Study: Advanced-Practice Nurse Care Comparable to Doctor Care

BALTIMORE—Today’s primary care physicians in the United States are too few in number to meet the healthcare needs of a burgeoning population; healthcare reform will only amplify the problem. That’s where nurse practitioners, nurse midwives and other advanced practice nurses enter the picture. But do these master’s-trained, board-certified nurses have the skills needed for autonomous practice that can help bridge the expanding gap between need and healthcare services? The answer is an unequivocal “yes,” according to “Advanced Practice Nurse Outcomes 1990-2008: A Systematic Review,” a groundbreaking assessment of the quality of care provided by advanced practice nurses in the United States.

Writing in Nursing Economics, Johns Hopkins School of Nursing associate professors Julie Stanik-Hutt, PhD, ACNP, CCNS, FAAN; Kathleen M. White, PhD, RN, CEA-BC, FAAN, and colleagues present what Stanik-Hutt calls “the stuff of which new health policy is made.” The analysis of 18 years of U.S. studies (1990-2008), found care by advanced practice nurses to be of comparable quality, safety, and effectiveness to that of physicians. Stanik-Hutt likens the study to research comparing the relative capacity of two different medications to treat the same illness; here, the study compares advanced practice nurse and physician effectiveness when treating people with the same illnesses.

The study, conducted by a multidisciplinary team and funded, in part, by the Tri-Council for Nursing, specifically found care by nurse practitioners and nurse midwives is as good as, and in some ways better than, that of physicians. Clinical nurse specialists not only enhanced the quality of care for hospitalized patients, but also reduced unnecessary hospital days, stays, and readmissions.

According to Stanik-Hutt, the findings reflect the distinct, but complementary prisms through which nurses and physicians view patients. Physicians treat and cure disease; advance practice nurses see patients, not pathology. Both provide effective interventions, but for different reasons. She said, “The study isn’t about who is a better health provider. Rather, the study suggests the value of enabling both doctors and advanced practice nurses each to do what they do best in a collaborative, but autonomous environment. When each profession works to its strengths, without the fetters of current regulatory restrictions, the unique contributions of both shine through. And that’s what I call a win-win for patient care and for providers alike.”

The Johns Hopkins University School of Nursing is a global leader in nursing research, education, and scholarship. The School and its baccalaureate, master’s, PhD, and Doctor of Nursing Practice programs are recognized for excellence in educating nurses who set the highest standards for patient care and become innovative national and international leaders. Hopkins was the first nursing school in the country with a Peace Corps Fellows Program and is ranked at the top of the enrollment rankings for colleges and universities that are Peace Corps Fellows/USA partners. Among U.S. nursing schools, the Hopkins community public health nursing master’s program is ranked first by U.S. News & World Report; the nursing graduate programs overall are also ranked first. Each year, the School’s nursing research program and faculty achieve placement among the top 10 in nursing schools for securing federal research grants and for scholarly productivity. For more information, visit .

Source: Johns Hopkins University School of Nursing


4 responses to “Study: Advanced-Practice Nurse Care Comparable to Doctor Care

  1. Lois Freeman DNP, CRNP-BC CCRN

    I would like to say that the outcomes of patirnts that are cared for ny the NP group is equal to the MD. The patients say tat we are more patient focused and taqke the time to talk to and teach them. Each specilist has a contribution to make to healthcare. Let’s take off the gloves and just take care of te patients.. They need us!

  2. Having worked side by side with one of the most talented clinicians, a pediatric nurse practitioner, for over 20 years, I can unequivocably say that NPs are extremely valuable members of a TEAM. As a pediatric otolaryngologist, the numbers of hours training, following the patient through the surgery, having seen the pathology up close, bearing ultimate responsibility, taking the night calls, etc. gives me as enormous advantage.
    It is insulting to me that b/c I am an MD that I don’t “care” about the patient and am there to only manage the disease. This article written by nurses does not really tease out what outcomes we are talking about. Caring for and about people requires complex skills and knowledge. The training for NPs is just not at the level where I would trust their autonomous practice. The model in my practice is a tight team and that allows us to deliver high quality care.

  3. Kathryn Gelo, MS, FNP, APN, NP-C, CWS

    This isn’t simply an article written by nurses. It is an article written by nurses with terminal degrees and several other advanced credentails between them, summarizing an 18 year study comparing the “outcomes we are talking about” to quote Dr Brodsky. I reread this article twice and I did not see any statement that would suggest that an MD does not care. I can’t imagine what advantage Dr Brodsky is referring to, NPs have had numbers of hours of training, NPs have followed patients through surgery, NPs have seen the pathology up close, NPs have taken night call, and make no mistake, NPs bear the ultimate responsibility for any descisions we make. Of course Dr Brodsky bears the ultimate responsibility related to her practice. With that in mind and her statement “The training for NPs is just not at the level where I would trust their autonomous practice.” I can’t imagine why any physician would want to be “ultimately responsible” for decisions anyone else makes. NPs possess complex skills and knowledge. The Science of Nursing has many parallels with the Science of Medicine but it also has distinct differences as well. Differences that are more often misunderstood by physicians and as a result of that misunderstanding, disrespected. Autonomous practice is a concept also very misunderstood. NPs want the regulatory restrictions removed in an effort to facilitate access to care for patients. We are not Lone Rangers. My definition of TEAM is the network of physicians, surgeons, nurse practitioners, nurses, physical therapists, specialists etc. who work together in many different practice models to deliver high quality care. I am licensed in a state that currently requires a MD/NP collaborative agreement. When the legislation changes to allow autonomous practice for NPs (and it will) we will still be a part of the same TEAM.

  4. Great post. I am very impressed with the quality of
    health content in here. Please update your site more
    often. I will drop by again regularly to see your updates.

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