Twenty-first-century primary care: new partnerships between nurses and doctors.

Abstract

What role will advanced practice nurses (APNs) play in tomorrow's health care system? The author shares her answer to this question by first looking at the history of APNs and nurse practitioners (APNs whose focus is primary care), explaining what they do, and tracing their increasing success in overcoming long-standing barriers to full acceptance as providers of care. The author emphasizes that while APNs' advancement has usually been based on demonstrating sameness of practice processes and outcomes with those of physicians, in actuality, APNs-whose advanced primary care is delivered with full accountability and is indistinguishable from such care delivered by physicians-offer a different style of practice, which involves caring, nurturing, support, engagement with patients, attention to illness prevention and health promotion, and patient education. It is this difference on which APNs' survival rests. The author then discusses the educational training, economic, marketplace, and other questions that must be answered if APNs and physicians are to achieve a non-competitive, richer future, one in which both work together as partners rather than as members of a hierarchical team. Ultimately, such a future will be possible only when APNs have the same independence, access to patients, and voice in the treatment plan that physicians do.