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NUR 740 Discussion 10.1: Scope of Practice and Patient Safety

The following post is a reflection on the American Medical Association’s (AMA) video interview with Michaela Sternstein, JD regarding scope of practice and patient safety. Michaela is the vice president of the AMA’s State Advocacy Resource Center. The interview detailed Michaela’s work in defining scope of practice between physician and non-physician providers. I agree with Michaela’s perspective that clear scope of practice guidelines allow physicians, non-physicians, and the entire healthcare team to work more efficiently together. Michaela mentions the importance for patients to understand the different members that make up their healthcare team. Healthcare encompasses a wide range of professions with varying skill sets. It can be confusing to patients to understand who is responsible for what part of their care. For example, I had a patient referred to our dermatologist by their oncologist for a skin rash. The dermatologist I work with specializes in oncodermatology. The patient was upset when the physician was not also a trained oncologist, even though their oncologist was the one that referred them. The COVID-19 pandemic put a new emphasis on healthcare workers in the media. El-Awaisi et al. (2020) used social media to determine the public perception of members in the healthcare team. Results found majority (57.9%) of social media users were discouraged with public perceptions focusing on doctors and nurses when other professions, like physician assistants, greatly contribute to patient care (El-Awaisi et al., 2020). Public education and awareness to the different titles and roles in healthcare is the first step to patients becoming familiar with their healthcare team. I disagreed with Michaela’s notion that physician assistants are wasting their time and resources lobbying for a name change. Titles are less important to colleagues in healthcare who already understand the role. However, titles can lead patients to make assumptions regarding a role without any background knowledge on the position. For example, physician assistant (PA) and medical assistant are two similar titles. Physician assistants are non-physician providers with a master’s degree that can diagnose and treat patients. On the other hand, medical assistants have a high school diploma/GED with a 1–2-year program to become certified clinical support staff. Staff in these roles have two different levels of education and responsibility in patient care. The names can be deceiving to people outside of healthcare. The American Academy of Physician Assistants (2021) officially changed their title from physician assistant to physician associate to reflect their role more accurately in healthcare as a non-physician provider. The title change will be an extensive process to implement, but it will be worth it for the PA community to feel comfortable with their title and role.

References

American Academy of Physician Assistants. (2021). Title change. AAPA. https://www.aapa.org/title-change/

El-Awaisi, A., O’Carroll, V., Koraysh, S., Koummich, S., & Huber, M. (2020). Perceptions of who is in the healthcare team? A content analysis of social media posts during COVID-19 pandemic. Journal of Interprofessional Care, 34(5), 622–632. https://doi.org/10.1080/13561820.2020.1819779

Stucky, C. H., Brown, W. J., & Stucky, M. G. (2020). COVID 19: An unprecedented opportunity for nurse practitioners to reform healthcare and advocate for permanent full practice authority. Nursing Forum, 56(1), 222–227. https://doi.org/10.1111/nuf.12515

Hi Skylar

It is apparent that scope of practice in the framework of healthcare practices has for long been a relatively controversial topic that has generated divergent opinions among distinct medical stakeholders. Based on the insights of the interview, I concur with your indications that laying out a lucid scope of practice guidelines for both physicians and non-physicians is integral towards fostering improved quality patient care. According to Cawley and Hooker (2018), clear scope of practice framework constitutes the fundamental basis for the development of collaborative care teams, which is critical in the realization of quality care deliverables among distinct healthcare providers. However, while it is true that patients require comprehensive awareness regarding distinct roles in healthcare, don’t you think that Michaela may also be right to insinuate that physician assistants may be wasting time lobbying for a title change? Although title transformation may indeed lead to the realization of the prevailing roles of physician assistants in contemporary care practices, it may also negatively alter the patients’ comprehension of the evolving responsibilities of non-physician assistants, thus putting the safety of patients in jeopardy (Al-Agba & Bernard, 2020).

References

Al-Agba, N., & Bernard, R. (2020). Patients at risk: The rise of the nurse practitioner and physician assistant in healthcare. Universal-Publishers.

