Academic journal article Nursing and Health Care Perspectives

An Inside View

Academic journal article Nursing and Health Care Perspectives

An Inside View

Article excerpt

NP/MD Perceptions of Collaborative Practice

The pressing dilemma in this era of health care reform is how to provide cost-effective, high quality health care for all Americans. At the present time, due to a number of complex factors, including attrition and economic disincentives, a shortage of primary care physicians exists in certain medically underserved areas the country. At the same time, however, primary care nurse practitioners are increasing in number.

Although nurses have been educated as NPs for more than 25 years, role expectations and relationships with collaborating physicians remain unclean Moreover, trends and legislative status of NPs vary from state to state (1). For example, NPs in Illinois have no statutory prescriptive authority, while those in 19 other states can practice independently of any physician involvement in prescription writing.

In 1992, 492 of the more than 27,000 NPs in the United States practiced in Missouri (2).With the passage of House Bill 564 on July 1, 1993, which addressed collaborative practice arrangements between physicians and registered professional nurses, including prescriptive authority, the state became embroiled in controversy (3). Among issues of concern were proposed requirements for on-site supervision of NPs by MDs and minimum geographic distance between the NP and the collaborating MD partner. Indeed, confusion regarding NP and MD perceptions of their collaborative practice roles had been apparent since the appearance of a study by Mauksch and Campbell in 1988 (4). Research to examine NP and MD perceptions of collaborative practice roles has been limited (5-8).

The present study was conducted to explore the development of roles, relationships, and practices of nurse practitioners (NPs) and physicians (MDs) in primary care collaborative practice (PCCP). In the first phase, specific objectives included a cross-sectional examination of factors influencing PCCP within the state of Missouri. NP and MD perceptions of barriers and facilitators to PCCP, key role components, and essential attributes of successful collaboration were examined.

In Phase 2, primary care collaborative practice was examined on a national scale. This part of the study, a longitudinal follow-up of the work completed by Mauksch and Campbell in 1988, addressed collaborative practice provider mobility and settings. It had various qualitative components, including satisfaction with tasks, perceptions of ideal and current collaborative practice, proficiency, issues in NP regulation, barriers to practice, and views about the future. Two primary research questions were asked:

* What are the characteristics and factors influencing successful collaborative practice among NPs and MDs in the state of Missouri?

* What changes have taken place during the past seven years in roles, relationships, and practices of NPs and MDs in primary care collaborative practice in the United States, and to what factors do NPs and MDs attribute these changes?

This report focuses primarily on findings from the national survey in Phase 2. Comparisons are made with findings from the Phase I survey, as appropriate.

Background The study by Mauksch and Campbell illustrates the confusion regarding NP and MD perceptions of their collaborative practice roles (4). For example, while 76 percent of the MD participants believed they had final authority over decision making, only 47 percent of the NPs believed that the MDs had final authority. Also, while 54 percent of the respondents believed that the ideal joint practice should be characterized by a contract that specifies the functions of the NP, only 3.1 percent of the respondents said that such a contract existed in their current practice.

In Missouri, passage of House Bill 564 prompted Melvin C. Kasten, MD, president of the State Medical Association, to publish results of an Ad Hoc Committee on Collaborative Practice. …

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