Uk Aprns

Identifying the Opportunity

The authors have decided to examine the role of Nurse Practitioners within the National Health System of the United Kingdom as compared to the practicing Nurse Practitioners in the United States. Considered in this essay are both the opportunities and restrictions on Nurse Practitioners in Primary Care. Nurse Practitioners are in a prime position to deliver quality healthcare. The presumption is that certain aspects of care provided by general practitioners could be provided by the Nurse Practitioners, therefore providing efficient and cost-effective care. While evaluating the equity and efficiency of medical services, Nurse Practitioners have a significant effect on the future delivery of healthcare in the United States and could have the same effects in the United Kingdom.

Methods

Sources of information included in this essay include database searches, websearches, and information requestions from colleagues and Professors at the University of Pennsylvania School of Nursing. The folllwing websites and database proved most useful:

Nurse Practitioners in the United States

In the United States health care delivery is changing and influenced by political and economic pressures, advancing technologies, and ever changing social attitudes and values. Nurse practitioners have integrated themselves into this evolving culture and have developed a practice that holistically builds on the health needs of individuals, incorporating their families and environment. Nurse practitioners respond to many factors, including the expansion of the nurse's role in the healthcare system, healthcare delivery problems, escalating costs, scarcity of primary care providers, and the predominance of specialists emerging in the medical field (Mick & Ackerman, 2002, pp.1-10).

In the United States, the introduction of the concept "nurse clinician" was developed in 1943, by Frances Reiter. The nurse clinician role incorporated three aspects of practice; 1) clinical competence, range of function, and expansion of service 2) expertise in the clinical coordination of continuity of care 3) the professional maturity in working and collaborating with medical professionals (Mick & Ackerman, 2002, pp1-10). After the initiation of the clinical nurse specialist role was developed, it was found that the master's prepared nurses offered excellent patient care, they were superb role-models, and had begun to incorporate bedside research in to practice, which was benefited by the entire medical profession. In 1965, upon examining societal needs and with the shortage of primary care providers, the expansion of the nurse's role was developed by Loretta Ford through the first nurse practitioner program.

According to the American Academy of Nurse Practitioners, in 2001 the number of nurse practitioners in the United States had increased from 30,000 to about 65,000. Despite the emerging nursing shortage, there are projected to be more than 100,000 in 2005. The nurse practitioners role has been utilized to educate patients on health promotion and disease prevention, increase access to healthcare, and promote the community-based care in areas that were facing physician shortages.

Nurse Practitioner's are registered nurses who have attained expertise in the clinical management of health problems and typically have had extensive practice and experience in the healthcare arena. Their educational requirements include four years of college with a B.S. in nursing or related field and approximately two years of graduate school, in order to obtain their master's degree as a nurse practitioner (Appendix A). Under state regulations, nurse practitioners provide many services including diagnosing and treating acute as well as chronic disease processes, provide services in to patients in primary care settings, hospital's inpatient and outpatient population, emergency rooms, long-term care settings, and a variety of community health settings. All nurse practitioners must be credentialed in their area of practice based on the Nurse Practitioner Act and along with being credentialed, they all have prescriptive privileges. In over half the states, nurse practitioners may practice without physician supervision, although in many instances nurse practitioners work collaboratively with physicians in practice, and according to the American Academy of Nurse Practitioners, all nurse practitioners are now eligible for direct Medicaid reimbursement in all of the states.

In the United States, managed care organizations were developed in order to attain health care quality and cost-effectiveness. The managed care organizations, in an effort to reduce costs have been looking to find the most efficient way to provide care, including the collaborative practices of physicians and nurse practitioners as well as the independent practices of nurse practitioners. In The Office of Technology Study (1986), they reported that the Nurse Practitioner cost per care episode was at least 20% less then the traditional medical provider cost with the same population (American Academy of Nurse Practitioners, 2002). Nurse practitioners cost 40% less than physicians and have demonstrated cost-effectiveness in services such as preventative care, incorporating their expertise in counseling, case management, and patient/family education (American Academy of Nurse Practitioners, 2002).

Nurse Practitioners in the United Kingdom

The NHS was set up 56 years ago and is now the largest organisation in Europe and recognized as one of the best health services in the world by the World Health Organisation. The NHS has a traditional structure of centralized planning and top-down management. Primary Care Trusts (PCTs) are local health organisations within the NHS responsible for managing the health services of General Practitioners in a local area. They work with local authorities and other agencies to provide health and social care locally to make sure the community's needs are being met. Currently, General Practitioners in each PCT are capitated for services in addition to acting as gatekeepers to specialist services. PCTs are now at the center of the NHS and get 75% of the NHS budget (National Health Services, 2003). The idea asserted in this essay is that the capitated price for a Nurse Practitioner as a primary care provider would decrease the overall expenditure on health services, thuse relieving the stress on the PCT allowable budget.

The role of a nurse practitioner is not as clearly defined in the United Kingdom as it is in the United States system. The title of United Kingdom Nurse