huang (2015), pinpoints that the costs of the health may be reduced by minimizing policies that use high costs of the providers of health care for services that may be offered with comparable outcomes and lower costs by the nurse practitioners. Both clinical and economic gains may be identified if the nurse practitioners are allowed to practice at their full capacity and legally. When nurse practitioners can maximize their full extent in education and training, the healthcare costs are lowered, and unnecessary spending is avoided ( Goolsby, 2011) . The barriers that exist in the nurse practitioners practice such as prescriptive authority, reimbursement policies, and the practice regulations should be eliminated to enable the nurse practitioners’ to work effectively and perform better. 

Cost-effectiveness is the basis for meaningful health as it provides the estimates of the degree of costs and health results. While examining the outcomes and expenses of interventions created to improve health, the cost effectiveness scrutiny is a guide to resource allocation. Based on the literature review, the cost effectiveness of the nurse practitioners’ in the primary care setting and other stings has been identified ( Goolsby, 2011) . The findings suggest theta comparing the physicians’ and nurse practitioners’ costs in the clinic. The nurse practitioner care was identified as the one which has considerably low costs. Additionally, the healthcare system is faced with the challenge of shifting demographics, political pressures, and economic challenges. The nurse practitioner is a potential answer to these challenges.

Conclusion

With robust proof supporting the nurse practitioners ability to offer cost-effective care as well as economic value, they are well positioned to meet the shortages in physicians and the increasing demand of the patients. Evidence provided in the literature review indicates that nurse practitioners’ can substitute the physicians in their scopes of practice and hence they should be granted with full prescriptive authority when handling the pediatric patients. Based on the stakeholders’ perspective, the most cost-effective approach is through utilization of the nurse practitioners because they are less costly compared to other healthcare providers. The reason for the improved patient’s satisfaction is based on the involvement of face-to-face conversation with each patient. They have a tendency of spending more time with each patient compared to the physicians’. NPS are vital to promote access health care services to the underserved communities. Most states do not incorporate the requirement of physical proximity required to supervise and collaborate the physicians. As a result, the PNs are allows providing the utmost primary care to the underserved communities and in the rural areas.

References

Allen, J. K., Himmelfarb, C. R. D., Szanton, S. L., & Frick, K. D. (2014). Cost-effectiveness of nurse practitioner/community health worker care to reduce cardiovascular health disparities.  The Journal of cardiovascular nursing ,  29 (4), 308. 

Goolsby, M. J. (2011). 2009–2010 AANP national nurse practitioner sample survey: an overview.  Journal of the American Academy of Nurse Practitioners ,  23 (5), 266-268.

Huang, L. (2015). Cost-Effectiveness of Nurse Practitioners.

Jennings, N., Clifford, S., Fox, A. R., O’Connell, J., & Gardner, G. (2015). The impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department: A systematic review.  International journal of nursing studies ,  52 (1), 421-435.

National Governors Association. (2012). The role of nurse practitioners in meeting increasing demand for primary care.  Washington, DC: National Governors Association .

Naylor, M. D., & Kurtzman, E. T. (2010). The role of nurse practitioners in reinventing primary care.  Health affairs ,  29 (5), 893-899.

Pohl, J. M., Hanson, C. M., & Newland, J. A. (2010). Nurse practitioners as primary care providers: History, context, and opportunities.  Who will provide primary care and how will they be trained .

Stanik-Hutt, J., Newhouse, R. P., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G., & Weiner, J. P. (2013). The quality and effectiveness of care provided by nurse practitioners.  The Journal for Nurse Practitioners ,  9 (8), 492-500.