Physician attitudes toward physician extenders: a comparison of nurse practitioners and physician assistants.

A survey of all physicians in the Eighth District Medical Society (Western New York) was conducted in 1975 to determine physician attitudes toward employment of and task delegation to nurse practitioners. The results of this study and one other similar study of nurse practitioners are compared to results of two previous studies examining physician attitudes toward physician assistants. It appears that physicians are somewhat more willing to employ and delegate tasks to a physician's assistant. Some correlates of physician attitudes toward each of the two types of physician extenders are also compared and discussed.     

Emergency Contraception Provision: A Survey of Emergency Department Practitioners

OBJECTIVES: To determine emergency department (ED) practitioner willingness to offer emergency contraception (EC) following sexual assault and consensual sex, and to compare responses of practitioners from states whose laws permit the refusal, discussion, counseling, and referral of patients for abortions (often called "opt-out" or "abortion-related conscience clauses") with those of practitioners from states without these laws. METHODS: Using a structured questionnaire, a convenience sample of ED practitioners attending a national emergency medicine meeting was surveyed. RESULTS: The 600 respondents were: 71% male, 29% female; 34% academic, 26% community, and 33% resident physicians; and 7% nurse practitioners and physician assistants. Many respondents (88%) were inclined to offer EC to those sexually assaulted by unknown assailants. More practitioners said they were willing to offer EC if the assailant was known to be HIV-infected rather than if the assailant had low HIV risk factors (90% vs. 79%, p < 0.01). More respondents would prescribe EC after sexual assault than consensual sex (88% vs. 73%, p < 0.01). The rates of willingness to offer EC were the same for practitioners in states with "abortion-related conscience clauses" and those from other states. CONCLUSIONS: Most ED practitioners said they were willing to offer EC. Although the risk of pregnancy exists after consensual sex, practitioners were less willing to prescribe EC after those exposures than for sexual assault. "Abortion-related conscience clauses" did not seem to influence willingness to offer EC.     

Who wants to work in geriatrics: Findings from a national survey of physicians and nurse practitioners

BackgroundAs the United States population is aging, there is a chronic shortage of geriatrics- and gerontology- trained clinicians despite a variety of incentives. With primary care clinicians also in short supply, health systems are trying to cope with the increasing demand for care for older adultsPurposeThe purpose of this study was to examine respondents' willingness to recommend their career to others and beliefs about changes necessary to enhance the supply of appropriately prepared cliniciansMethodsThis study used a national survey of a stratified sample of 276 physicians and 134 nurse practitioners working in primary care and geriatric practices.FindingsAmong nurse practitioner respondents, 29% would "definitely" recommend a career as a geriatrician vs. seventeen percent of physicians; thirteen percent of physicians would "definitely" recommend a career as a nurse practitioner specializing in adult/gerontology vs. 42% for nurse practitioners. Those trained in geriatrics were more likely to recommend a career in the field.DiscussionNurse practitioners and physicians differ in their willingness to recommend careers in in gerontology and geriatrics, but less than a majority would strongly recommend careers in either specialty. Based on clinical reports, substantial reforms in payment and reimbursement for services may be necessary to bolster the geriatric field's attractiveness, and better prepare the workforce to care for older adults.     

The clinical trial as a means for organizational change: report of a case study.

An attempt was made to introduce an innovation (nurse practitioners) into an organization (an outpatient clinic) using the format of a clinical trial. Staff physicians evaluated patients as to their acceptability for care by nurse practitioners before and after a 12-month trial. "Acceptable" patients were randomly assigned to control (regular clinic) and experimental groups (nurse practitioner care). There was a statistically significant increase (p less than 0.001) in physicians' willingness to delegate patients to nurse practitioners for care after the trial. Initial assessments of "acceptable" were highly associated with demographic variables such as age, race, and level of education. Patients' medical status, rather than personal characteristics, were found to be associated with decision making on re-evaluation. Positions were created for nurse practitioners on the staff of the clinic at the end of the experiment.     

