One of the hopes embedded in the health law was to expand the role of nurse practitioners and physician assistants in addressing the nation’s shortage of primary care providers. But a new study questions whether that’s actually happening in doctors’ offices.
Of the more than 4 million procedures office-based nurse practitioners and physician assistants independently billed more than 5,000 times in a year to Medicare – a list including radiological exams, setting casts and injecting anesthetic agents – more than half were for dermatological surgeries.
That’s not surprising, according to Ken Miller, president of the American Association of Nurse Practitioners, because when patients are older, skin problems such as “boils, skin tags and warts” are pretty typical.
“I think that’s where you’re going to see the majority of procedures that are occurring both in primary care and in some of the other specialties like geriatric clinics,” he said.
The Aug. 11 study, published in the JAMA Dermatology analyzing 2012 Medicare claims, is suggesting that nurse practitioners and physician assistants should face higher regulation if performing surgical procedures.
The study’s lead author, Dr. Brett Coldiron, a dermatologist and clinical assistant professor at the University of Cincinnati, said while the “intent for mid-level nurse practitioners was to give primary care,” the level of surgical billing implies that may not necessarily be true.
He said those mid-level providers – PAs and NPs – “are doing invasive procedures and surgery. I’m not sure they were trained to do that.”
But practitioners who perform specialized procedures often have received additional training, according to Miller.
“If they find something that is out of their scope, they will refer – and it’s the same thing that primary care physicians do,” he said.
The study’s analysis found that a majority of procedures billed by nurse practitioners and physician assistants relate to dermatology specifically, a trend Coldiron said could stem from the frequency of dermatological procedures being performed in offices rather than hospitals, along with the higher rate of skin cancer among the older patients Medicare covers.
The nurse practitioners performing specialized dermatological procedures often have received extra training, Miller said, and they often attend “the same symposiums and conferences dermatologists actually attend.”
“If they’re in the same subspecialty of dermatology, they may be doing these procedures because that’s how they’ve been trained,” he said.
He thinks no more than 3 or 4 percent of nurse practitioners actually end up specializing in a specific area of care. But all nurse practitioners will often see patients with dermatological conditions, and the treatments they require are usually not “extraordinary,” he said.
Coldiron said while the mid-level providers may have received extra training within a relevant specialty, many likely lack the expertise of doctors who have done a residency within the field. “If nurses are going to practice surgery, that’s not [nursing] – that’s medicine,” he said.
Nurse practitioners and physician assistants have been suggested as a potential solution to shortages in primary care physicians, providers whose roles were emphasized in the Affordable Care Act. But both Coldiron and Miller suggested that may not be the case in practice.
It would be a mistake to treat any one kind of health care provider as a silver bullet to fix primary care shortages, Miller said. Though he expressed concern that particular geographic areas may lack sufficient access to primary care, nurse practitioners or physician assistants can’t fill that gap, he said.
What “health professionals are all trying to provide is quality care that is convenient and accessible,” he said, adding that, “there is not enough primary care out there, and there is not one discipline out there” to meet patient needs.
The study cautioned that a boost in mid-level providers performing surgical procedures could lead to more cases of malpractice, a concern Coldiron said suggested a need for greater regulatory oversight of nurse practitioners and physician assistants.
But that kind of argument is a “red herring,” Miller argued.
“There have been no real studies out there that show nurse practitioners are less safe than physicians,” he said. “What we’re all trying to do,” he added, “is we’re trying to provide the best care and the best quality of care.”
This article was produced by Kaiser Health News with support from The SCAN Foundation.
[Image credit: Flickr user DIBP Images]
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When you are interested in pursuing a career as a nurse practitioner, you have to decide which is the right way. The moment you check the specialties, you will find several parts. You have to check the work environments that require experienced and trained
professionals. Nurse practitioners who want to work in a practical environment, consider more important roles such as surgical nurse practitioners. If you are intrigued by this special work field, you have to know some important things before you embark on the journey. Now it’s time to figure out whether can nurse practitioners do surgery or not.
The term surgical nurse practitioner can be applied in various situations.
For example, those who work in trauma surgery can be considered surgical nurse practitioner, but the ones working in the cardiology department is different.
So, it’s not right to state that nurse practitioners have a standard population for patients.
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These professionals can assist in complex procedures such as brain tumor removal from a kid, but they can do nose jobs directly without playing the assistant part.
It depends on where their job leads.
Surgery is generally a complex procedure.
For big and serious operations surgical nurse practitioners are required to provide pain medications, help in healing, and assist the patient through the recovery stage.
Nurse practitioners normally get to spend more time with the patient and their families rather than the surgeon.
