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Primary Health Care Services

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    For five decades nurse practitioners have been providing safe, effective, quality primary care services to all ages and populations. As a testament to their commitment and excellence nurse practitioners are being chosen as provider of choice by millions of Americans. Becoming a skilled provider is a dynamic process that occurs over time. Effective role development is essential in becoming a dynamic, compassionate, and knowledgeable clinician.

    In the sat, “nurses functioned independently and autonomously before the rise of organized medicine”, so the nurse practitioner (NP) role was not an entirely new concept (Lucille, 2009, p. 13). Since the inception of the first NP program in 1964, advanced practice registered nurse education has evolved from four month certificates, to bachelors, masters and even doctoral programs. “Although often still focusing on primary care, from the asses forward the NP role evolved to include adult/geriatrics, family, women’s health, neonatal, acute care, and other specialty roles” thus proving the adaptability of a nurse practitioner.

    A common counterpart to the nurse practitioner is the physician’s assistant (PA). According to Lucille (2009), the physician’s assistant role, established in 1961, stemmed from a disagreement in the curriculum of advanced practice nurses, the use of physician instructors in lieu of nursing instructors, and an overall non-supportive stance for the advancement of nursing. While both roles share a common goal of providing patient-centered quality health care and require physician supervision, in Michigan, there educational experience and methodology differ greatly.

    Nurse practitioners build on their skills and education received as a registered nurse, and progress to either a master or doctorate level. Conversely, physician assistants require two years of college work in basic and behavioral sciences in addition to prior healthcare experience before being accepted into a master’s level program. Differences in methodology are attributed to caring versus curing. Nurses have a strong background in theory and have caring ingrained into their practice, whereas PAS garner their education primarily from physicians and are more focused on curative processes.

    Both roles are invaluable and need to be utilized to their fullest potential to eliminate the bottle neck we are going to experience when the AC is fully implemented. Health care provider education, and continuing medical education, varies greatly between clinicians, particularly between the NP and the physician. Nurse practitioners are required to attend four years at an undergraduate level with subsequent certification as a registered nurse, after which they are eligible to attend graduate school at the masters or doctorate level.

    Naps are able to sit for licensee exam after successful implosion of graduate school and begin practice immediately after certification. Physicians are also required to attend four years at an undergraduate level. After which they attend an additional four years at medical school where they earn their doctor of medicine (MD). Newly graduated Meds enter into a residency program, with a duration of three to seven years, where they receive professional training under the supervision of senior physicians.

    Physicians also have the choice to attend a fellowship if they choose to specialize, which may be another one to three years of highly specialized training. Continuing education also differs between the two roles. Michigan Naps are required to complete 40 hours of continuing education every two years while Michigan physicians are required to have 150 hours of continuing medical education every three years. Reimbursement is going to continue to be an issue until Apron are viewed as equals to physicians.

    There is a lot of frustration with some of the coding and billing for reimbursement, however it is fortunate to have your own Billie and be able to rely on that person for those purposes. It has been reported that for Blusterous Bluefishes if we bill $100 for something, say a physical, the doc gets reimbursed $100 the NP gets $62, which can be a cause of discord With an ever- widening scope of practice and professional responsibility, more and more nurse practitioners are obtaining hospital privileges.

    There are a number of benefits to this. Hospital privileges improve the continuity of care for patients by allowing you to actively participate in their inpatient care. Hospital privileges also improve the image of nurse practitioners among patients and colleagues. Nurse practitioner led clinics are becoming increasingly prevalent. Because of their preparation and model of care, Naps will have a pivotal position in health care, responding to the demographic and epidemiological demands of an expanding, aging, and chronically ill population.

    Research supports the safety and quality of APRON care, and with the provider demand significantly higher than the supply NP clinics are an excellent way to absorb the strain. In my eyes I believe that PA’s and Naps should be able to work independently. I think it is unfair in a way that they are paid lower but at the same time an actual physician goes a bit further in their education. In my experience, I have actually had better experiences with a Nurse Practitioner than I have my own Physician.

    I felt like the NP was much more thorough and went above and beyond to figure out what was going on with me health wise than my Physician that usually is in and out in ten minutes. Definitely felt like I got more bang for my buck seeing the NP and came away feeling like I was truly cared for. I believe that some people may be afraid of seeing a PA or a NP just due to the fact that they are not actually a Physician. I could see this being more of an issue with the older generation since you did not e many of these until now.

    I think they just need to be informed that they can do everything a physician can do, well almost. If I had a choice right now, would rather see the NP than my own physician just because felt like I was better taken care of than I was by my own physician, but this is just my opinion. In my eyes, you never know what you will get until you actually try it for yourself.

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