The Struggle for Full Practice in North Carolina

That nurse practitioners (NPs) delivery high-quality care, equivalent to that provided by physicians, is well documented. However, many states have laws that restrict NPs from full practice authority, limiting their ability to comprehensively meet patient needs. North Carolina is a state that has very restrictive laws, with NPs working under physician supervision. In this article we address the effect restricted practice has had in North Carolina and the introduction of Senate Bill 695 (the Modernize Nursing Practice Act) that, if passed, would legislate full practice authority for NPs in our state.     

Gender and the attribution of the nurse practitioner and physician status

The purpose of this study was to discover whether sex-role sterotypes were used to identify members of two professions, nurse practitioners and physicians. Participants reported whether they believed a videotaped health care provider was a physician or a nurse practitioner. Results showed that male providers tended to be identified as physicians, whereas female providers tended to be identified as nurse practitioners. Findings indicate that understanding and enactment of the nurse practitioner and physician roles are still affected by gender issues and that both physicians and nurse practitioners remain subject to the force of sex-role stereotypes.     

Management of patients in the intensive care unit: comparison via work sampling analysis of an acute care nurse practitioner and physicians in training.

BACKGROUND: Little is known about aspects of practice that differ between acute care nurse practitioners and physicians that might affect patients' outcomes. OBJECTIVE: To determine if time spent in work activities differs between an acute care nurse practitioner and physicians in training (pulmonary/critical care fellows) managing patients' care in a step-down medical intensive care unit. METHODS: Work sampling techniques were used to collect data when the nurse practitioner had 6 months' or less experience in the role (T1), after the nurse practitioner had 12 months' experience in the role (T2), and when physicians in training provided care on a rotational schedule (nurse practitioner not present, T3). These data were used to estimate the time spent in direct management of patients, coordination of care, and nonunit activities. RESULTS: Results for T1 and T2 were similar. When T2 and T3 were compared, the nurse practitioner and the physicians in training spent approximately half their time in activities directly related to management of patients (40% vs 44%, not significantly different). The nurse practitioner spent more time in activities related to coordination of care (45% vs 18%; P < .001) and less time in nonunit activities (15% vs 37%; P < .001). CONCLUSION: The nurse practitioner and the physicians in training spent a similar proportion of time performing required tasks. Because of training requirements, physicians spent more time than the nurse practitioner in nonunit activities. Conversely, the nurse practitioner spent more time interacting with patients and patients' families and collaborating with health team members.     

Emergency Physicians' Attitudes Toward the Emergency Nurse Practitioner Role: Validation Versus Rejection

A qualitative grounded theory approach was used in this study, which examined the attitudes of a group of emergency physicians toward collaborative practice with emergency nurse practitioners. Interviews were conducted with five physicians who were not currently working with nurse practitioners. Responses were coded, and a substantive theory model of dependent collaboration emerged. The physicians supported the emergency nurse practitioner role on the grounds that it be supervised in the traditional fashion by the physician. Concerns regarding education, trust, liability, and capability were identified. Deficits in knowledge regarding training and the role/function of nurse practitioners were also identified.     

Who is a nurse practitioner? Processes of care and patients' and physicians' perceptions.

During a repeat of a previous study of nurse practitioners conducted at the University of Kansas, an opportunity occurred to examine the impact of two different styles of care provided by nurse practitioners on patients and physicians with whom they worked. The two nurse practitioners involved had similar backgrounds in terms of work experience. The participated in the same training program for nurse practitioners, practice in the same environment, and cared for patients randomly allocated to one or the other practitioner. One practitioner saw her patients more often and for longer periods of time, ordered more medications, and less often sought physician consultation. She also was most optimistic regarding the impact of her services on patients' conditions. The other was more dependent upon physicians for validation of her actions. Physicians did not distinguish between the two practitioners in terms of their performance. However, patients cared for by the practitioner whose behavior suggested an integration of medical and nursing care processes saw nurses as a more common source of information about illness and demonstrated more significant shifts in preferences for services provided by nurses rather than physicians. No significant changes were noted from pretest values among patients cared for by the other nurse practitioner.     

