A Model for Nurse Practitioner-Physician Comanagement - The Clinical Advisor
Nurses, nurse practitioners, and doctors have formed more partnership-driven relationships over the last few decades. Doctors have come to rely on nurses and . A total of % of nurse practitioners reported working in a practice with a physician, as compared with % of physicians who reported working with a nurse. Perceptions of nurse-physician relationships were assessed using the .. lower than clinical nurse specialists and nurse practitioners (Table 4).
The backlash seems to be a result of the increased independence granted to Nurse Practitioners in many states. Despite tension between the two practicing bodies, there are plenty of examples of healthcare teams that cultivate a positive, healthy, symbiotic relationship between all members of all licensure.
You may be a part of one and know that without a doubt, patients benefit from a healthcare team that is cohesive. The animosity between NPs and MDs is very much alive and sometimes tangible. Many facilities employ nurse practitioners in settings where they will assess, diagnose, treat, prescribe, and get paid a smaller salary than a doctor would for performing those same tasks.
The Evolution of the Nurse-Doctor Relationship
Especially amongst the twenty-three states that allow NPs to practice independently without physician oversight, there is a big movement towards equal pay grades between the two providers. So what is the best thing to do? Pay all providers giving the same service the same wage? Or calculate salaries that are commensurate with schooling, training, and scope of practice?
From a corporate perspective, the answer is easy. Companies will always find an excuse to tip the pay scale to their benefit, and level of education is a perfect pretext.
A second point of contention is in regards to title. Academia and medicine happily share the prefix of Dr with distinct paths and practices. However, when it comes to the world of patient care, this title is part of a heated debate. Doctorates of Nursing Practice earn their doctorate degree and with it, the Dr prefix. However, when standing in front of a patient in a clinical setting, some argue that it is deceiving for a DNP to introduce themselves as doctor, even unacceptable if they passively allow patients to use the title.
A Model for Nurse Practitioner-Physician Comanagement
No matter who you are or where you stand on each argument, it can be said that ego lies at the center of the feud. But in order to grow and move forward in a progressive way, we must put down our egos and work on the kinks in our own system, and for nurses, the first step could be examining the NP education system.
The academic framework for nurse practitioners undergoes a lot of scrutiny from the physician sector due to its stark difference in structure from medical school and residency.
However, it is important to give a voice to the nurses who feel the shortcomings of advanced practice programs. Since this review aims to aggregate data of qualitative and quantitative evidence and not to re-interpret findings, an integrative synthesis was the method chosen for this literature review [ 34 ]. Methods A number of methods are available for the synthesis of qualitative and quantitative evidence [ 3538 - 42 ].
Evolution of Nurse/Doctor Relationships
A majority of these methods focus on effectiveness or intervention reviews and add findings of non-experimental research to the synthesis of trials in a separate step parallel or multi-level synthesis. They suggest an integrated approach that is reflected in the simultaneous process of synthesising data from quantitative and qualitative research under themes that were addressed in studies using a variety of designs and methods.
We drew on principles described by the Joanna Briggs Institute [ 43 ], the Cochrane Qualitative and Implementation Methods Group [ 38 ] and the thematic synthesis approach for qualitative data developed by Thomas and Harden [ 37 ] for literature reviews on participant views. The latter matched the purpose of this review that also looked at views and perceptions. Eligibility criteria Studies were included in the review if they focused on a population of NPs nurses with a postgraduate certification and an advanced level of practice autonomy [ 4445 ] and MPs in primary health care settings.
Study designs that generated qualitative or quantitative data were included. Opinion papers and anecdotal reports were excluded. Information sources and search strategy The following databases were searched: The review also contains grey literature such as theses and dissertations.
When available medical subject headings or index terms were used in each database. The inclusion period of papers comprised the years from January to September to ensure the inclusion of papers that reported collaboration between NPs and MPs from countries where the NP role has been implemented for a much longer time and collaboration may be at a more advanced stage than in other countries [ 46 ]. No language restrictions were applied.
MD vs. NP: Putting Egos Aside
One reviewer examined the full text of potentially relevant papers for final inclusion or exclusion in the review.
Reference lists of included papers were screened for eligible studies. Assessment of methodological quality A separate appraisal tool was used for each included study type [ 35 ].
The following were chosen due to their brevity, clarity, appropriateness; and because their items covered the most common assessment criteria of other tools: Data extraction Firstly, study details such as the methodology, the population and the context of the study were extracted from each study and organised in an evidence table Additional file 2: Secondly, findings were extracted from the primary sources into a spreadsheet and grouped under one of the outcome categories: Findings to be extracted from qualitative studies for the purpose of this review were themes, key concepts or results and conclusions developed by the authors of the papers [ 3751 ].
No direct quotations of individuals were extracted since they were considered raw data and not the outcome of an interpretative process undertaken by the authors [ 52 ]. A separate table was created for relevant quantitative data and organised under the same outcome categories as the qualitative data.
Data analysis and synthesis Repeated screening of the articles and reading of extracted data in spreadsheets enhanced the iterative process of developing sub-categories [ 53 ].
These sub-categories were further collapsed into descriptive themes [ 37 ]. This approach is similar to content analysis, suggested by Dixon-Woods et al. Results from quantitative studies were juxtaposed with qualitative findings within each descriptive theme and outlined in a descriptive summary, supported by tabulation of data [ 55 ].
Since the synthesis of findings in this review was a meta-aggregation [ 43 ] of results, it was summative and did not include the re-interpretation of the primary data [ 5556 ]. Results The literature search identified papers.
After excluding duplicates and papers published before there were papers for review. In total there were 30 papers included in the review, reporting 27 studies.