Awareness is on the rise for the significant shortcomings in nurse practitioners’ training in the United States at a time of aggressive efforts to expand their ability to practice without physician supervision.
The training difference between nurse practitioners and physicians are stark:
- Some nurse practitioners can get their degree in as few as 18 months after becoming a registered nurse and they can do it through an online-only program. MDs and DOs, meanwhile, complete four years of medical school after earning their bachelor’s degree and there are no online medical schools.
- Nurse practitioners do not face a residency training requirement, while physicians must complete a three-to-seven-year residency depending on their specialty.
- Nurse practitioners experience just 500–720 patient-care hours in training. Physicians accrue around 20 times that, undergoing 12,000 to 16,000 hours of patient-care experience.
Now an investigation by reporters at Bloomberg News is bringing the bigger issue to a more mainstream audience, telling readers that nurse practitioners “increasingly treat patients independently, including in specialty practices and emergency rooms” and that “when they aren’t well trained, the results can be tragic.”
The series—“The Miseducation of America’s Nurse Practitioners” (registration required)—comes at a time when there are more than 300,000 nurse practitioners in the U.S. and it continues to be the fastest-growing profession in the nation. In 2014, there was one nurse practitioner for every five physicians. Last year, the ratio was 1-to-2.75. By 2032, the nurse-practitioner ranks are expected to climb by 45%, Bloomberg News reported.
In the first part of its “The Nurse Will See You Now” series documenting “how the increasing reliance on ill-trained nurse practitioners is imperiling US patients,” the Bloomberg News investigation explores the following.
Real-life scenarios of patients experiencing bad outcomes after being treated by an inexperienced nurse practitioner. For example, a 60-year-old Florida man, Fred Bedell, went to Florida Lake Hospital’s emergency department with dangerously high blood glucose—582 mg/dl.
A newly licensed nurse practitioner who did most of his courses online saw Bedell and sent him home instead of admitting Bedell and giving him intravenous fluids. Bedell, who never saw a physician during this episode of care, died days later of diabetic ketoacidosis.
Firsthand accounts from nursing students and professors who say a rising number of nurse-practitioner programs are graduating students who are not properly prepared to care for patients. For example, the former director of the country’s largest nurse-practitioner program said she could not recall denying a single student from being accepted and that the school that awarded one of every seven nurse-practitioner degrees in 2022 “became all about the money.”
Nurse practitioners trying to change the field for the better from within are meeting resistance and even hostility. Some nurse practitioners say “they fear professional reprisals for voicing their concerns.” One example is Texas-based nurse practitioner John Canion, who in 2018 worked with others to create a new professional organization that would in-part focus on standardizing and improving nurse-practitioner education. The American Association of Nurse Practitioners threatened the group with a copyright-infringement lawsuit.
The financial news organization also published a companion episode of its Bloomberg Big Take Daily podcast called “Why You’ll Want to Know How Your Nurse Practitioner Was Trained.”
A growing concern
Expanding nonphysician providers’ scope of practice can make patients less safe, especially when health professionals present themselves in a way that makes it difficult for patients to understand their role or training.
Fighting for Physicians
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AMA survey data shows that scope of practice tops the list of 2024 legislative priorities for medical association professionals surveyed, with 86% ranking it at the top of their legislative priority list.
The AMA is fighting scope creep, defending the practice of medicine against a wide array of inappropriate scope of practice bills so far this year. These efforts include measures that would allow optometrists to perform surgery, pharmacists to test for and prescribe medications for several conditions and bills that would allow them to treat substance-use disorder or even HIV outside a physician-led team.
Cost-cutting measures have driven a large amount of the growth in nurse practitioners and physician assistants in emergency medicine, despite research showing that these nonphysicians often deliver costlier care when practicing outside the physician-led care team.
A paper that the National Bureau of Economic Research published showed that Nurse practitioners delivering emergency care without physician supervision or collaboration in the Veterans Health Administration increased lengths of stay by 11% and raised 30-day preventable hospitalizations by 20% compared with emergency physicians.