Public attitudes toward some changes in the division of labor in medicine.

This study examined public attitudes toward the delegation of medical tasks to nonphysician health workers. Data were obtained in household interviews of a probability sample of the adult residents of Cuyahoga County, Ohio (N = 808). The proportions of the sample giving approval to care from nonphysicians varied widely among the 18 tasks on which opinions were elicited. The results of the public survey were compared to those from an earlier national survey of physicians. Physicians' responses paralleled the responses of the lay public regarding most tasks. However, with respect to regular checkups on babies and prenatal checkups, markedly higher proportions of the physicians than the public were willing to delegate to nonphysicians. The analysis indicated that public attitudes toward task delegation in medical practice do not bear strong relationships to social status indicators, political self-designations, or preceived health status.     

Using cost-analysis techniques to measure the value of nurse practitioner care

Nurse practitioners are in a unique position to deliver high-quality care to a variety of populations and are being utilized in many countries worldwide. Although certain aspects of the nurse practitioner role may differ from country to country, limited financial support and competition for access to patients make it incumbent on nurse practitioners to document the cost-effectiveness of their care. Cost analysis, a business tool that can be used by any practitioner in any health care system, was used to examine business practices of an academic-based nurse-managed centre. In order for this tool to be effective, nurse practitioners must become comfortable with using cost-analysis techniques in their practices. Linking outcome data with cost data was found to be one method for explicating the value of nurse practitioner practice. Nurse practitioners must also recognize that they are competing with primary-care physician practices and other primary health-care practices. It is vital for nurse practitioners to document both the quality and the costs of their care in order to compete with physicians and other health care providers, in order to influence policy and other health-care decision makers.     

Nurse Practitioners: Reevaluation of the Need for and Willingness to Hire by Nurse Administrators, Nurse Practitioners, and Physicians

A survey of all nurse administrators and advanced practice nurses and a simple random sample survey of licensed physicians in Nevada were completed to reevaluate the perceived need for and willingness to hire nurse practitioners (NPs). The reevaluation was deemed necessary based on a similar survey that was completed by these authors in 1990. At that time significant questions were raised concerning the lack of understanding of the role of NPs in and their contribution to the health care team.
The results of the study clearly indicate that the unique contributions of the NP to the health care team should be further publicized and clarified. In addition, for some physicians, a significant disparity continues to exist between the optimal, collaborative role and the more readily accepted dependent role of the NP. The family NP (FNP) continues to be the most desired specialty for those who hire NPs.     

Counseling medical patients about cigarette smoking: a comparison of the impact of training on nurse practitioners and physicians

Health providers believe that eliminating smoking is an important health promotion goal, but physicians and nurse practitioners may differ in the implementation of that belief. To determine whether nurse practitioners or physicians were more likely to counsel smokers to quit smoking, 12 internal medicine nurse practitioners (100 percent female) and 40 internal medicine physicians (30 percent female) were studied at four San Francisco Bay-area Kaiser Permanente Medical Centers, both before and after training in smoking-cessation counseling. In addition, exit phone surveys of at least 15 smokers per participant were completed as soon as possible following an office visit to the participant (269 nurse practitioner patients; 948 physician patients). It was found that nurse practitioners discussed smoking with patients more often than did physicians (64 percent vs. 50 percent; p less than 0.001), asked patients more often whether they were interested in quitting (49 percent vs. 40 percent; p less than 0.01), distributed more smoking-cessation literature to patients (37 percent vs. 25 percent; p less than 0.001) and made more follow-up appointments about smoking (36 percent vs. 19 percent; p less than 0.001). These differences in counseling behavior between the two groups were not explained by differences in patient characteristics of the two groups. The authors concluded that, given the same training, nurse practitioners are more likely to counsel smokers about quitting than are physicians.     

