In the News

Nurse practitioners bring depth, perspective to wide spectrum of patients

(Reprinted by permission from Group Health. Originally published in News & Notes from Michael Soman, president/chief medical executive, Group Health Permanente, Nov. 7, 2008)

As radical acts go, it veers to the tame. When a supervisor warned her not to attend a patient’s funeral, the young nurse went anyway. “I cared for him many months,” she recalls of the cancer patient, “and I grew close to his family. It didn’t make sense to me that I couldn’t continue to support them.”

Rewarded by the widow with a bear hug in the middle of a vast cathedral, Marie-Annette Brown never looked back.

Brown, Group Health’s Endowed Nursing Professor in Chronic Illness Care at the University of Washington, was one of the nation’s first nurse practitioners (NPs). In the three decades since she earned her bachelor's degree at Vanderbilt University, Brown, who went on to also receive a PhD, has mentored several new generations of nurse practitioners as a professor at the School of Nursing.

Brown’s path has been glorious, but seldom easy. The ability of nurse practitioners to prescribe and to practice autonomously stirred up the dust of controversy in the early 1970s. Acceptance in this state was slow and partially fuelled by Brown’s testimony before lawmakers in Olympia.

Nurse practitioners are a part of a larger group with additional education called advanced practice nurses. In Washington, they are licensed as ARNPs. There are approximately 3,500 nurse practitioners in Washington state, and with colleagues across the country, they’re celebrating Nurse Practitioner Week.

Group Health was quick to grasp the value of the nurse practitioner role and their master’s degree preparation. According to Executive Director of Nursing Operations Barbara Trehearne, PhD: “Nurse practitioners are able to deliver the full spectrum of preventive, acute, and chronic illness care, and they bring unique qualifications to the role and to our organization.”

Fears that nurse practitioners couldn’t produce health outcomes comparable to other clinicians proved unfounded, Trehearne says. “Thirty-five years of research has demonstrated that nurse practitioner performance in patient satisfaction, clinical outcomes, and cost-effective care parallels that of other providers.”

Despite the research and decades of experience, misconceptions about nurse practitioners persist, Brown explains. “One is that they see less complex patients, or are only able to care for a very limited scope of patients. In fact nurse practitioners have very thorough preparation to diagnose and treat illness, prescribe all medications, and order diagnostic tests. They have special expertise in areas such as primary care, urgent/emergency care, acute care, cardiology
and women’s health."

Nurse practitioners share a common approach, Brown says. “They’re trained to build relationships and understand the patient’s health in the bigger picture of their life—that makes them especially valuable in the treatment of chronic disease.”

The evolution of the educational preparation for all advanced practice nurses led over time to a punishing coursework load. “Eventually it took twice as many credits to become a nurse practitioner as it did to earn a master’s anywhere else at the university,” Brown explains.

Brown recently championed a DNP degree—a doctorate for nurse practitioners. That degree, too, has engendered concern.
     

As a recipient of the UW School of Nursing outstanding teaching award and Fellow in the Academy of Nursing, Brown says dispute over the new program caught her by surprise. “How can the acquisition of more knowledge ever be harmful?”

Assessment and application of evidence-based approaches demands more critical thinking than ever before, Brown says. “We’re looking at an explosion in the complexity of both patients and technology. It follows we’d need more skills to enhance the quality of our future practices.”

Two Group Health nurse practitioner staff members are currently enrolled in the University’s new DNP program. One is Caroline Hobbs, of Urgent Care at the Capitol Hill Campus and Consulting Nurse Services. The other is Sarah Matthews, who specializes in dermatology and also manages phototherapy.