Are Nurse Practitioners Leading Inter-professional Care Teams?

Abstract

Nurse Practitioner (NP) legal authority to practice is governed by state law and regulations and unfortunately differs by state. In some states NPs may practice independent of physicians, but in others their practice is restricted by required physician supervision. Regardless, in the IOM’s Crossing the Quality Chasm (NAS, 2001) and in the Future of Nursing (NAS, 2010) experts recommend that NPs practice to the full extent of their education and training in inter-professional (IP) teams. In addition the Future of Nursing recommends nurses function in leadership roles on these inter-professional teams. How can this be accomplished if physicians are also on these teams? Can nurses or NPs really lead physicians? There is a growing body of evidence that reports on NPs participating in IP teams deliver optimal care as well as provide highly rated education to medical students, physician residents and to health professions students outside of nursing. There are probably many NPs out there leading IP care teams, but published evidence of this is virtually non existent. What is keeping our profession from taking on more leadership roles in IP teams, not roles as managers or administrators but IP patient or population care teams and subsequently reporting on them? I believe that, despite our increasing numbers, our increasing levels of education, and our demonstrated competence, and even independent practice in many states, there is still a culture within our educational and healthcare systems that makes it difficult for nurses to lead. For example, anecdotal reports from states where independent practice has recently been achieved do not show a rush to accept this responsibility. Comments overheard at national meetings demonstrate complacency with the role of a “mid-level” provider (a word I do not use lightly but conveys the exact meaning of a level of care underneath the physician). These types of comments are very concerning to those of us who have lived through NP struggles to practice to the full extent of our education and training and still live in states where the struggle continues. Well, if we want NPs to lead, we need to start with education. More is not enough; the content, quality and experiences during that education must help NPs become confident that they can lead. Leadership has not been a priority for many NP programs; instead emphasis is placed on clinical practice competence only. In order to be able to lead others in practice an NP must have confidence in his or her own knowledge and skills as a clinical provider and a leader. Let’s make learning to lead as important as learning to provide clinical care. Our patients and our healthcare system will thank us.