Cawley, J. F., & Hooker, R. S. (2018). Determinants of the physician assistant/associate concept in global health systems. Int J Healthcare,k,4(1), 50-60. https://doi.org/10.5430/ijh.v4n1p50

Hello Skylar,

I agree with you that scope of practice between physician and non-physician providers creates a conducive environment for physician and non-physician providers to work together. The harmony and coexistence between these two groups of workers benefit both organizations and patients (Leem et al., 2019).  The scope of practice specifies the assignments rendered to both physicians and non-physician providers to reduce chances of conflict of interests or any form of disagreement between parties. The American Medical Association’s (AMA) understands the importance of coordination between physician and non-physician providers (Choi et al., 2019). Therefore, the organization leadership has created scope of practice to safeguard work environment for both groups of physicians. The outbreak of COVID-19 pandemic necessitated additional nurses to attend to the increasing new cases of infections. As a result, physician and non-physician providers were important in handling patients of the pandemic both within and outside healthcare facilities.

References

Choi, S., Jang, S. G., & Lee, W. (2019). The scope of practice for registered nurses in 64 South Korean laws. Journal of Korean Academy of Nursing49(6), 760-770. DOI: https://doi.org/10.4040/jkan.2019.49.6.760 (Links to an external site.)

Leem, C. S., Choi, S. J., Lim, K. C., Yi, Y. H., Jeong, J. S., Shin, Y., … & Kim, E. M. (2019). Common scope of practice for advanced practice nurses in Korea derived from expert agreement. Journal of Korean Critical Care Nursing12(3), 35-49. DOI: https://doi.org/10.34250/jkccn.2019.12.3.35 (Links to an external site.)

Hello Evans

You provided a concise reflection of the video. Indeed, a clear scope of practice guidelines allows physicians, non-physicians, and the entire healthcare team to work more efficiently together. I also agree that it is important for patients to understand the different members that make up their healthcare team. Do you agree with the speaker’s view that the scope of practice should not be expanded to allow nurses to practice independently? Perhaps you could expound your view on this observation because the speaker presents that physicians undergo lengthy and vigorous training that prepares them to become leaders. In my view, I agree with the speaker. My discussion established that nurse practitioners are important members of the Physician-led healthcare team but they are not trained to practice independently. Nurses are not required to go through years of medical residency training and get only 500 to 720 hours of clinical training compared to the 10,000 to 16,000 hours that physicians receive (Peacock & Hernandez, 2020). It would be unjust and morally wrong to place nurses and physicians at the same level despite physicians going through more lengthy and cumbersome training (Peacock & Hernandez, 2020). Again, what is your thought on the speaker’s point that expanding the scope of practice will not increase access to health care? I also support the view because States like Oregon which allow for independent practice have not witnessed any significant shift of nurses to rural areas (Feyereisen & Puro, 2020). On the contrary, evidence demonstrates that states that need physician-led health care teams have witnessed a significant increase in the number of nurse practitioners as opposed to states that allow independent practice (Tsuyuki et al., 2018). You had an excellent discussion. 

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NUR 740 Discussion 10.1: Scope of Practice and Patient Safety

NUR 740 Discussion 10.1: Scope of Practice and Patient Safety

References 

Feyereisen, S., & Puro, N. (2020). Seventeen states enacted executive orders expanding advanced practice nurses’ scopes of practice during the first 21 days of the COVID-19 pandemic. Rural and Remote Health20(4). DOI:10.22605/RRH6068

Peacock, M., & Hernandez, S. (2020). A concept analysis of nurse practitioner autonomy. Journal of the American Association of Nurse Practitioners32(2), 113-119. doi: 10.1097/JXX.0000000000000374

Tsuyuki, R. T., Houle, S. K., & Okada, H. (2018). Time to give up on expanded scope of practice. Canadian Pharmacists Journal/Revue des Pharmaciens du Canada151(5), 286-286. https://doi.org/10.1177/1715163518793844

Thank you Skylar for this discussion. I agree that there should be a clear guidelines of scope of practice as stated by Michaela in the video (American Medical Association [AMA], 2021). Physician and non-physician providers should understand the limits of their practice so that both physician and non-physician providers can work efficiently together as a team (Beeber et al., 2019). As mentioned, there should be a leader in a care team. This has been traditionally given to physicians which I do not think others are challenging. I find your support for title very important. Titles may be insignificant to clinicians because they understand the roles of different clinicians. Patients and others outside healthcare get confused and clarity about title can guide them. Many patients do not want to be treated by a nurse practitioner just because they believe they are nurses and will not understand their disease process. This may not be entirely true especially in primary health care. Another example is when patients hear the name “physician assistant”, they believe they are an assistant in healthcare. They may not know that they have masters degree and capable of treating patients in primary healthcare. Patients would believe they are not in good hands when “physician assistants” are attending to them. Patients may conclude the treatment is not exclusive and may want to seek a second opinion from a physician. You rightly mentioned that patients may even confuse physician assistants with medical assistants. Patients may think that a physician assistant is even less qualified to understand their disease than a registered nurse. This is contrary because physician assistants are properly trained and qualified to practice in primary healthcare. There should be a need for a title change as our healthcare evolves over time. The traditional ways can change to make way for clinicians’ training and public acceptability.

