Bloomberg Businessweek Gets It Wrong: Nurse Practitioners Provide Safe, Reliable Care to Millions of Americans

Bloomberg Businessweek Gets It Wrong: Nurse Practitioners Provide Safe, Reliable Care to Millions of Americans

Strong & Growing Evidence Supports the Role of the Advanced Practice Nurse Practitioner with Patients

Washington, DC — Millions of Americans receive safe, quality care from more than 385,000 nurse practitioners each year. Nurse practitioners help diagnose and treat illnesses and provide life-saving care to children, adults and seniors in a diverse range of communities across America. They represent some of the best that nursing has to offer, thanks to the experience and wisdom of tens of thousands of nurse educators at schools and programs nationwide.

That is why it was dismaying to see how they were so misrepresented in the recent Bloomberg Businessweek article, The Miseducation of America’s Nurse Practitioners. The story unfortunately cherry picks alarming or tragic anecdotes—which can be done for any profession, including medical doctors and journalists—rather than focusing on the sophistication and standards of excellence reflected in today’s advanced degree nurse practitioner programs, many associated with leading academic institutions, top-tier teaching hospitals, and premier health care systems.

In making the case against the increasing number of states that have expanded their scope of practice (SOP) to grant nurse practitioners full practice authority (FPA) without physician oversight, they argue that this puts patients at grave risk and imperils quality of care. Any death or injury due to health care malpractice or negligence deserves our deepest sympathy. In fact, though, strong and growing evidence supports the role of the advanced practice nurse practitioner as providers of the highest caliber, capable of providing outstanding patient care with full practice authority.

For instance, scholars Sara Markowitz and Andrew J.D. Smith published their recent findings in a working paper that examined the effects of expanding nurse practitioner scope of practice to full practice authority, using outcome data from the National Practitioner Data Bank (NPDB) available through December 2022. In Nurse Practitioner Scope of Practice and Patient Harm: Evidence from Medical Malpractice and Adverse Action Reports (Sara Markowitz, Andrew J.D. Smith, NBER, April 2023), they write:

We find that allowing NPs to practice without physician supervision leads to no changes in the number of malpractice payouts for NPs. We also observe no harm as measured by counts of adverse actions for reasons of safety violations and prescription drug violations. We also examine spillover effects to physicians and find that physician malpractice payout counts decrease after the passage of FPA, indicating a benefit to the physicians from severing the legal supervisory relationship with NPs.

Moreover, they note:

Our results agree with that of McMichael et al. (2018) and show that FPA is associated with a 21-24% reduction in physician malpractice rates. More importantly, we show that there is no evidence of an increase in NP malpractice rates after the FPA enactment. The results for adverse actions also point to no changes in terms of safety and prescription violations after FPA enactment.

Acknowledging the concerns about patient safety arising from the movement to grant nurse practitioners FPA, Markowitz and Smith conclude:

These results add to the growing literature showing that removing physician oversight requirements from the NP SOP results in health outcomes that are either no different or slightly better under NP care, with lower costs and more patient access, and with no evidence of harm or other downsides to patients.

Another study, this one by the U.S. Veterans Administration, one of the largest employers of NPs in the 50 states, District of Columbia and Puerto Rico, randomly assigned more than 800,000 patients with diabetes, ischemic heart disease, and hypertension and controlled for a host of variables, including age and geography, to either a nurse practitioner (NP) or a physician (MD). (Outcomes of primary care delivery by nurse practitioners: Utilization, cost and quality of care, Chuan-Fen Liu, PhD, et. al., NIH, National Library of Medicine, Health Serv Res, v. 55(2), Apr. 2020) The investigators concluded:

Patients reassigned to NPs experienced similar outcomes and incurred less utilization at comparable cost relative to MD patients. NPs may offer a cost‐effective approach to addressing anticipated shortages of primary care physicians.

While noting that prior research “suggests that primary care NPs provide comparable clinical care compared to MDs,” their study found: 

• NP patients did not differ from MD patients in VA health care costs
• Compared to MD patients, NP patients had less utilization of primary care, specialty care, and inpatient services
• NP and MD patients achieved similar quality of care in chronic disease management
  

With the persistent and well-documented shortage of both physicians and nurses, nurse practitioners have filled a gaping void in primary and preventative care, helping patients and families manage chronic illnesses and debilitating conditions, particularly in underserved and diverse communities. Nurse practitioners, along with nurses at every level of education and experience, also serve as frontline responders to severe and acute emergencies, be they natural disasters or the effects of a global pandemic, as our devastating experience with COVID-19 so graphically demonstrated.

The Bloomberg Businessweek article notes it is the first in a series. We hope that future articles will offer a more balanced perspective.

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