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To the Editors:
I am writing to comment on the article, "Effect of a Multidisciplinary Intervention on Communication and Collaboration Among Physicians and Nurses" (January 2005: 71–76). In this prospective study, a multidisciplinary team including a nurse practitioner and a hospitalist with a team of residents and interns was created and compared with a unit of similar design without a multidisciplinary team. In addition to the creation of the team in the intervention unit, daily multidisciplinary rounds were conducted with the goal of increasing collaboration and improving communication between all members of the healthcare team. I applaud the journal’s recognition of the importance of this role and the coverage of the contributions of nurse practitioners in acute care areas.
I am concerned, however, about the way that the role of the nurse practitioner (NP) was represented in the context of this article. The NP’s responsibilities delineated within the article included accompanying attending physicians and residents during working and teaching rounds, promoting use of disease-specific pathways, providing patient education, making follow-up phone calls to patients, and providing home visits if necessary. The role, as described, does not reflect critical components of a true NP role including autonomy, collaborative clinical practice, and overall patient management. This appears to be a gross underutilization of the skills and educational preparation of an NP. The role that is described in this article is the role of case manager, clinical nurse specialist, or senior registered nurse.
An NP can provide direct patient care in a multitude of specialized practice settings. The NP practices autonomously in the clinical setting with collaboration from a single physician or physician team. In a time when the role of the NP remains misunderstood, it is imperative that every professional reader is introduced to the NP role in its most authentic form, that of a direct provider of patient care. The following statement is particularly troubling, "In order not to violate the autonomy of the residents and interns, the nurse practitioners did not admit patients on their own or write orders without the consent of a resident or an intern." In my view, this statement undermines the worth and purpose of functioning in an NP role and sends a powerful negative message to every healthcare professional, patient, and family member who has not been otherwise educated on the scope of NP practice.
Until advanced practice nurses start aggressively educating physicians and administrators on the important facets of the NP role, it will be very difficult to maintain the respect deserved in the patient care arena. Such education is especially important in the inpatient setting, where these NP professionals are expected to create their new role in an unfamiliar setting.
Baltimore, Md
The Authors Reply
We agree with Elizabeth Zink’s statement that the components of autonomy, collaborative clinical practice, and patient management are within the scope of practice of acute care nurse practitioners (NPs). However, as noted in the manuscript, the study NPs were not permitted to practice within the full spectrum of the NP role at the request of the residency program director and the department of medicine at our institution. It was feared that the residents’ education would be compromised if NP autonomous practice led to diminished patient responsibilities for the residents. In addition, there was concern that it would be bad for housestaff morale if some, but not all, residents had an NP to perform all patient care duties and thereby unevenly reduce housestaff workload.
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