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Guideline for the Nurse Practitioner and the General Practitioner
Guidelines for the Nurse Practitioners and the General Practitioner
University of Cincinnati UCBA
Colleen Stanton
Eng. 2089
Professor Benander
March 12, 2014
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Guideline for the Nurse Practitioner and the General Practitioner
Abstract
Practices of the General Practitioner and the Nurse Practitioner are changing due to the
new Affordable Care Act healthcare system .The change is also dealing with the cost of
healthcare. Facing each state is whether or not the Nurse Practitioners are ready for the
challenge. This change in the professional role of each is up for debate in the Senate of all the
states in the USA, and other countries in 2014. There are states that have changed the role of the
Nurse Practitioner and others have not. General Practitioners studies have been performed to
compare care from General Practitioner and Nurse Practitioners at home and abroad. Priorities
that play a part in the legislative in 2013 were debated by the American Association of Nurse
Practitioners(Singer ,2013) .The issue is based on the shortage of General Practitioners and to
increase preventive and acute care that is given by the Nurse Practitioner. Groups of physicians
do oppose the change (Chen &Getty, 2013). The American Association of Nurse Practitioners
(Singer, 2013) provides the background debate and what is coming next in the Affordable Care
Act.
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Guideline for the Nurse Practitioner and the General Practitioner
Becoming a Practitioner
There are also others that want to know the thoughts and reasoning behind being a
General Practitioner or a Nurse practitioner (Sibbald, 2003). Their goals when it comes to
becoming a General Practitioner or Nurse Practitioner are to provide the quality care to the
public and make a difference within society. They are very content with their practice and with
their choice of the profession. Generally most practice until they can retire and some beyond
retirement. Due to being so committed they find it difficult to leave their patients. Their work
becomes very personable to them and their daily life. For they are on call to practice seven days
a week, twenty four hours a day. So many General and Nurse Practitioners stay on as practicing
physicians due to the love and commitment of the profession.
Guidelines for Nurse Practitioners and General Practitioners by State
Some of the states that have allowed the Nurse Practitioners to expand their profession
are Oregon (Gray, 2013), Alabama (Cason, 2013), and New Mexico (Aaronson, 2013). These
states have enhanced the care given by the Nurse Practitioner. The Nurse Practitioner is allowed
to diagnose and prescribe medicine set by the Senate and within their state without the approval
of a physician. There are other states that have followed suite and some that are debating their
changes. Some Nurse practitioners (Aaronson, 2013) have even moved their practice to areas
that allow them to care for their patients without the supervision of a physician. This allows them
to have a more profitable margin in order to provide better care for their patients. With the extra
income they are able to add equipment, supplies, along with staff for their practice. Which in the
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Guideline for the Nurse Practitioner and the General Practitioner
long term will benefit the overall health of the community that they serve .With their
independence to make their own decisions of the care they give the patient it fills the need within
the healthcare system. Then there is a drawback of those who do not approve of the changes
made by their states. This is felt from all aspects of professionals. It is going to be a long drawn
out process to get everyone within the states to approve the change. It is like anything else, not
everyone will be happy with the outcome that their state has made. The map below will better
explain how the USA is divided among the states on the care that the Nurse practitioner is
allowed to preform within the medical field. (SEE page 5) below.
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Guideline for the Nurse Practitioner and the General Practitioner
(EXHIBIT 1) This is a map that shows what states within the USA that either allows or disallows the
Nurse Practitioners to practice in the same capacity as the General Practitioners. As presented in
the map, the United States is divided in their policies when it comes to the roles of the Nurse
Practitioners within the medical profession in the United States. (Pearson, 2012)
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Guideline for the Nurse Practitioner and the General Practitioner
Other Country’s Healthcare Changes
The countries of China, Germany, and Australia are also in the process of converting the
Nurse Practitioner role within their health care system. China, Germany, and Australia are
looking at allowing them to perform more for the patient. China (Anli 2010) has conducted
studies which include a count of the nurse to hospital ratio. The ratio was 0.38 to 1, which is
lower than other countries. Although the cause of the shortage in China pertains to a wide range
of reasons, they have chosen only two to focus on. The first is the inequities and imperfections
within China’s healthcare system, second was the recruitment of China’s nurses by developed
countries. It is a project that seems to be undertaking in all countries around the world, not just
China. They are not alone, the USA is in need to improve medical care and reduce the cost at the
same time. Each country is looking at the cause, effect, and the solution .Each country is also
looking at their solutions that they may implement in solving their problems. Australia (Offredy,
1999) preformed a three state study involving nurse practitioners in roles as an independent nurse
practitioner, community health nurse practitioner, epilepsy nurse practitioner, and a community
nurse practitioner. The results of these studies has proven very powerful allowing for the
appropriate legal framework and policy infrastructure to be implemented, in order to succeed.