They provide better information on the state of the patient, give answers to queries, and provide stability during a chaotic time.
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If you don’t know yet whether can nurse practitioners do surgery or not, we have to dig in a little deeper.
Can nurse practitioners perform surgery?
When you have the query can nurse practitioners perform the surgery you must know the first task of these professionals in the operating room is to assist the surgeon.
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The actual task will be dictated by the surgeon who is leading the operation and depends on the type of surgery.
A nurse practitioner can do many things like opening the surgery location, suturing wounds, fixing the laparoscopic cameras, providing suction, and other tasks that the surgeon requires at the time of the surgery.
However, there are some nurse practitioners who perform surgery.
They are able to carry out operations such as flap reconstructions, excisions of facial skin cancer, and this is done without any consultant by their side.
Can nurse practitioners perform surgical abortions?
Can nurse practitioners do surgery, more specifically, surgical abortions?
If it’s a first-trimester abortion, then it’s safe to get it done by a trained nurse practitioner. The assistants of physicians and certified midwives can conduct abortion.
Recently in the United States, in some states, it has been regulated that nurse practitioners can provide abortions.
Also, in the other areas, this task is prohibited for non-physicians.
However, the outpatient ward abortion is very safe too. The task can be provided by trained nurse practitioners or physicians.
In California state, 13% of women go for first-trimester abortion because the second stage has more complications.
The shifting of population distribution for abortions to the earlier stage is less costly.
Recently, non-physicians are allowed to do abortions in the four states of the US, Vermont, Montana, New Hampshire, and Oregon.
In other places, nurse practitioners are allowed to give medications but they can’t perform the abortion.
Also, some other states have laws to forbid non-physicians from performing abortions.
Now you know whether can nurse practitioners perform surgery and in what states.
What can nurse practitioners do in surgery in states that surgery is not allowed?
That’s coming up next.
What can nurse practitioners do in surgery?
Can nurse practitioners do surgery? Yes. But what else nurse practitioners do in the surgery room?
Nurse practitioners have a huge role in the surgery room.
They prepare for the operation and provide aftercare. They also require some credentials that allow them in this job.
Preparation for surgery and aftercare
Every nurse practitioner from APRNs to RNs have the task of preoperative care.
This falls in their daily duties. As part of this care, a nurse practitioner has to assist the patient in their well-being.
They have to determine the anesthesia part, answering questions about the surgery. The assistants of the nurse normally take care of these tasks, like physical preparation, fixing electrical leads to the chest, also shaving and cleaning the area of surgery.
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Before the surgical procedure starts the nurse practitioner has the job for preoperative things, like primary care, labs, any type of testing and so on.
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The main reason for this evaluation is to provide better safety to the patient and to sustain the anesthesia during the operation period.
On the day of the surgery nurse practitioners has to meet the patient, give answers to their questions like the procedure, the benefits, and risks of it, any concerns with aftercare as well.
In the setting
Can nurse practitioners do surgery? Yes. But what can nurse practitioners do in the setting stage?
This is the moment the patient enters the OR the nurse practitioner and their team go for the preparation and positioning of the surgery.
The nurse will give indications and information to their team, and the things they have to do during the procedure.
After the main incision, the main task of the nurse practitioner is to assist the surgeon, so that they don’t have to ask for tools when it’s required.
Then there are other responsibilities like hospital laws, the comfortability part between the surgeon and the nurse, implant replacement, retraction, exchange of surgical tools, help with exposure, graft harvesting and much more.
When the surgery is about to close, the nurse practitioner has to finish the operation by performing the closing of the incision.
This very task is done in the presence of the surgeon, and by the policy of the healthcare institution.
After the surgery is done and the incisional closing part is over, the nurse practitioner assists the surgical team to reposition the patient to the hospital bed and transport them to the recovery ward.
In the recovery ward
Once the patient has been transferred to the recovery room, a nurse practitioner has post-operative responsibilities.
They have to take charge of the patient and their discharge to home as well. They often have to take care of the outpatient department settings and the follow-up part too.
For the post-surgical patients, the nurse practitioner provides order on patient care, medicated therapies, pain management and so on.
The follow up on inpatient, and discharge is included in the responsibilities of nurse practitioners.
After a patient is discharged a nurse practitioner has to take care of the incision monitoring, clinical management, recommendation for therapy, postoperative imaging, and every other essential thing.
In normal surgical procedures, it requires one to two visits to the clinic, but if it’s a more extensive procedure, it requires repetitive tests even after the postoperative recovery of the patient.
These parts are also regarded as the duties of nurse practitioners.
At this point, you should know pretty well whether can nurse practitioners do surgery or not.
If you would like to learn more nursing-related stuff check out these articles of ours:
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