AKRON, Ohio –Nurses aren’t doing enough.
Or, perhaps more to the point, nurse practitioners — registered nurses who have completed advanced training programs in medical specialties — aren’t allowed to do more.
That’s the thought of Margaret Wineman, dean at the College of Nursing at the University of Akron, who like many wants a greater role for nurses in areas including medical homes, primary care, wellness and fighting the H1N1 flu.
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In Ohio, nurse practitioners have a collaborative arrangement in which they join with a physician in a practice. Wineman prefers a more independent “plenary authority” where nurses have more power to prescribe medications, treat patients and work on their own.
That would mean changes in Ohio law that have yet to come. But Wineman thinks proposed legislation on medical homes could open the door to expand duties for nurse practitioners.
Below are excerpts from an interview in which Wineman discusses the need for maximizing nurses — nurse practitioners in particular — and new collaborations on the horizon that could add nurses to the workforce.
Q. Will it be difficult to give more duties to nurses in the midst of an, albeit stalled, nursing shortage?
A. Even in the nursing shortage, nursing as a workforce encompasses 2.5 million professionals. Nurses represent the largest health-care workforce in this country, and we need to take full advantage of them. There are 8,000 advanced-practice nurses in Ohio. About 4,000 are nurse practitioners. I think we need to fully utilize them in Ohio.
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Q. How can this be accomplished without significant changes in state legislation?
A. I don’t know if I can speak to logistics. But House Bill 198 is introducing a medical home demonstration project. (The legislation, introduced in June, would fund and oversee medical home pilot projects in the Dayton and Toledo areas as well as establish scholarships for medical students entering primary care. It creates a council to oversee the medical homes and currently emphasizes physician participation in the project, not nurse practitioners).
It’s a great opportunity in Ohio to include nurse practitioners as the leaders in these homes, and have a demonstration project to collect information on comparative outcomes. My understanding of family practice doctors is that they really highly regard nurse practitioners in terms of practice, but don’t want to put them in a position to be in the lead in medical homes. I think we need to take full advantage of nurses’ scope of practice in Ohio and across the country.
Q. But can a nurse take the place of a doctor — even in the minds of patients?
A. Many physicians in medical school right now are choosing to go into specialty areas (not general practice). We don’t have time to waste when it comes to people’s health. Research on patients with acute chronic problems says that a nurse practitioner’s care is equal to that of other primary-care providers. Patients express satisfaction with the care. The evidence supports using nurse practitioners.
When you think about today’s health-care environment, it’s related to self-care behavior. Individuals need health professionals to help coach them in terms of wellness activities, helping set up plans and helping stick to plans, and helping negotiate the health-care system. We will be seeing more hospitalizations and more deaths from the H1N1 virus. And there’s basic education to prevent that: hand-washing, how do you cover mouth. Nurses can do that.
In convenience clinics, nurses do basic screenings. They should do more in-depth screening and, when needed, call in a consultation.
Q. How can you add more nurses into the workforce?
A. One of the areas is by partnerships. That has helped us remarkably. Over the last five years, we’ve increased the undergraduate student body at the College of Nursing by about 50 percent in part through collaborative agreements.
We may soon develop an accelerated program for medics. The University of Akron wants to be a go-to university for veterans. The post 9/11 GI Bill provides 36 consecutive months of full state tuition. We’re working with two military academies in the West to develop a program so individuals in the military with the proper degrees can go into an accelerated program to get health-related degrees. We’re in the fledgling stages with this.
