During my phone call to Mr. Steele he informed me once again, “I’m changing doctors”. This client had been referred to Case Management for his new diagnosis of prostate cancer, for which watchful waiting had been recommended. But he also had uncontrolled Type II Diabetes, hypertension and numerous other problems as well as a history of noncompliance. In the four months since I had opened him to Case Management, he had changed primary care doctors twice, and now he was changing again.
Mr. Steele and I had developed a good rapport and he wanted me to recommend a new Primary Care Physician. Knowing his track record, I was more than a little uneasy making a recommendation.
His noncompliance was due to not understanding “why” he was told to do something. Once he was educated on the “why” and “how” he was happy to comply. He was very proud of the progress he was making with his lifestyle changes. I was afraid if he did not like the PCP I recommended it could damage the trust we had built and the progress he had made.
I began asking him why he decided to stop seeing his previous 3 doctors. He spent the next 10 minutes telling me all of the reasons he was not satisfied. They all seemed to stem from the same issues, he did not feel that he was heard, respected or educated. In his opinion, each visit was a waste of his time.
I then asked him what he was looking for in a doctor. He wanted someone who would listen to him, spend more than 3 minutes with him, educate him, and take the time to make sure he understood the plan of care before he left the office. I told him he was not looking for a doctor, he was looking for a Nurse Practitioner.
Nurse Practitioners play an important role in healthcare, but many people do not understand who they are. Nurse Practitioners are Registered Nurses who receive advanced education and clinical training resulting in a master’s degree. The training they receive prepares them to provide both preventative and acute health care services to individuals of all ages. The American Nurses Association states that 60 to 80 percent of primary and preventive care can be performed by Nurse Practitioners. They focus on the overall health and wellness of their patients by using a comprehensive approach to healthcare and providing high-quality, cost-effective, individualized care for patients.
- Take health histories
- Perform physical examinations
- Diagnose and treat acute problems
- Diagnose and treat chronic problems
- Order and interpret x-rays, labs, and other diagnostic tests
- Prescribe and manage medications
- Prescribe and manage therapies
- Provide counseling and health education
- Refer to other health professionals as needed.
Quality of Care
Research has shown that care provided by Nurse Practitioners is comparable to physician provided care. Studies have also shown that NP’s achieve equal or higher patient satisfaction scores when compared to physicians and spend more time with patients during clinical visits. In regard to quality-related outcomes calculated by actual changes in physiological findings, such as lower weight, blood pressure, blood sugar and cholesterol, NP’s successfully manage hypertension, diabetes and obesity as well as physicians. In addition, the findings of process related quality measures such as providing preventive education, prescribing accuracy, patient satisfaction and time spent with patients show that NP’s provide equal or superior quality of care.
While patients did not show a preference for an NP or Physician for nonmedical aspects of care, they did report a preference for care from a physician for medical aspects of care. I believe this is due to lack of education. Patients believe only physicians can diagnose, treat and heal their illnesses.
The Case Manager’s Role
As Case Managers, it is our job to educate them on the equal care NP’s provide. Not every patient will be better served by an NP, but when appropriate we can spread the word on the great care NP’s are providing. The next time your patient tells you they can’t get an appointment with the doctor for a month, but can get in with the NP in a week, use that opportunity to educate the patient about the NP.
And as for Mr. Steele, he made an appointment with the NP in his Primary Care Physician’s office. He is very happy with the care he receives and has been compliant with his care for over 6 months.
This post was written as part of the Nurse Blog Carnival. http://thenerdynurse.com/nurse-blog-carnival More posts on this topic can be found at http://yourahi.org/blog. If you are interested in participating find out more details and sign up. Nurse Blog Carnival http://thenerdynurse.com/nurse-blog-carnival