What is so special about a nurse practitioner?

By now most of us have heard of a nurse practitioner. But what exactly is a nurse practitioner? What can they do? How can they be incorporated into a medical practice?

A nurse practitioner is a registered nurse who has completed graduate-level education and advanced-practice training. Nurse practitioners can see a wide range of patients, both well and sick, and perform many in-office procedures. Prescribing medications, ordering and interpreting tests, hospital admitting and discharge privileges, and hospital rounding are just a few of the privileges falling within the scope of a nurse practitioner.

The next question is what is so special about a nurse practitioner? The answer, for the most part, lies in the approach nurse practitioners take in their patient care. The physician typically uses a disease-based or problem-based approach meaning that the focus is more on diagnosing a problem and treating that problem. Nurse practitioners use an approach that is nursing-based, focusing on the patient and his/her environment as a whole. Nurse practitioners not only diagnosis problems and treat those problems, but we incorporate that treatment and that response into their family, their culture, their daily lives and their community.  We focus on teaching people ways to stay healthy and have the capability to treat people for their acute and chronic illnesses.  Both approaches to care are important and together give the patient a more complete resolution and stabilization of their condition.

In our practice we do a lot of collaboration; not only from nurse practitioner to physician but also physician to nurse practitioner. Many times either I have gone to a physician or a physician has come to me to work with a patient. The benefit of this collaboration is that the patient’s immediate need is met and she does not have come back for another visit, ultimately resulting in a quicker resolution of the problem. Since the nurse practitioner can practice independently, when our doctors leave the office to go to the hospital for a delivery, the nurse practitioner can see the patients. Again, the patient is seen avoiding an appointment that needs to be rescheduled. Thus, patient satisfaction is increased, problems are immediately addressed and patient outcomes are improved.

For instance, in our practice, most of our OB patients with diabetes get seen twice a week. One day the patient sees her physician who manages her pregnancy. The other day she sees the nurse practitioner. Although her pregnancy is monitored when she sees the nurse practitioner, the focus of this visit is on her diabetes and how to maintain good glycemic control and still check blood sugars four times a day, eat six times a day, take care of three children and work full-time. This type of visit can be very time consuming. Using the nurse practitioner in this manner allows the physician to continue to focus on those patients that need physician-specific attention. It also gives the patient more education, individual attention, encouragement and incorporation of her disease into her individual lifestyle. The benefit to the patient is she gets the best of both worlds, which ultimately optimizes the outcome for her and her pregnancy.

With the current and future changes in health care, nurse practitioners will become an even more important part of a medical practice. By using nurse practitioners to see well-checks and to monitor established therapies, the physician is freed up to focus on surgical cases and those conditions that fall outside the scope of a nurse practitioner.

But how do patients view nurse practitioners? My experience is that most patients love nurse practitioners. All for the above reasons plus more. There are many patients in our practice that will see their physician for certain problems and the nurse practitioner for other problems. Some patients are not comfortable talking to a physician about certain issues. Although the care that the patient receives from both the physician and the nurse practitioner is the exact same, the title “doctor” can still intimidate some. The nurse practitioner is a little more on their level on the totem pole and can be less intimidating. After talking to many patients regarding nurse practitioners once they see one, they are be hooked. This keeps your patient in your practice, helps to grow your practice, and gives your patient complete and “holistic” management of their condition, and other options for care.

Kim Sakovich is a nurse practitioner who blogs at Kim’s Korner

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  • Steve

    They also turn into pumpkins at 4pm each afternoon.

  • webhill

    I’m not a physician, but when I read “Nurse practitioners not only diagnosis problems and treat those problems, but we incorporate that treatment and that response into their family, their culture, their daily lives and their community,” I felt insulted on behalf of physicians everywhere. Honestly, if I did not think that my physician could not only diagnose and treat me, but also take into account my living situation, cultural needs, etc, then I would find a new physician.

  • SteveBMD

    “The physician typically uses a disease-based or problem-based approach
    meaning that the focus is more on diagnosing a problem and treating that
    problem. Nurse practitioners use an approach that is nursing-based,
    focusing on the patient and his/her environment as a whole.”