April 25th 1998 for the field of nursing in Australia became one of their most memorable in their
history of medicine. That was the day that Australians recognized and implemented the title of
‘Nurse Practitioner’ in New South Whales. The doors were opened and the programs and
Legislative was introduced. The Nurse Registration Board gave it the title ‘The Nurse Act
(1991)’. If they were registered by the New South Whales they could use the title of ‘Nurse
Practitioner’. They still were unable to prescribe drugs that are classified as addition drugs.
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Guideline for the Nurse Practitioner and the General Practitioner
The Patient and Healthcare Changes
So that leads us to the patient and how it will affect them as the healthcare evolves now
and in the future. Patients today will have to accept the changes just since they have been
implemented, either by the state or the Senate .Since everyone is effected with the change, the
care of the USA and other countries are up for debate in 2014. How we chose to embrace it is up
to each individual state and the Senate. A patient today can get medical care without even going
to a doctor’s office (Kenney, 2013). It could be a room within the pharmacy at Kroger’s,
Walgreens, Myers, or CVS. These are places you can get food, clothing, health items, along with
healthcare. Society today wants things to be more convenient. Today’s generation wants
everything fast, accurate and precise. They are very knowledgeable of the care they need to
correct the illness in which they have. Patients today know more about their own bodies and how
to treat them. This is due to the changes within the medical field, public knowledge of
technology, along with the media, and internet. The patient can also call a doctor on the phone or
go through the internet for a physical and get diagnosed. One more way to cut cost and improve
healthcare.
The Need for Doctors in the USA
Another crisis that faces the USA today is the lack of professionals that are going to
college to become a doctors (JAMA, 2000) or nurse. The numbers have decreased drastically to
where we are short of both professions. So in order to fill the need of the Practitioner to care for
the increased population’s healthcare recipients, the USA needs to increase the Nurse
Practitioners role to accommodate that need. This could open doors for the doctors that come to
the United States to practice medicine. (Rampel, 2013). Along with them they bring their
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Guideline for the Nurse Practitioner and the General Practitioner
knowledge and expertise. Once here, they find it hard to pass the testing system to become a
physician within the United States. They obtain employment within the field of medicine, but not
all in the profession as a doctor. In 2010 a Physician named Sajith Abeyawickrama, who came
from Sri Lanka, with the desire to practice medicine in the USA. Instead he is teaching exam
prep on genetics at Kaplan Medical in Newark, N.J. He is among one of the many doctors who
has to teach rather than practice in the field of medicine within the United States.
Some of what Nurse Practitioners Perform
The process that the nurse professionals have to go through, along with the legislative
legal aspect is overwhelming to say the least. But they continue on, heads held high, and proceed
with pride on a journey that they feel strong about. Their only quest is to improve their
profession to better serve the public.
Examples of what Nurses Practitioners preform today within their profession abroad or
within the United States. They conduct assessments, preforms lab test along with evaluating
results, diagnose the symptoms by sight and actual results of test. They relay their finding to the
General practitioner, so that he or/she can make the final decision on all the facts from the labs
and assessment. This allows the General Practitioner to finalize the diagnoses and prescribe
further testing or medication if needed. The Nurse Practitioners cannot do this on their own, only
with the General Practitioners approval and signing off on the visit. If implemented the Nurse
Practitioners would be allowed to perform all of the steps above without the General
Practitioners input.
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Guideline for the Nurse Practitioner and the General Practitioner
General Practitioners are aware of the practices and process of the Nurse Practitioners.
They perform the same clinical performances day in and day out, as a professional. They have
master the art of their profession along with other vital information within their field. This gives
them the capability of preforming the art of medicine and providing patient care. The” American
Nursing Practitioner Association” has issued a license to them within their field of medicine. It
allows them to perform as a Nurse Practitioner on a daily base. The test is very in-depth and you
have to be knowledgeable of all parts of the medical field, and in pharmacology to obtain the
license from the “American Nurse Practitioner Association”.
