Does The Increasing Prevalence Of Nurse Practitioners (NP) Providing Primary Care Affect Patient Safety?

162017_132140396847214_292624_nThere are more than 234,000 nurse practitioners (NPs) licensed in the United States, and they practice in every state and in the District of Columbia, according to the American Association of Nurse Practitioners (AANP). 89.2% of NPs are certified in an area of primary care (62.4% are certified in practice family medicine), and 95.8% of NPs prescribe medications. NPs hold prescriptive privileges in every U.S. state and in the District of Columbia, which includes prescribing controlled substances. Patients make over 870 million visits to NPs every year in the United States.

The University of Colorado offered the first NP program in 1965. Now, nearly 23,000 NPs graduate each year from programs at over 374 colleges and universities.

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An article appearing on bmj.com in 2006 stated, “Nurse practitioners can provide care that leads to increased patient satisfaction and similar health outcomes when compared with care from a doctor. Nurse practitioners seemed to provide a quality of care that is at least as good, and in some ways better, than doctors.” The article further stated, “Patients are at least as satisfied with care at the point of first contact with nurse practitioners as they are with that from doctors,” but the article cautioned, “Although assessments of the quality of care and short term health outcomes seem to be equivalent to that of doctors, further research is needed to confirm that nurse practitioner care is safe in terms of detecting rare but important health problems.”

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An article appearing in the Journal for Nurse Practitioners in 2013 stated, “Evidence regarding the impact of nurse practitioners (NPs) compared to physicians (MDs) on health care quality, safety, and effectiveness was systematically reviewed. Data from 37 of 27,993 articles published from 1990-2009 were summarized into 11 aggregated outcomes. Outcomes for NPs compared to MDs (or teams without NPs) are comparable or better for all 11 outcomes reviewed. A high level of evidence indicated better serum lipid levels in patients cared for by NPs in primary care settings. A high level of evidence also indicated that patient outcomes on satisfaction with care, health status, functional status, number of emergency department visits and hospitalizations, blood glucose, blood pressure, and mortality are similar for NPs and MDs.”

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The result of a study published in 2000 in The Journal of the American Medical Association (JAMA) entitled “Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians A Randomized Trial” concluded: “The results of this study strongly support the hypothesis that, using the traditional medical model of primary care, patient outcomes for nurse practitioner and physician delivery of primary care do not differ.”

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The AANP reports, “The body of literature supports the position that NPs provide care that is safe, effective, patient-centered, timely, efficient, equitable and evidenced based. Furthermore, NP care is comparable in quality to that of their physician colleagues. Patients under the care of NPs have higher patient satisfaction, fewer unnecessary hospital readmissions, potentially preventable hospitalizations, and fewer unnecessary emergency room visits than patients under the care of physicians.”

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Nonetheless, the American Medical Association espouses caution with regard to NPs providing primary care to patients: “The American Medical Association supports the use of patient-centered, team-based patient care … Health care teams require leadership, just as teams do in business, government, sports and schools. Physicians bring to the team the highest level of training and preparation and as such are the best suited to guide the other members of the team. Nurses are indispensable, but they cannot take the place of a fully trained physician. Physicians are trained to provide complex differential diagnoses, develop a treatment plan that addresses multiple organ systems and order and interpret tests within the context of a patient’s overall health condition. The training and education of NPs is appropriate for dealing with patients who need basic, preventive care or treatment of straightforward acute illnesses and previously diagnosed, uncomplicated chronic conditions. NPs and physicians have skills, knowledge and abilities that are not equivalent, but instead are complementary. The most effective way to maximize the talents of the complementary skill sets of both professionals is to work as a team … The AMA believes that the best model has physicians in the lead, with care provided by all professionals performing up to their level of training, at the discretion of the physician leader.”

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One of the largest professional liability insurance companies that provides liability policies to nurse practitioners in the United States reported that between 2009 and 2011, the average paid indemnity for nurse practitioner professional liability claims rose by 19%, from $186,282 to $221,852. The most frequent allegations made against nurse practitioners involved the failure to diagnose and delay in making a correct diagnosis, failure to provide the proper treatment and care, and medication prescribing errors.

A survey of 1,100 NPs in 2012 found that the amount of the average total paid professional liability claim was directly correlated with level of education, with higher levels experiencing higher average total paid amounts. NPs who indicated they were not supervised at all had the highest average total paid amounts.

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Another study of professional liability claims made against NPs, for the period from 1998 to 2008, found that “Despite recent tort reform measures and innovative defense strategies, claim severity is trending upward.”

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Our Concerns

MedicalMalpracticeLawyers.com has noticed a significant increase in inquiries from medical malpractice victims throughout the United States regarding the medical care and treatment they received from NPs. Some of these potential victims have alleged that they were unaware at the time they received medical treatment (either in the hospital or in a medical office) that their medical providers were NPs. Many had no idea regarding the medical education and medical training that their NPs had received. Some even thought that their NPs were medical doctors (most NPs wore white lab coats with their names embroidered on them, just like medical doctors).

Most of the inquiries regarding possible nurse practitioner malpractice involved the failure to timely diagnose a serious medical condition, the negligent failure to refer to a medical specialist, the failure to provide appropriate medical treatment for a serious medical condition, or issues involving medications prescribed by NPs.

Many of the inquiries we have received regarding nurse practitioner malpractice claims also involve the failure of the NP to have been appropriately supervised by a physician or the failure of the NP to seek consultation with appropriate medical professionals.

Our conclusion, based on anecdotal evidence from inquiries we have received, is that NPs provide satisfactory care and advice regarding common ailments and routine medical care but a problem may arise with the care provided by NPs when the circumstances are complicated or esoteric. Nonetheless, the inquiries we receive regarding NP malpractice claims rarely involve a complaint regarding an aloof or arrogant NP who failed to listen to the patient or spend sufficient time with the patient, whereas such complaints regarding medical doctors are not uncommon.

If you or a loved one suffered harm as a result of the medical negligence of a nurse practitioner in the United States, you should promptly find a nurse practitioner malpractice lawyer in your state who may investigate your nurse practitioner malpractice claim for you and represent you or a loved one in a nurse practitioner malpractice case, if appropriate.

Click on the “Contact Us Now” tab to the right, visit our website, or call us toll-free in the United States at 800-295-3959 to find medical malpractice attorneys in your state who may assist you.

Turn to us when you don’t know where to turn.

This entry was posted on Tuesday, June 27th, 2017 at 5:26 am. Both comments and pings are currently closed.

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