    This statement is an insult to physicians like me (and, now that I think about it, the vast majority of my colleagues) who indeed see the “problem” as resulting from an interface between the patient and his or her environment, and whose “treatment” requires intervention at the level of the patient and environment, not just the specific pathology.

    In fact, the only ones who ask me to focus on a problem are the insurance companies.

  • http://primarycarenext.blogspot.com/ Keegan Duchicela, MD

    I’m sorry, but modern primary care education has already taken what’s good about the nursing model and incorporated it into their training many years ago. I reject the false assertion that the “nursing model” is unique at all.

    What you’re describing about “incorporating treatment and that response into their family, their culture, their daily lives and community” is the exact type of training family physicians have gotten for decades. And our contemporary graduates are even better trained in this regard. Take a look at the ACGME requirements for family medicine residency programs and tell me it doesn’t completely incorporate many of the great things about the “nursing model” of care… and then some.

    Modern family medicine residences have at least three full months of their training dedicated to health projects that work to study and improve their community in meaningful ways. Many residency outpatient clinics serve low income patients, where taking into account the family’s socioeconomic status and cultural influences is essential to providing good care.

    The required didactic sessions and lectures they have over the 3 years of their training are centered around learning how to treat everybody within the context of their family and their community. Plus they learn the disease model of medicine. They go hand in hand.

    And to the credit to my physician colleagues in other specialties, many of these skills are taught as part of modern medical school education as well.

    • KCF

      As a nurse practitioner, I am ashamed of this article. There are definitely great reasons to have nurse practitioners in a family practice setting, but this piece takes a superiority stance that is out right disrespectful to physicians, whose training is comparable to none. I sincerely hope that this NP is the exception and not the rule.

      • http://primarycarenext.blogspot.com/ Keegan Duchicela, MD

        I don’t think it’s a conscious effort at assuming superiority, but lack of knowledge as to what modern medical training is like…. especially for primary care focused IM residencies, family medicine, and pediatrics.

        The ACGME has declared that: residents must be able to provide family-centered patient care that is culturally effective, developmentally and age appropriate, compassionate, and effective as part of their core competencies.

        And I have to give a shout out to my peds colleagues for pioneering patient/family centered bedside rounds, which incorporate the best aspects of many disciplines, including nursing.

  • Marni

    ‘The physician typically uses a disease-based or problem-based approach meaning that the focus is more on diagnosing a problem and treating that problem. Nurse practitioners use an approach that is nursing-based, focusing on the patient and his/her environment as a whole. Nurse practitioners not only diagnosis problems and treat those problems, but we incorporate that treatment and that response into their family, their culture, their daily lives and their community. We focus on teaching people ways to stay healthy and have the capability to treat people for their acute and chronic illnesses. Both approaches to care are important and together give the patient a more complete resolution and stabilization of their condition.”

    Yeah. Ok. This is what I do every single day at work as a primary care physician. This is why I went into primary care. If that’s what is so special about nurse practitioners…they need to go back to the drawing board.

  • KCF

    I’m not sure it was a conscious thing either. That doesn’t make it any better though.

  • http://www.ausmed.us/curriculum.php International Medical Schools

    A very neat and clean discussion about Nursing career and it’s prospectus…………:)

  • J-M

    If you think this NP is arrogant, have you ever seen/talked to an anesthesia nurse? OMG! I just met a parent at my daughter’s school that is a PA. She can hardly bring herself to speak to lowly underlings like me… I don’t want anything to do with an advanced paractice nurse. Luckily my gp lets me see him instead of them.

  • AMS

    Ms. Sakovich,
    what you’ve just written … is one of the most insanely idiotic things I have ever heard. At no point in your rambling, incoherent post were you even close to anything that could be considered a rational thought. Everyone on this website is now dumber for having read it. You have affended many, and may God have mercy on your soul.

    • Dan

      I’m willing to bet the 2 thumbs down have never watched Billy Madison..

      • AMS

        Haha…never miss a chance to quote some Billy Madison

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