Archives for July 2013

Arizona Nurses Primary Care Autonomy

Learn more about the primary care autonomy given to nurses in ArizonaOne of the major factors affecting overall satisfaction that nurses have with their career and pay grade is the continued struggle over the scope of authority that they can or should have regarding patient care and autonomous decision making.  This article delves into Arizona nurses primary care autonomy.

According to a survey of 972 clinicians in the New England Journal of Medicine, physicians and nurses perceive their primary care roles and skills—and their effect on costs and care quality—very differently from one another. 66% of the surveyed physicians believe that doctors provide “a higher quality of examination and consultation” than nurse practitioners (NPs), whereas greater than 75% of surveyed NPs disagreed with that assessment. Further, 77% of NPs said they believe that expanding their roles would decrease costs, compared to 31.1% of surveyed physicians. Additionally, the NPs were more likely than the physicians to believe that NPs should be in charge of medical homes and receive equal payment for the same clinical services as physicians.

For their part, a member of the Medicare Payment Advisory Commission (MedPAC) said that advanced practice registered nurses (APRNs) and physician assistants (PAs) should receive equal Medicare compensation as physicians for performing higher-level services. Also, the president and chief executive of the Dean Health System in Madison, Wisconsin, Craig Samitt, M.D., recently suggested that doctor’s pay from Medicare should decrease 15% for services that APRNs and PAs can perform better, as well as increase pay rates for APRNs and PAs in rural communities to encourage growth of care in those areas.

The 2012 Pearson Report in the American Journal for Nurse Practitioners shows that only 18 states and Washington D.C. nurse practitioners to diagnose, treat or prescribe medications without physician involvement (Alaska, Arizona, Colorado, Hawaii, Idaho, Iowa, Maine, Maryland, Montana, New Hampshire, New Mexico, North Dakota, Oregon, Rhode Island, Utah, Vermont, Washington and Wyoming). Another eight states do not require physician involvement for diagnosis or treatment, but they do require it for prescribing medications (Arkansas, Kentucky, Massachusetts, Michigan, New Jersey, Oklahoma, Tennessee and West Virginia). The remaining states (just under half of all states) require physician involvement to prescribe, diagnose or treat patients. Yet even in states where APRNs may operate independently of physicians they only receive 85% of what a doctor would be paid for a similar service. And in states where APRNs must work under physician direction the physician receives full payment at their regular fee schedule rate.

There is no shortage concerns on both sides of this “turf war.” Naturally, many physicians are concerned with potential lost income and authority, and many fear that a lower quality of care will result because of care provided by less educated and trained health care professionals. On the other hand, primary care nurses can alleviate cost, access and quality concerns in the health care system. This is particularly true since physician shortages are expected to balloon even further as 30 million new patients receive federally-mandated health insurance coverage, expanding the need for professionals who can provide primary care services.

Arizona affords relatively greater autonomy to nurses compared with most states, as indicated in the 2012 Pearson Report. Although the Centers for Medicare & Medicaid Services (CMS) recently expanded their medical staff definition to include APRNs and PAs, permitting nonphysician practitioners to have similar privileges as other medical staff members, these altered oversight rules and role definitions still require approval by the governing bodies that grant privileges. As the economic climate fluctuates, and the demand for both nurses and physicians correspondingly ebbs and flows, it will be interesting to see which states make the jump to allow greater primary care autonomy for nurses.

Arizona Nurse Pay Inequality

Learn whether there is an inequality in nurse pay in ArizonaOne of the more interesting developments to come out of the economic recession is the affect it has had on nursing employment in the United States. More men have entered the nursing profession and more states have enacted legislation permitting nurse practitioners to provide primary care duties under certain circumstances than ever before. Yet despite these changes there are still debates and concerns centering on payment equality and job satisfaction, and erasing inequities between physician and advanced practitioner pay faces potent arguments and statistical hurdles from both sides.

A recent report by the Robert Wood Johnson Foundation revealed the conflicting balance between nurses’ opinions of their jobs and of their salaries. 85% of surveyed nurses were satisfied with their jobs and 90% believe that they make a difference in their communities. On the other hand, 59% believe they are not fairly compensated, and 67% believe that their salaries are inadequate, with 56% believing that there are limited opportunities for promotion or other forms of career advancement. The survey notes that nurses have lower reported salary ranges than most state health department positions.

A change in the gender dynamic of nursing has played a significant role. According to the U.S. Department of Health & Human Services, a Census Bureau study of the nursing profession revealed that the number of male registered nurses (RNs) more than tripled from 2.7% in 1970 to 9.6% in 2011, and the number of male licensed practical nurses (LPNs) and licensed vocational nurses (LVNs) more than doubled to 8.1% over the same period. Per Alicia Caramenico, editor of FierceHealthcare, “the influx of men into the profession… could provide welcome relief, given research suggests the nursing shortage will reemerge as the U.S. economy improves,” citing a November study in the New England Journal of Medicine. However, although women still dominate the profession at 91% of all nurses in 2011, men out-earned their female counterparts by an average of $60,700 to $51,100. Further, men were more likely to be nurse anesthetists (41%), which pays more than twice that of other nursing fields ($162,900). While this is smaller than the gender pay gap in other professions, medical professionals are concerned at the continuation of this disparity.

The Public Health Nursing Workforce Advisory Committee recommends further research into how health care reform affects public health nurses regarding their functions, responsibilities and education requirements. This in turn may illuminate reasons for pay discrepancies and could help eliminate the gender gaps where they are truly inequitable. Identifying where there is a need for more training and professional development opportunities may also help.

Please contact Chelle Law with any questions regarding Arizona Nurse Pay Inequality at 602.344.9865.