Becker's Hospital Review

48 CMO / CARE DELIVERY Letter to the editor: Nurse practitioners are not 'mid-level' providers By Colleen Chierici, BSN, RN; Aney Abraham, DNP, NE-BC, RN; Lynne Braun, PhD, CNP, FAHA, FAANP, FPCNA, FAAN; Rae- chel Ferry-Rooney, DNP, APRN, ANP-BC; Ingrid Forsberg, DNP, APRN, FNP-BC; Terry Gallagher, DNP, APRN, FNP-BC; Angela Moss, PhD, APRN, ANP-BC F ieen physicians are expected to be let go from Naperville, Ill.-based Ed- ward-Elmhurst Hospital by March 31, as reported by Becker's Hospital Review. ese physicians, who work in immediate care clin- ics, will be replaced by nurse practitioners. is has understandably upset physicians and hearing of anyone losing their job is distressing. But as a group of nurse practitioners, we take umbrage with two things: the use of the term "mid-level" by Becker's and the implication pa- tients are being put in danger by this decision. e term "mid-level" is outdated and de- rogatory toward nurse practitioners because it suggests that the care they provide is not "high-level." Nurse practitioners, trained at the masters and doctoral level, are visited 1.06 billion times a year by patients. In addition to being healthcare providers, nurse practitioners ed- ucate, innovate, conduct research and are in- volved with the development of health policy at the state and federal level. Since the introduction of the role of the nurse practitioner in 1965, researchers have rigorous- ly studied the quality of care nurse practitioners provide as well as their outcomes. is large body of research has consistently demonstrated that nurse practitioners provide safe, effective, patient centered, timely and efficient care. A 2014 study demonstrated a link between nurse practitioners having full practice authori- ty and a decrease in readmission rates for Medi- care-Medicaid patients. Readmission rates are one of the quality indicators CMS uses to gauge the safety and efficacy of hospitals. A 2012 study from Australia demonstrated similar patient outcomes between physicians and nurse practitioners in a fast-track emer- gency department, although the nurse practi- tioners had higher patient satisfaction rates. Similarly, in critical care settings, nurse prac- titioners have demonstrated improved time to consultation/treatment, mortality, cost savings and patient satisfaction. Nurse practitioners are 25 percent of health- care providers in rural America, where access to care has been a long-standing problem and healthcare providers are desperately needed. e number of nurse practitioners in rural practice settings increased 43.2 percent be- tween 2008 and 2016. Nurse practitioners also fill critical healthcare gaps in densely populated areas, and partic- ularly so among the most vulnerable such as low-income families, immigrants, and persons suffering from homelessness, mental illness, and substance abuse. In Illinois, approximate- ly 50 percent of the nearly 4,000 Illinois-li- censed nurse practitioners provide care in the Chicago metro area and do so among some of the city's neediest populations. e high quality care that nurse practitioners bring to healthcare was recognized by the Department of Veterans Affairs in 2016. e VA announced full practice authority for ad- vanced practice nurses, joining the now 20 states with full practice authority in the U.S. With this policy change the VA recognized that nurse practitioners provide safe and ef- fective primary care while improving patient access to care. To be sure, all members of the healthcare team are valued and indispensable to pro- ducing excellent outcomes for our patients. We are disappointed our physician colleagues have been laid off as many of us work along- side physicians in equitable practice-settings. But the care nurse practitioners provide is not "mid-level," nor are we physician replace- ments. We have our own clearly defined pro- fession and our goal is to provide the highest standard of care to patients whether that is inpatient or outpatient, rural or urban areas. ere is plenty of work for us all — our pa- tients need us. All authors are faculty, nurses and nurse prac- titioner clinicians at Rush University College of Nursing and Rush Health in Chicago. n Northwell Health affiliates with 600-physician group By Emily Rappleye N ew York's largest health system, Northwell Health, and its largest inde- pendent medical group, CareMount Medical, joined forces with a clin- ical affiliation agreement announced Dec. 10, 2019. The New Hyde Park-based health system and Chappaqua-based medical group, which remains independent as part of the agreement, launched their new partnership Jan. 1, which may include clinical integration and population health initiatives. The two entities also plan to collaborate on ambulatory strat- egy. Northwell has roughly 750 outpatient facilities and 200 primary care prac- tices, while the multispecialty medical practice brings a team of more than 600 physicians and advanced practice providers at 45 locations to the partnership. CareMount also operates urgent care centers, clinical laboratories, radiology services sites, endoscopy suites and infusion suites. "We're extraordinarily pleased to be taking this important next step in our re- lationship with CareMount, which has a well-earned reputation for delivering high-quality care and optimizing the patient experience," Michael Dowling, president and CEO of Northwell, said in a news release. "We look forward to pur- suing mutually beneficial opportunities that will further enhance patient care." CareMount clinicians were given faculty appointments at Northwell's Zucker School of Medicine at Hofstra, based in Hempstead, N.Y. The agreement builds on CareMount's existing relationship with Northern Westchester Hospital in Mount Kisco, which is part of Northwell Health. n

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