(Authors: Wendy M. Nehring and Patti Vanhook, East Tennessee State University; Lin Zhan, University of Memphis; Kay Lindgren, University of Tennessee-Chattanooga; Colleen Conway-Welch and Bonnie Pilon, Vanderbilt University; Kathy Martin, Tennessee State University; Susan Jacobs ( formerly interim dean, now professor emeritus), University of Tennessee Health Science Center-Memphis.)
For every Tennessean to have health care, we must have nurse practitioners as primary care providers.
Though the Supreme Court has issued a decisive judgment on the Patient Protection and Affordable Care Act, the dust is still settling for the new health care landscape in America.
Even with the unanswered questions, this is clear: More people than ever will have ready access to health care, especially primary health care.
This fact is drawn in sharp relief in Tennessee, where as recently as 2009, access to primary care services for nearly 1 million residents was limited to providers willing to deliver service to the uninsured and underinsured. During that year, 910,215 Tennesseans did not have insurance. Through the Affordable Care Act’s mandate that everyone must have health insurance by 2014, such numbers are going to drastically change.
That fact begs the obvious question: Who will provide health care for all of these people?
The most obvious answer is physicians, but nurse practitioners, nurse midwives, and physician assistants must be part of that answer, too. Even prior to passage of the Affordable Care Act, our health care system had come to rely on nurse practitioners, nurse midwives, and physician assistants as crucial components of primary and preventive care for patients.
As deans of colleges of nursing throughout the Volunteer State, we can speak to the value of nurse practitioners and nurse midwives in the primary care equation. Nurse practitioners and nurse midwives are committed, competent professionals who are prepared to help Tennessee meet the health care challenges of today and tomorrow through the provision of high quality care for all who need it.
In 2011, nurse practitioners and nurse midwives at the University of Tennessee Health Science Center-Memphis, the University of Tennessee-Chattanooga, the University of Tennessee-Knoxville, East Tennessee State University, the University of Memphis, Vanderbilt University and state Federal Qualified Health Centers amassed 565,000 visits. The insurance status for patients who were seen in these clinics ranged from 52 percent to 72 percent uninsured.
These clinics, while providing primary and preventive care to patients who might not have received it elsewhere, also served as centers for educating the nurse practitioners and nurse midwives of tomorrow. A survey of the schools and colleges in Tennessee showed that when it came to their advanced practice nurse graduates (which include not only nurse practitioners and nurse midwives, but nurse anesthetists and clinical nurse specialists), nearly 50 percent in some instances and as high as 90 percent in others are working with underserved populations.
The care they provide is of the utmost quality, too: Less than 1 percent of advanced practice nurses had consumer complaints reported to the Tennessee Board of Nursing in 2009, 2010 and 2011, and less than one-hundredth of 1 percent of those complaints required disciplinary actions.
The words “nurse practitioner” and “nurse midwife” have become so pervasive that everyone has heard them. Still, some may ask the two-fold question What is a nurse practitioner or a nurse midwife, and where do they practice?
ANSWER: They are registered nurses who must have also attained a master’s degree or doctoral degree, and they must be certified to practice by passing a comprehensive national certification examination.
As to where these nurses practice, it includes but is not limited to primary care clinics, health departments, school-based clinics, hospitals, specialty practices, Federally Qualified Health Centers, rural health clinics and academic health science centers.
These nurse professionals are particularly valuable in the primary care setting because their education and training allows them to provide a more advanced level of care to patients, including prescribing medications — slightly more than 6,000 nurse practitioners and nurse midwives have a license to prescribe. This authority is legislated, and it requires nurse practitioners and nurse midwives to have physician collaboration for prescription oversight.
That’s an important point, as it reflects the collaborative model that exists between physicians and nurse practitioners and nurse midwives. It is a professional model that is patient-centered, works for patients, and it works for lowering costs of care, too.
As we navigate this new health care landscape, where more people than ever will have easier access to care, it is important that we maintain these rules and regulations as they exist. Any limitations placed on nurse practitioners and nurse midwives through new legislative action could contribute to higher health care costs for our state, and limit the number of primary care providers just as more patients than ever will seek out such care.
The administration and faculty of our state’s nursing programs are committed to educating nurse practitioners and nurse midwives who are prepared to deliver the highest quality health care. As the Institute of Medicine recommended in 2010, nurses should practice to the full extent of their education and training and should be full partners, with physicians and other healthcare professionals, in redesigning health care in the United States. We believe strongly that careful consideration should be given to any suggested legislative mandate that limits the practice of nurse practitioners and nurse midwives.
The improved overall health of Tennesseans — which could have a positive ripple effect on our economy and our quality of life — depends heavily on more of our citizens receiving quality primary health care and preventive health care. And nurse practitioners and nurse midwives are a crucial part of that equation.
In simplest terms, it boils down to this: For everyone in Tennessee to have health care, nurse practitioners and nurse midwives must be part of the solution.