References

American Medical Association. (2021). AMA successfully fights scope of practice expansions that threaten patient safety. Retrieved June 28, 2022, from https://www.ama-assn.org/practice-management/scope-practice/ama-successfully-fights-scope-practice-expansions-threaten (Links to an external site.)

Beeber, A., Palmer, C., Waldrop, J., Lynn, M. R., & Jones, C. B. (2019). The role of doctor of nursing practice-prepared nurses in practice settings. Nursing Outlook, 67(4), 354–364. https://doi.org/10.1016/j.outlook.2019.02.006

Skyler,

Healthcare is a team effort. Each healthcare provider is like a member of the team with a special role. Some team members are doctors or technicians who help diagnose disease. Others are experts who treat disease or care for patients’ physical and emotional needs. I agree with you that public education and awareness to the different titles and roles in healthcare is the first step to patients becoming familiar with their healthcare team. As the number of medical students entering primary care as a specialty declines, this deficit is increasingly being filled by mid-level providers such as physician assistants and nurse practitioners (PAs and NPs). Despite these providers’ abilities to provide a similar quality of care as physicians, confusion likely exists regarding the kind of care these providers are able to deliver in comparison to the more widely understood physician profession (Perrault, 2018). Little is known about the public’s knowledge regarding what kinds of duties these mid-level providers can perform in comparison to physicians (Perrault, 2018). It is very important to fill this gap. Healthcare organizations could be doing a better job helping prospective patients understand the similarities and differences between PAs, NPs, and physicians (Perrault, 2018). Improving provider biographies, a primary source of information for prospective patients, might be one venue for educating about the duties that NPs and PAs can perform, which may lead to a greater willingness to utilize their services (Perrault, 2018).

 

References

Perrault, E. (2018). Primary Care Confusion-Public Knowledge of NP and PA Duties and Their Information Gathering Behaviors. Journal of general internal medicine33(11), 1857–1858. https://doi.org/10.1007/s11606-018-4580-x

Skylar, thank you for your post this week.

 

(R)I agree with you when you say that names and titles can be deceiving to people outside of healthcare. They can also confuse those inside healthcare frequently (Malik et al., 2019). Some have suggested that nursing needs better branding (Godsey et al., 2020). That as nurses we need to better define and advertise the type of role we want to project and that patients will come to expect. I understand the desire to change the title of Physician Assistants to Physician Associates. It communicates that they are not an assistant like a Medical Assistant, but I suspect that is more important to their profession than to the patient, who, in my opinion, see Doctors and everyone else as two distinct groups. That has been my experience. The important undercurrent in all of this is there is room for everyone. More caregivers that are better educated and with greater experience are a benefit to the patient regardless of the name we give them. (I)Do you believe there is a significant difference in the perception that patients have when they are informed that the nurse has a bachelor’s degree versus a master’s degree? Would you expect the patient to know without looking at their badge that they were dealing with a more advanced nurse? (S)I believe it does come across in ways that the patient can perceive when dealing with all the different levels and titles in healthcare. (E)Perhaps that would be an interesting study to understand patient perceptions of where the education level is or is not on the nurse’s badges. Would they perceive a difference without the cue that there is more education and experience behind the nurse credentials? I believe there would be.

References

Godsey, J. A., Houghton, D. M., & Hayes, T. (2020). Registered nurse perceptions of factors contributing to the inconsistent brand image of the nursing profession. Nursing outlook, 68(6), 808-821. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398865/pdf/main.pdf (Links to an external site.)

Malik, B. H., Krishnaswamy, R., Khan, S., Gupta, D., & Rutkofsky, I. (2019). Are physician associates less-defined force multipliers? Comparative role definition of physician associates within the hierarchy of medical professionals. Cureus, 11(12).

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