In my last President's Message, I wrote about the opportunities for nursing and other healthcare professions to “keep the voice alive that argues for the social contract that has for so long been buried in the marketplace.”
1 That social contract has to do with aiding the safe passage of people through illness and health problems, protecting the public as they encounter health care, and providing for the common good in terms of the social determinants of health.
One of the many threats to that social contract and that common good is the diminishing access to primary health care and the fragmentation of that which is accessed. Over the course of the past few years, there have been many calls for reforming the payment incentive system and health professions education to create a real system of primary health care—person-focused and coordinated.
I have written over the past year about important nursing contributions to healthcare reform, patient-centered care, and care coordination.2, 3, 4 American Academy of Nursing (ANN) leaders have been active participants in a number of interprofessional gatherings examining models of care that bring healthcare professionals together in providing patient-centered, coordinated primary and transitional care. At the same time, there have been other gatherings focused on protecting the turf of one or more health professions.
The recent publication of a policy brief about physicians and nurse practitioners (NPs) in primary care is a clear indicator of coming together, rather than breaking apart over fulfilling the social contract with the American public. The February 2009 publication of the American College of Physicians (ACP) policy brief entitled Nurse Practitioners in Primary Care5 is a clear bridge between our 2 professions, implicitly centered on the social contract. While some in the nursing community have criticized the document because no nurse practitioners were on the writing committee, I would urge those critics to read the document carefully. It reflects a careful reading of the literature about the education, outcomes, and practices of nurse practitioners in primary care and clearly had the benefit of interviews with nursing leaders in the field. There is strong acknowledgement of the common ground between advanced practice nursing and medicine in terms of the social contract and related policy:
The American College of Physicians recognizes that NPs and physicians have common goals of providing high-quality, patient-centered care and improving the health status of those they serve. In addition, physicians and NPs share concerns regarding appropriate reimbursement for services provided, especially related to care coordination, and the decline in the primary care workforce.5
The authors go on to affirm that patients' needs and preferences should be met by the health professional with the most appropriate skills for those needs, that team care and collaboration is often the best way to provide that care, and that advance practice nursing is important in primary care. Further, the authors emphasize that nursing should be developing licensing and examination for nurse practitioners and specifically oppose the development of such examinations by the National Board of Medical Examiners for the Doctor of Nursing Practice (DNP). The document also calls for testing of nurse-led demonstration models for the patient-centered medical home demonstrations. They do not go quite so far as to rename these healthcare homes.
Among the final recommendations are 2 that are near and dear to my heart: “…research efforts to identify and disseminate effective models of collaboration, referral, and co-management of patients between and among nurse practitioners and physicians” and incorporation of “opportunities for professional multidisciplinary training and team development…into the education and training of all health professionals.”5
This is a very important policy paper and an invitation to real collaboration. I invite leaders in the nursing profession to join AAN in accepting this and other invitations to shape the interprofessional nature of reformed health care.
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