Is the ‘Nurse Practitioner Mindset’ Doing NPs a Disservice?

I recently had a conversation with a nurse practitioner student frustrated that her clinical preceptors had been primarily MDs. She felt that while working alongside a physician was valuable for clinical learning, she was not taught to practice like a nurse practitioner, ‘caring for the whole patient’. Questioning her further about her experience, she felt that NPs might spend more time with their patients as opposed to running ‘patient mills’ which had been her experience with physician preceptors. 

I related to this student’s frustration in regards to the time providers are expected to spend with patients. Fee-for-service reimbursement models in healthcare encourage quick visits as treating greater numbers of patients is the easiest way to improve practice revenues. However, I have always questioned this sentiment of the ‘nurse practitioner mindset’, typically explained by NPs as the distinction from physicians in which nurse practitioners ‘care for the whole patient’. Promoting our value as nurse practitioners with such characteristics may be hurting us more than helping us. 

Are NPs the only ones who 'care for the whole patient'?

Nurse practitioners are educated in a different manner than that of physicians. Our training involves more theory-based curriculum and often occurs in a stepwise process with time spent in a nursing role between degrees. A background in nursing also gives NPs a somewhat different perspective on patient care. As nurses we have changed a bedpan or two, been on the receiving end of orders, and spent substantial amount of time with each of our former patients carrying out nursing interventions. The disconnect comes when we step into the nurse practitioner role - that of a provider. Does this perspective benefit as we become providers? Realistically, it has both benefits and drawbacks. 

An inaccurate distinction

The sentiment that nurse practitioners ‘care for the whole patient’ is typically presented in such a way that it assumes physicians do not. This is a mindset with which I disagree. Of course MDs treat patients with more in mind than the problem at hand. As healthcare providers, we all prescribe medications taking into consideration other body systems that might be affected. We order home health services for patients who may not be capable of carrying out treatment plans on their own. We prescribe less expensive medications to those who will not be able to afford pricier alternatives. Such considerations are a natural consequence of being an experienced and capable provider in either profession. ‘Caring for the whole patient’ does not distinguish NPs from MDs.

The problem with the 'NP mindset'

Nurse practitioners who promote the 'NP mindset' and 'caring for the whole patient' often neglect to take financial aspects of patient care into account. Of course, superior patient care occurs in a one hour visit as opposed to a 15-minute encounter. But, can a medical practice stay afloat paying staff salaries and other overhead expenses with each provider treating only a handful of patients each day? Probably not.

Nurse practitioners approaching their work with the idea that such visits should be the norm find themselves frustrated with their employers, and laves employers frustrated with NPs. As nurse practitioners we must seek a more balanced perspective. Yes, we provide excellent patient care, but we must do so in a manner that sustains our practices financially. Promoting the idea that NPs are different in that we take more time with patients and somehow provide care that doesn’t conform to business principles is a disservice to our image. And, it gives NP students an unrealistic expectations as to how employers measure workplace success. 

Value - the real distinction

As nurse practitioners, one of our greatest assets is our value. Yes, we provide excellent patient care. And, perhaps this is what we intend to convey when we talk about the ‘NP mindset’ and ‘caring for the whole patient’. Having spent time placing foley catheters, administering medications, and interacting with patients in the nursing role lends itself to providing excellent service. We’ve heard the comments made when the provider leaves the room, and worked our way up the educational ladder. This allows us to talk with our patients about healthcare in a way with which they can relate. Delivering this type of service to patients keeps them coming back. 

Not only do we as nurse practitioners excel in relating to our patients, we do so in a cost effective manner. NP salaries overall are significantly lower than those of physicians. As a result, hiring nurse practitioners is a business savvy move in most practice settings. A high standard of patient care at an affordable cost can't be beat. 

Healthcare providers, both NPs and MDs alike, would prefer lengthier visits to provide better care. Unfortunately, this ideal isn’t always practical. Sure, with lower salaries compared to physicians, practices can afford to schedule longer patient visits with nurse practitioners onboard. Promoting our profession based on the fact that we 'care for the whole patient', however, does us a disservice.

Employers are primarily concerned with the bottom line - revenue. If we want to advance our profession, as NPs we must market ourselves in a way that is attractive to practices inevitably focused on this metric. Our overall value is our best asset, 'caring for the whole patient' and the 'nursing mindset' are not what makes NPs an attractive asset to an employer. 

 

Comments

I believe NP in certain settings such as ER and Urgent Care, are expected to use the "medical model" when caring for patients. Otherwise, you would only see PA hired in these areas.

Ari

I don't agree! NP holistic model does not just focus on the illness as with physicians!!
Yes, learning the medical aspect and integrating that with the nursing model is difficult but, that is what separates PA's from NP's.
We Nurse Practitioners will look at and take into consideration that a medical condition effects not only that one body part but, it effects the patients lifestyle, family dynamic and their peace of mind. Most medical models don't have time for that! The problem is not the NP model, the problem is conducting patient care via conveyer belt as the finances dictate the medical model!!

Natalie