Nurse Practitioners in Independent Practice: A Welcome Change

When I was an intern, I probably learned more about medicine from nurses than anyone else.  When I was a geriatric fellow, I know I learned from the nurse practitioners in our program.  Over the last thirty years I’ve worked, hired, and supervised a multitude of nurse practitioners.  Let me start by saying that when it comes to taking care of vulnerable older adults, I’d trust many of the nurse practitioners that I’ve worked with more than many doctors.  I know that’s a pretty strong statement, and it definitely deserves some additional explanation and qualifications.

Let me be clear. My advice to nurse practitioners and physician assistants has long been to become lifelong learners.  As a physician, I spent the first two years of medical school learning subjects that would form the basis for the next two clinical years.  As an intern and resident, I worked long hours and spent every available moment reading about the patients that I was caring for, and their conditions.  Once I went out into practice, I continued that process.  Most of us do.  There is a lot to be said for the amount of time we spend gaining experience in caring for patients.  That’s why it’s called the “practice” of medicine.

Nurse practitioners, many of whom may already be experienced longtime nurses, go through NP training and then go out into practice.  The advice I give to them is that if they approach their patients with the goal of constantly learning, in five to ten years, they will gain a similar body of experience as a physician receives in their training, even if the part that is considered formal education is less hours.  The most important traits any physician or practitioner should cultivate in clinical practice are humility—knowing what we don’t know—and being willing to ask for help when we need it.  That applies to internists, family physicians, geriatricians, cardiologists, and physician assistants/advanced practice nurses.  Conversely, a clinician who is unwilling to ask for help, or who overestimates their own clinical acumen, is a menace.

Then there’s the matter of geriatrics.  Most physicians receive a paucity of training in geriatrics.  In fact, traditional internal medicine training runs counter to the geriatrics training we receive.  Instead of focusing on diagnosis, treatment and cure, geriatricians focus on function and quality of life.  Instead of looking at prescription medications to treat conditions, we look at opportunities to deprescribe.  I’ve trained countless nurse practitioners to provide the geriatrics approach to care.  I trust their judgment and the care that they deliver.  Are they physicians? No.  Are they geriatricians? Not exactly.  Do they deliver excellent care? Often.

All of us have limitations.  All of us should be lifelong learners.  We need to understand our own limitations and work as professionals with that knowledge.  We are all members of the healthcare team.  Working together, it is our professional responsibility to care for our patients. We don’t accomplish anything by minimizing our respective roles and value.  We all share the responsibility of delivering care.  I’ll always be honored to provide that care alongside dedicated nurse practitioners who share my passion for caring for the frail, vulnerable elder population.  At CALTCM, we have long supported the importance of the interdisciplinary/interprofessional team in post-acute and long-term care, and we welcome the independent practice of nurse practitioners as a way to improve access to care. 

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Comments on "Nurse Practitioners in Independent Practice: A Welcome Change"

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Rafael Herrera - Monday, November 02, 2020

Kudos to Dr. Wasserman. Your keen observance of the medical practice through humility and constant learning is key and much needed in a society that is reluctant to accept and complement other schools of thought. Thank you for your confidence in our nurse's ability to work hand in hand with physicians in our service of healing.

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