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She can be reached at reports wsj. This debate is not about protecting turf. Patients today need primary-care physicians and nurse practitioners, working as a team along with other key health-care professionals. There is no question that nurse practitioners are vital. Many provide expert advanced care and some primary-care services as well. But they cannot replace primary-care physicians, or work free of physician collaboration. There is a huge difference in the two professions. Primary-care physicians receive extensive and diverse medical education and clinical experience.
Far from unnecessary, as some people suggest, this strengthens a physician's diagnostic skills. Every physician also has an undergraduate degree and completes 21, hours of a standardized educational and training process, including passing exams that are overseen by one certification body. Total hours of coursework and training for a nurse practitioner, by contrast, range from 3, to 6, License requirements vary from state to state, and accreditation can come from one of three groups, each with different criteria.
When patients are sick, the last thing they need to be concerned about is the meaning of their primary provider's degree. The work of many nurse practitioners begins only after a physician has already made a diagnosis. The more undifferentiated the patient's complaints, the more that patient needs a primary-care physician who has the education and training to consider many possibilities and to choose the right course of action, creating a comprehensive, coordinated treatment plan.
Studies do show that nurse practitioners are appreciated by patients. But they are not achieving the same clinical outcomes as physicians. In fact, many of the outcomes noted in these studies result from collaborative practice with physicians. The University of Missouri Department of Family and Community Medicine conducted a recent study of all comparative research on the topic and concluded "substitution of physicians by independent nurses providing comprehensive primary care is not an approach supported by the literature.
Nor will empowering nurse practitioners ease strains on the health-care system or lower the cost of medical services. States that currently allow independent practice are part of our broken national health-care system. Giving nurse practitioners greater freedom in these states has not resolved high cost or inefficient care.
Those states still have primary-care access issues as well. In fact, nurse practitioners in some of these states make career decisions that increasingly mirror those of physicians: More are going into sub-specialty careers in urban and suburban areas, which aggravates the shortage of primary-care providers in certain rural areas.
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Further fragmentation is not the answer. We need more current research, but a study published in in the journal Effective Clinical Practice found that patients assigned to nurse practitioners used more medical services than did patients assigned to primary-care residents or attending physicians.
Patients assigned to nurse practitioners had 13 more hospitalizations annually for each patients, and more specialist visits than those who received care from physicians. Monitoring patients with stable chronic conditions is an appropriate role for a nurse practitioner in team-based care.
But a primary-care physician must help when chronic conditions become unstable—a change that is inevitable. Nurse practitioners say they can make referrals to specialists at such times. But worsening shortness of breath can be caused by a heart, lung or other problem. A primary-care physician trained to work through interrelated differential diagnoses is more likely to make the right call—and order the right care—sooner, saving everyone time, worry and money. The issue here isn't whether one group is better than—or just as good as—another. All of us together are smarter than each of us alone.
[Full text] The importance of clinical leadership in the hospital setting | JHL
But nurse practitioners are not physicians. The medical expertise of primary-care physicians must be a part of the team-based care patients need and deserve. To require patients to accept less is unacceptable. This scrutiny has increased the emphasis on the role of health professionals, including nurses, in monitoring standards, developing and evaluating better ways of working as well as advocating for patients and their families; and led to a substantial momentum in the quality and safety agenda, including the promotion of various strategies such as promoting evidence-based practice.
In the hospital sector, the demands placed upon leaders have become more complex, and the need for different forms of leadership is increasingly evident. To derive cost efficiency and improve productivity, there has been intense reorganization.
Coupled with these reforms has been increasing attention upon improving safety and quality, with programs instituted to move attention beyond singular patient—clinician interpretations of safety toward addressing organizational systems and issues of culture. In part, this shift has been in response to growing recognition that while designated leaders in positions of formal authority within hospitals play a key role in administration and espousing values and mission, such leaders are limited in their capacity to reshape fundamental features of clinical practice or ensure change at the frontline.
There is considerable evidence to suggest nurses may experience dissatisfaction with the working environment in hospitals, 38 with poor work environments impacting negatively on the delivery of clinical care and patient outcomes. The thrust of much recent attention upon attaining reform in hospitals through clinical leadership has positioned clinical leadership as a vehicle for improving clinician engagement in not only their own work, but also the care delivery microsystems in which they operate.
This type of work engagement requires forms of citizenship behaviors that are focused upon improving clinical systems and practices. Hospitals are complex socio-political entities, and the ability for engagement and leadership among clinicians can be hampered by power dynamics, disciplinary boundaries, and competing discourses within the organization. The tension inherent between clinical and administrative discourses is evidenced in the findings from the evaluation of clinical directorate structures in Australian hospitals, with close to two thirds of medical and nursing staff surveyed reporting the primary outcome of such structures was increased organizational politics.
Edmonstone 11 cautions that without structural and cultural change within institutions, the move toward clinical leadership can result in devolution of responsibility to clinicians who are unprepared and under resourced for these roles.
Should Nurse Practitioners Be Able to Treat Patients Without Physician Oversight?
Evidence emerging from the NHS suggests particular value in leadership coalitions between managers and clinicians. There is also a concern that many health professionals may not be well prepared to understand the nature of leadership, or take on leadership roles because of the lack of content on leadership in undergraduate course curricula. As Gagliano et al comment, there is some evidence that health service provider groups are attempting to address issues pertaining to leadership issues through design and implementation of leadership development programs. Other countries have developed education and professional development programs in clinical leadership for doctors, nurses, and allied health professionals working in their respective health systems.
Some of these programs have similar features to UK NHS leadership frameworks and associated strategies. For example, in New Zealand medical schools are working to provide leadership training in their undergraduate medical curriculum. Globally, the International Council of Nurses identifies leadership as one of the major considerations underpinning their activities and has established a Global Nursing Leadership Institute as a vehicle for these activities.
Clinical leadership, if it is to be evident and successful, requires broader clinician engagement and forms of citizenship behaviors within the clinical context that mediate the realization of this form of leadership. Much has been written in the organizational and health care literature about employee work engagement and the benefits derived through promoting work engagement. Considerable evidence confirms positive associations between constructs such as job satisfaction, work performance, improved productivity, and engaged employees. Edmonstone 35 cautions that the emphasis upon competency-based leader development has done little to foster effective clinical leadership in the UK, despite its potential usefulness, and informative and summative evaluation of leader development.
Although considerable discussion has occurred on the need for clinical leadership, and large scale pubic inquiries evidence the considerable patient harm that has occurred in the absence of such leadership, 7 , 8 there continues to be a major disconnect between clinicians and managers, and clinical and bureaucratic imperatives. The debate over who is best positioned to lead service delivery and the place of clinicians in governance continues. Effective clinical leadership is associated with optimal hospital performance. It is allied to a wide range of hospital functions and is an integral component of the health care system.
Developing clinical leadership skills among hospital nurses and other health professionals is of critical importance. However, despite the widespread recognition of the importance of effective clinical leadership to patient outcomes, there are some quite considerable barriers to participation in clinical leadership.
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As the focus on hospital performance intensifies, leadership to increase efficiencies and improve quality will be of increasing importance. Commonwealth of Australia. Accessed March 22, Mountford J, Webb C. When clinicians lead. McKinsey Q Healthcare. February 1—8, Global health care leadership development: trends to consider.
J Healthcare Leadersh. Siriwardena A. Releasing the potential of health services: translating clinical leadership into healthcare quality improvement. Qual Prim Care.
nabburaxipe.gq Schyve P. Accessed April 21, Department of Health.
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