When it comes to going from Nurse practitioner, to preforming as a General Practitioner,
why not implement a test to challenge their knowledge. A test that is similar to that of the
General Practitioner or Specialist. This would allow the “American Medical Association” to
make the transition of the profession less complicated. This allows the “American Medical
Association” to see at what level of knowledge they have. At this point they can be educated in
the areas they need, not what they already know. By preforming these test it will cut down on
time and money. This will also impact the cost of healthcare in the long term. That is what we
are all reaching for, a more affordable healthcare cost, without effecting the care that is given. To
provide the care with the most knowledgeable professionals in the field of medicine. To also
keep our Practitioners from going to either another countries, or to other fields of medicine and
remaining Practitioners as their profession.
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Guideline for the Nurse Practitioner and the General Practitioner
Reference
AANP and TX aanp.org press release AUSTIN. "Nurse practitioner Unveil Federal Legislative
Priorities." American Association of Nurse Practitioners (2013).
<www.aanp.org/publication/aanp>.
Aaronson, Becca. "Moving Time for Nurses Who Don’t Need Doctors." The Texas tribune 30
November 2013, National ed. 1 December 2013. <http://metersvc.nytimes.com/meter.gif"/>/ uirebaaronson@texastribune.org/ or/ texastribune.org.>.
Anli, Jiang. "Nursing Shortage in China: State, Cause, and strategy." Nursing Outlook 58.3
(2010): 122-128. <alj1018@yahoo.com.cn>.
Cason, Mike. "Alabama Senate passes bill to allow nurse practitioners to prescribe more durgs."
Connect Alabama 16 at 4:50 PM April 2013 . 17 at 7:59 PM April 2013.
<connect.al.com- mcason@al.com>.
Cassidy, Amanda. "Nurse Practitioners and Primary Care." Health Policy Briefs 33.2 (2012). 15
May 2013. <www.healthaffairs.com>.
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Guideline for the Nurse Practitioner and the General Practitioner
Chen, Pauline and MD Getty. "The Gulf between Doctors and Nurse Practitioners/ Doctor and
Patient." The New York Times 27 11:31am June 2013: 2. <www.
thenewyorktimes.com/Dr. Pauline Chen on medical care.>.
Gray, Christopher David. Senate Gives Unanimous Blessing to Exspand Nurse Practitioners'
Dispensation. passed Senate Bill 8. Portland: The Lund Report, 2013.
<info@thelundreport.org>.
JAMA. "Your Doctor's Education." JAMA (2000).
Kennedy, Kelly. "Next year herolds major changes in nations healthcare/ Photos Gruder Jack."
USA Today 6 11:24am EDT May 2013. <www. usatoday.com>.
Markewitz, Andreas. "Nurse practitioners replacing young doctors:it works, but does it make
sense?" European Journal of Cardio-Throracic Surgery 43 43 (2012): 23 - 24.
<andreasmarkewitz@bundeswehr.org>.
Offredy, M. "Advance nursing practice; the case of nurse practitioners in three Australian states."
Journal of Advance Nursing 31-(2) 31.2 (1999): 274 -281. 2000.
Pearson, Linda J. ""Health Policy Brief: Nurse Practitioners and Primary Care Health Affairs,
October 25, 2012." American Journal For Nurse Practitioners "Health Affairs, (2012).
<http://www.healthaffairs.org/healthpolicybriefs>.
Rampel, Catherin. "Path to US Practice is Long Slog to Foregin Doctors/ Photo by Moran
Karsten." The New York Times /Business Day Economy 11 August 2013. <="http://metersvc.nytimes.com/meter.gif">.
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reserved, Copyright 1995- 2014 American Medical Association All rights. American medical
Association was adapted from "Your Doctor's Education"in JAMA,. 6 Sept 2000.
<www.americanmedicalassociation.com>.
Sibbald, Bonnie. "Primary care;National survey of job satisfaction and retirement intentions
among general practitioners in England." British Medical Journal 326 326 (2003): 1-4.
19 September 2002. <www.bmj.com>.
Singer, Patti. Doctors Need Nurse Practicioners 2014 USA Today. 11 November 2013. N.Y.)
Democrat and Chronicle 9:18 am EST November 11, 2013 The (Rochester.
<www.usatody.com>.
Uncategorized, admin at 12:52 pm under. "Nurse Practitioner Conference 2013/ Educational."
(2013). <www.conference2013.org>.