Physician Perceptions of Advanced Practice Providers on Hospitalist Teams

Little is known about physician perceptions of nurse practitioners (NPs) and physician assistants (PAs) on hospitalist teams and the factors that impact their perceptions. Academic physician hospitalists were surveyed to better understand those factors, focusing on NP/PA experience, training, and physician experience with NPs/PAs. Perceptions by hospitalist physicians of NPs/PAs were strongly positive. Notable findings include the perceived positive impacts of NPs/PAs on clinical care provided, practice efficiency, and physician satisfaction. Most respondents prefer working with NPs and PAs with multiple years of clinical experience, particularly those who have participated in training beyond NP/PA graduate programs of study.     

Variation in spirometry utilization between trained general practitioners in practices equipped with a spirometer

OBJECTIVE: To explore spirometry utilization among general practitioners and identify practitioner and practice-related factors associated with spirometry utilization. DESIGN: Multivariate multilevel cross-sectional analysis of a questionnaire survey. SETTING: Some 61 general practices involved in a spirometry evaluation programme in the Netherlands. All practices owned a spirometer and were trained to perform spirometry. SUBJECTS: A total of 144 general practitioners and 179 practice assistants. MAIN OUTCOME MEASURES: Extent of spirometry utilization for five indications from national COPD/asthma guidelines, practitioner and practice-related factors associated with spirometry utilization. RESULTS: The response rate was 97%. General practitioners used spirometry mostly to evaluate treatment with inhaled steroids (58%). Significant practitioner-related factors associated with spirometry utilization were: general practitioners' job satisfaction, general practitioners' general interest in research, and prior participation in spirometry training. Practice-related factors associated with spirometry utilization were: presence of a practice nurse, delegation of medical tasks to practice assistants, use of spirometry in different rooms, and use of protocols in practice. CONCLUSION: Practitioner- as well as practice-related factors were associated with the extent of spirometry utilization. In particular, it is essential to improve practice-related factors (e.g. presence of a practice nurse, more delegation of medical tasks to the practice assistant).     

Impact of a designated hepatology nurse on the clinical course and quality of life of patients treated with rebetron therapy for chronic hepatitis C.

A two- to three-fold increase in mortality from hepatitis C is predicted in the next 10-20 years as the largest cohort of patients age. More qualified providers are needed to care for this population. The objective of this study was to assess the impact of a hepatology nurse practitioner as compared to care by a physician on the quality of life and treatment outcomes of patients with chronic hepatitis C. Seventy-five patients with chronic hepatitis C were assigned to either a nurse practitioner or physician and asked to complete a SF-36 Health Survey quarterly to measure their perceived quality of life.Two-sided t-tests comparing the quality of life scores in the physician and nurse practitioner groups at weeks 1, 12, and 24 were calculated using SPSS version 12.0 (Chicago, IL). Although marginal differences between physicians and nurse practitioners were noted for physical function at week 1, bodily pain at week 12, and role physical at week 24 by the patients, no statistically significant differences were observed overall in the quality of life scores reported by the patients according to healthcare provider. The treatment outcome data for the nurse practitioner groups showed 12/25 (48%) of patients with genotype 1 achieved a sustained virologic response as did 13/22 (59%) of patients with genotype 2 or 3. In the physician groups, 11/27 (41%) of patients with genotype 1 achieved a sustained virologic response as did 14/23 (61%) of patients with genotype 2 or 3. These results suggest nurse practitioners can provide effective care to the chronic hepatitis C population.     

Nurse Practitioners: Need for and Willingness to Hire as Viewed by Nurse Administrators, Nurse Practitioners, and Physicians

The problem investigated in this project was the identification of need for and desire to hire nurse practitioners in a rural western state. Participants included licensed nurse practitioners, nurse administrators of licensed agencies, and licensed physicians in the state of Nevada. The survey examined the participant groups' views of the need for and their desire to hire nurse practitioners. The findings showed differences among the groups in relation to their education levels and whether they were practicing in rural or urban areas. The most pronounced finding was the indicated need for more information related to the role and functions of nurse practitioners before hiring them. Recommendations for future study are also included.