Editor's Note: which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Rebekah Bernard, MD, a family physician at Gulf Coast Direct Primary Care in Fort Myers, Florida. The views expressed in these blogs are those of their respective contributors and do not represent the views of or UBM Medica.
The United States is facing a physician shortage.[i] Efforts are being made to increase physician training programs through Graduate Medical Education (GME) funding, with bills H.R. 2267 and S. 1301 slowly winding their way through the political process. In the meantime, some organizations see the physician shortage as a golden opportunity to increase the production of non-physician healthcare providers, including nurse practitioners (NP) and Physician Assistants (PA).
Nurse practitioner organizations have been particularly active in promoting a nursing role in the health system, encouraged by the Institute of Medicine’s 2011 Future of Nursing report, which called for a radical change to health care delivery in the United States with a push towards higher levels of nurse education to achieve “full” nurse partnership with physicians.[ii] Nursing schools rallied to the call by creating a goal of increasing baccalaureate trained nurses and doubling the number of nurses with a doctorate degree by 2020.[iii]
Unfortunately, this focus on increasing nursing scope of practice has led to several dangerous consequences. The first adverse effect of increased NP production is a decline in bedside nurses, one of the most critical components of our healthcare system.
Bedside nurses are the cornerstone of quality medical care delivery across healthcare settings. The United States is facing a nursing shortage, due to a combination of factors: the aging of the population, retirement of experienced nurses and the transition of nurses from bedside to a provider role.
The first way that increasing nurse scope of practice is affecting bedside nursing is that as nursing programs encourage more advanced training, fewer students are entering associate level training.[iv] Associate level (ADN) registered nursing degrees are two-year programs, available through community colleges, which offer a shorter and less expensive track toward becoming a nurse. Students can work and attend school at the same time, and can enter the workforce after two years of study, rather than four.