Expanding Role of Nurse Practitioners: Good or Bad for Patients?

John Fisher
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Stopping Medical Injustice
With a shortage of primary care physicians, 28 states, including New York, are considering expanding the authority of nurse practitioners.  Nurse practitioners are registered nurses with an advanced degree in nursing and they want the power to practice without a physician's supervision or collaboration, prescribe narcotic medications and be called "Doctor".

The American Medical Association, which supported the national health care reform legislation, believes that a doctor shortage is not reason to put nurses in charge and endanger patients. Nurse practitioners, on the other hand, say there is no danger and that they are as highly trained and as skilled as doctors.  In some states, nurse practitioners with a doctorate in nursing practice cannot use the title, "Doctor", but most states allow it.

Will expanding the role of nurse practitioners be good for patients? Generally, nurse practitioners are acceptable medical providers for routine and common illnesses, but it is not acceptable for a nurse practitioner to provide care to a patient suffering from a complex medical condition or a potentially life-threatening condition. 

I handled a case where a 48 year old male, Client "Z", had a three month history of a fever of unknown origin and an unexplained weight loss of 20 pounds. Client "Z" sought treatment on a number of occasions over a three month period from his primary care physician for his symptoms, but he was seen by a nurse practitioner at each visit. Instead of ordering a blood culture, the nurse practitioner simply documented the symptoms and told Client "Z" to take Motrin for his pain. Client "Z" was not seen by his primary care physician on any of the office visits, and his physician did not even review the medical records prepared by the nurse practitioner.

After three months of the same symptoms, Client "Z" succumbed to a massive stroke caused by bacterial endocarditis, an infection in the inner lining of his heart.  Had the nurse practitioner ordered a blood culture, as the standard of care required for a fever of unknown origin, the bacterial endocarditis most likely would have been detected and IV antibiotics would have cured the endocarditis.  Client "Z" would not have sustained a massive stroke and brain damage had he received the appropriate medical treatment.

The moral of this example is that the nurse practitioner never should have been treating Client "Z".  Client "Z"'s history of a fever of unknown origin and an unexplained weight loss did not present the common or routine situation that can be handled by a nurse practitioner.  Client "Z" should have been seen by his physician, who generally spend four years in undergraduate school, four years in medical school and an additional three years in primary care residency training.

This case illustrates the risks of expanding the role of nurse practitioners.  Simply put, a nurse practitioner does not have the medical education, training or experience to handle complicated cases that should be handled by a physician. Unfortunately, many nurse practitioners believe that they are just as qualified as physicians and they see no reason to limit their patient care to uncomplicated or routine cases.
Getting a nurse practitioner instead of a real medical Doctor is lowering standards. As a patient I want a real doctor, no substitute. If a nurse wants to be a Doctor then go to medical school and compete for a place like everyone else. Nurse practitioners are using the back door because most likely they were not able to use the front door.
by Amy Fisher October 24, 2012 at 01:49 AM
Why is the medical community afraid to recognize a nurse practitioner as a "doctor" when he/she has earned that right along with pharmacists, psychiatrists, ministers, professors, and even medical doctors. For a nurse practitioner that has acquired her DNP, she should be able to use it just like any other profession! She is not saying she is a Medical Doctor! I think the physicians are the ones that are scared because nurse practitioners are well educated and have the training and skills to be a provider. Most patients prefer a NP over a MD. If she works for her doctorate and receives it she should be called Dr. just like any other profession. Geez! Get off your high horse! There is plenty of patients and money to go around!
by Angie August 28, 2012 at 05:41 PM
This is a horrible article; it reminds me of A Christmas Story and Ralphy’s red rider theme, except I give it a D-. If client Z is real, that NP failed him. However, one incompetent NP does not condemn the whole lot of us. I have known several incompetent doctors who have made similar mistakes. A national study shows that patient outcomes are nearly identical between doctors and NPs. On another note, not all NPs want to be called “doctor” I have yet to meet a master’s prepared NP who even thought about being called “doctor.” Some NPs do hold Doctorate degrees and should rightly be called doctor as would any other dentist, occupational therapist, physical therapist, optometrist, chiropractor, or clinical psychologists. None of these professional are denied their title and many work alongside medical doctors and doctors of osteopathic medicine without confusion. I always introduce myself as follows, “Hi, I am Dr. Male, I am a Nurse Practitioner”
by John Male, DNP April 2, 2012 at 09:58 AM
There has got to be a better case than this to provide strength to the argument that NP's should not provide care to a patient suffering from a complex medical condition or a potentially life-threatening condition. I would be suprised if a Licensed Practical Nurse failed to realize the urgency to obtain blood cultures on a patient with this presentation. I do feel that we NP's can safely handle patient conditions within our scope of practice and should colloaborate with a physician without reservation because not all of us think we are as highly trained or as skilled as doctors. In the case of client Z, why was motrin ordered for pain when he presents with a three month history of fever of unknown origin and unexplained weight loss of 20 pounds?
by Jim Betancourt NP-C January 25, 2011 at 11:20 AM
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