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Evolving Scope of Practice: Nurse Practitioners Weigh In

Jon McKenna | November 30, 2022 | Contributor Information

Physicians and nurse practitioners (NPs) both enjoy high demand as the country deals with shortages of healthcare professionals. Meanwhile, expanded practice roles for NPs have been quickly gaining traction. The need for doctors and NPs to work effectively together constantly rises. How is it going?

Seven hundred and fifty NPs who work with physicians told us about their working relationships with those professionals and how they changed during the COVID-19 pandemic. They also expressed their thoughts about nurses' expanding practice abilities.

A previous Medscape report gave physicians' opinions on working relationships with both NPs and physician assistants (PAs). A third report on working relationships through the eyes of PAs will be published this week.

(Note: Some chart data in this presentation do not add up to 100% because of rounding.)

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Evolving Scope of Practice: Nurse Practitioners Weigh In

Jon McKenna | November 30, 2022 | Contributor Information

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Evolving Scope of Practice: Nurse Practitioners Weigh In

Jon McKenna | November 30, 2022 | Contributor Information

By an overwhelming margin, doctors characterized their working relationship with NPs as "very good' or "good" (87%), but NPs were even more praiseworthy of physicians in that regard.

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Evolving Scope of Practice: Nurse Practitioners Weigh In

Jon McKenna | November 30, 2022 | Contributor Information

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Evolving Scope of Practice: Nurse Practitioners Weigh In

Jon McKenna | November 30, 2022 | Contributor Information

Six in 10 NPs said that their working relationship with doctors amid pandemic pressures — from enforcing mask and vaccination policies to crazed, short-staffed schedules — emerged mostly unchanged.

As for physicians' opinion, an even greater share (72%) felt that their working relationship with NPs was unaffected. Doctors were somewhat less likely than NPs to say that the relationship either improved or worsened, somewhat or a lot (20% and 8%, respectively).

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Evolving Scope of Practice: Nurse Practitioners Weigh In

Jon McKenna | November 30, 2022 | Contributor Information

On average, NPs and physicians graded one another quite similarly for the quality of their patient treatment. Seventy-one percent of doctors were satisfied, to varying degrees, with NPs' patient interactions. Another 15% of physicians were neutral and 14% were somewhat or very dissatisfied with how NPs work with patients.

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Evolving Scope of Practice: Nurse Practitioners Weigh In

Jon McKenna | November 30, 2022 | Contributor Information

Here is another area where doctors and NPs sized one another up in similar terms.

Around three fourths of NPs were somewhat or very satisfied with how physicians work collaboratively with other members of the healthcare team. Meanwhile, a nearly identical share (75%) of physicians said the same of NPs.

And NPs were dissatisfied, to varying degrees, with the way doctors work with staff around as often as physicians were with NPs (10%).

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Evolving Scope of Practice: Nurse Practitioners Weigh In

Jon McKenna | November 30, 2022 | Contributor Information

Sixty-three percent of NPs found fault with doctors' calls on patient treatment at least sometimes. Flipping the microscope around, 80% of physicians had issues at least sometimes with an NP's treatment decisions. Twenty-six percent of doctors said they see questionable treatment often, and 19% say rarely.

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Evolving Scope of Practice: Nurse Practitioners Weigh In

Jon McKenna | November 30, 2022 | Contributor Information

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Evolving Scope of Practice: Nurse Practitioners Weigh In

Jon McKenna | November 30, 2022 | Contributor Information

NPs surveyed more often doubted a physician's treatment calls than another NP's. Sixty-three percent of NPs said they had "occasionally" or "often" questioned a doctor's treatment decisions, whereas 53% raised the same issue about other NPs. And only 2% of NPs "never" had questions about a physician's treatment approach.

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Evolving Scope of Practice: Nurse Practitioners Weigh In

Jon McKenna | November 30, 2022 | Contributor Information

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Evolving Scope of Practice: Nurse Practitioners Weigh In

Jon McKenna | November 30, 2022 | Contributor Information

Physicians were emphatic on this issue: About 9 in 10 said that their workplaces provide enough in the way support such as personal protective equipment (PPE), mental health programs, and sufficient staffing.

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Evolving Scope of Practice: Nurse Practitioners Weigh In

Jon McKenna | November 30, 2022 | Contributor Information

When we put that question to NPs and asked about specific support efforts, they were emphatically positive about PPE and other safety equipment. The majority of NPs who feel that staffing levels are sufficient was smaller, and it was even smaller when it comes to adequacy of workplace mental health programs.

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Evolving Scope of Practice: Nurse Practitioners Weigh In

Jon McKenna | November 30, 2022 | Contributor Information

About half the states give NPs expanded patient treatment abilities, or full practice authority (FPA). Medscape asked both NPs and doctors what they thought of this trend.

About 3 in 4 NPs saw this trend in a positive light, and none of those surveyed felt it is a negative development. However, physicians were less enthusiastic (18% positive, 47% neutral, 34% negative).

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Evolving Scope of Practice: Nurse Practitioners Weigh In

Jon McKenna | November 30, 2022 | Contributor Information

With the overwhelming majority of NPs answering yes, this was another question that showed a sharp division with physicians. Only 31% of doctors thought more states should give FPA to NPs, and 69% said they shouldn't.

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Evolving Scope of Practice: Nurse Practitioners Weigh In

Jon McKenna | November 30, 2022 | Contributor Information

Strong majorities of both doctors and NPs said they have experienced a patient's expressed desire to consult with a physician rather than a nurse. About 7 in 10 doctors said yes, they have experienced this kind of pushback from patients.

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Evolving Scope of Practice: Nurse Practitioners Weigh In

Jon McKenna | November 30, 2022 | Contributor Information

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Evolving Scope of Practice: Nurse Practitioners Weigh In

Jon McKenna | November 30, 2022 | Contributor Information

NPs and doctors characterized their patients' response to nurses' expanded practice abilities differently. Physicians said that patients are somewhat to very favorable less than half as often (45%). They depicted that patient reaction as somewhat to very unfavorable much more frequently (27%) than NPs did.

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Evolving Scope of Practice: Nurse Practitioners Weigh In

Jon McKenna | November 30, 2022 | Contributor Information

Less than half of NPs agreed with the idea that they collaborate better with one another than with doctors. An even smaller share of doctors (23%) answered yes to this question, indicating they firmly feel that a more effective team pairs them with an NP.

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Evolving Scope of Practice: Nurse Practitioners Weigh In

Jon McKenna | November 30, 2022 | Contributor Information

Interestingly, physicians more often (51%) felt that both nurses (in career development) and patients (in quality of care) benefit when an NP earns a doctorate, residency, or fellowship. The 30% who responded "unsure" shows that many NPs have difficulty evaluating the pros and cons of advanced degrees.

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Evolving Scope of Practice: Nurse Practitioners Weigh In

Jon McKenna | November 30, 2022 | Contributor Information

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Evolving Scope of Practice: Nurse Practitioners Weigh In

Jon McKenna | November 30, 2022 | Contributor Information

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Medscape RN/LPN Compensation Report 2022

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