Anne Mason, DNP, ARNP: AMA needs to do less trolling, more collaborating

Recently the Washington State University College of Nursing marked national nurse practitioner week with social media posts about the role of nurse practitioners in health care.

One post in particular drew a handful of critical comments on Twitter calling into question nurse practitioners’ education and effectiveness.

Turns out, the American Medical Association is encouraging this disrespectful and trollish online behavior with their own (since deleted) Twitter campaign under the hashtag #Stop- ScopeCreep.

It’s disheartening that this powerful organization would choose to attack nurse practitioners amid a global pandemic, health care provider shortages and in the World Health Organization’s Year of the Nurse and Midwife.

As the American Association of Nurse Practitioners said in an open letter to AMA leaders, “While NPs and physicians are working diligently each day to care for millions of American patients sickened, hospitalized – and in the worst cases – dying from COVID-19, your association has chosen to focus its energies on an offensive campaign designed to alarm and misinform the public and policymakers.”

The AMA has not made a secret of its opposition to expanded scope of practice laws for nurse practitioners and physician assistants in spite of increasing evidence that nurse practitioners are safe, effective and affordable health care providers. A 2017 study led by Catherine DesRoches, associate professor of medicine at Harvard Medical School, found that patients managed by nurse practitioners had a lower risk of preventable hospitalizations and lower use of emergency room services and other health care resources.

A 2019 study led by Christine Everett, associate professor in the Duke University School of Medicine, found no clinically significant differences in health outcomes for people with diabetes no matter what type of provider (MD, NP or PA) provided their care. WSU College of Nursing associate professor Tracy Klein, PhD, recently published a study showing that giving nurse practitioners in Oregon the authority to prescribe buprenorphine brought that gold standard treatment for opioid addiction to people who might not have had access before, especially in very rural areas.

Interestingly, the historical professional animosity between NPs and MDs cited by the American Medical Association does not match the reality of nurse practitioner experiences in Washington.

Nurse practitioners typically enjoy good working relationships with MDs and other professionals. That’s certainly the case at WSU Health Sciences, where we not only educate students to work together in interprofessional teams, we also model that behavior with nursing students and nursing educators taking part in team-based care. Range Community Clinic was developed as an interprofessional health care organization affiliated with WSU and led by executives from the WSU colleges of Nursing, Pharmacy and Pharmaceutical Sciences, and Medicine. When COVID-19 infections grew in Pullman, a team that included medical, pharmacy and nursing students as well as their MD, PharmD and NP faculty came together to meet the health care needs of the community.

With nearly 7,000 licensed nurse practitioners in Washington last year and the authority to practice independently from physicians, we treat patients in nearly every health care setting – hospitals, outpatient clinics, nursing homes, community health centers and prisons. And, with a shortage of primary care physicians in this country, especially in rural areas, we are helping address that problem.

Premera Blue Cross agrees. Earlier this year, the health insurer committed $4.7 million to create the Rural Nursing Health Initiative, establishing enhanced clinical placements for nurse practitioner students throughout the state. The WSU College of Nursing is one of six nursing programs taking part. In addition, the Department of Veterans Affairs believes nurse practitioners provide sound care to the nation’s veterans. Last year the VA granted full-practice authority to nurse practitioners across its vast system, meaning NPs can work independent of physician oversight. And in our current health care crisis, nurse practitioners continue to play a critical role; quickly standing up telehealth care, addressing mental health concerns and supervising drive-through test sites.

It’s well past time for the AMA to stop sowing doubt about the care provided by nurse practitioners and denying the vital role we play in our health care system. The organization says it is “Dedicated to … removing obstacles that interfere with patient care and confront the nation’s greatest public health crises.”

That’s a goal we all share.

Anne Mason, DNP, ARNP, PMHNP-BC, is Associate Dean for Graduate Programs and Doctor of Nursing Practice Program Director at the Washington State University College of Nursing. She is also a practicing Psychiatric-Mental Health Nurse Practitioner.