Research
Since 1965, Advanced Practice Registered Nurses (APRN’s) have been providing high quality, competent, and compassionate care to their patients.
Since then, numerous research studies have consistently shown that APRN’s can and do work independently of physician oversight, and provide care that is consistent with, and sometimes surpasses that of physicians. From comparable outcomes, to higher patient satisfaction, to lower utilization and ED visits, APRN’s are consistently shown to be at LEAST as competent as physicians. In fact, patients say they receive better education from APRN’s than any other group!
While physicians have (finally) begun to come around to the undeniable fact that patients are human beings who are multifaceted, and are not just their diseases, Nurses have been treating the whole person since the time of Florence Nightingale! Nurse Practitioners bring this important foundation with them to their patient care. Patients who see Nurse Practitioners routinely say their Nurse Practitioner listens to them more than any physician they see. For to heal the person, one must understand not only their illness, but also who they are and what their goals are. Nurse Practitioners have done this all along. This is the very foundation of the nursing process that sets Nurses apart from all other healthcare practitioners!
On this page are links to some of that research. We recommend you take some time and look through them, and read for yourself! There are numerous organizations and individuals who have and continue to argue against true full autonomy for APRN’s. However, the proof is in the pudding. Or, in this case, the science. With over a half century of proof of concept, the argument that APRN’s need to be supervised by a physician holds no water. There is no valid argument to not allow true full practice authority to all APRN’s in the state of Florida. When you are satisfied that Nurse Practitioners do, in fact, provide quality, competent patient care – without the unnecessary cumbersome burden of physician oversight, please call or write your state legislator and governor to let them know you want Nurse Practitioners in Florida to be legally allowed to practice to the fullest extent of their training and education, and to be overseen by ONLY the Board of Nursing.
To read the study, please click on the bold title of each. The study will open in a separate window.
As new studies are published, the page will be updated.
The Future of Nursing by The Institute of Medicine 2010. This report published by the Institute of Medicine (IOM) states “a number of barriers prevent nurses from being able to respond effectively to rapidly changing health care settings and an evolving health care system.” The report continues to state that “The United States has the opportunity to transform the health care system, and nurses can and should play a fundamental role in this transformation.” And that “Nurses should practice to the full extent of their education and training”. In it’s recommendations, the committee states, in part: “Advanced practice registered nurses should be able to practice to the full extent of their education and training. To achieve this goal, the committee recommends the following actions.
Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians (2000) – This study compared outcomes for patients randomly assigned to nurse practitioners or physicians for primary care follow-up and ongoing care after an emergency department or urgent care visit. The conclusion of the study states “In an ambulatory care situation in which patients were randomly assigned to either nurse practitioners or physicians, and where nurse practitioners had the same authority, responsibilities, productivity and administrative requirements, and patient population as primary care physicians, patients’ outcomes were comparable.”. It’s interesting that the American Medical Association agrees that APRN’s provide care comparable to physicians when they are given the same level of autonomy and authority.
Substitution of doctors by nurses in primary care. (2018) This was a review of 16 total studies, with the purpose of evaluating the impact of doctor-nurse substitution in primary care on patient outcomes, process of care, and resource utilisation including cost. The authors’ conclusions state, in part: “[t]he findings suggest that appropriately trained nurses can produce as high quality care as primary care doctors and achieve good health outcomes for patients. Indeed nurses providing first care for patients needing urgent attention tend to provide more health advice and achieve higher levels of patient satisfaction compared with doctors”.
Outcomes of primary care delivery by nurse practitioners: Utilization, cost, and quality of care. (2020) The authors examined differences in utilization, costs and clinical outcomes between NP‐assigned patients and MD‐assigned patients. They found that patients assigned to NPs were less likely to utilize primary care, specialty care and inpatient services; had no difference in costs; and experienced similar chronic disease management compared to MD-assigned patients.
Does primary care diabetes management provided to Medicare patients differ between primary care physicians and nurse practitioners? (2017) Researchers found Lower cost and better quality of care was attributed to chronic care patient management by NPs.
Medication adherence, costs, and ER visits of nurse practitioner and primary care physician patients: evidence from three cohorts of Medicare beneficiaries. (2019) Researchers examined differences in good medication adherence, office-based and specialty care costs and ER visits between patients seen by NPs and primary care physicians using Medicare Part A, B and D claims between 2009 and 2013. The three drug classes were anti-diabetics, blood pressure medications, and statins. Across all three medications, beneficiaries seeing NPs experienced lower office-based and specialty care costs and ER visits.
Differences in the delivery of health education to patients with chronic disease by provider type. (2014) This original Centers for Disease Control and Prevention (CDC) research evaluated the rate of health education provided by NPs/certified midwives, PAs and physicians to patients with chronic diseases. The authors found that health education delivery to patients with chronic conditions was higher among NPs and PAs than physicians.
Patient satisfaction with primary care: Does type of practitioner matter? (2004) This study evaluates the relationship between patient satisfaction and practitioner type during primary care visits at a managed-care organization. A retrospective observational study of 41,209 patient satisfaction surveys randomly sampled between 1997 and 2000 for visits by pediatric and medicine departments identified higher satisfaction with NP and/or PA interactions than those with physicians, for the overall sample and by specific conditions.
Interspecialty differences in the obstetric care of low-risk women. (1997) This study examined differences among obstetricians, family physicians, and certified nurse-midwives in the patterns of obstetric care provided to low-risk patients. Researchers concluded: “The low-risk patients of certified nurse-midwives in Washington State received fewer obstetrical interventions than similar patients cared for by obstetrician-gynecologists or family physicians. These differences are associated with lower cesarean section rates and less resource use.”.
Linking obstetric and midwifery practice with optimal outcomes. (2006) This study compared midwifery and medical care practices and measure optimal perinatal outcomes using a new clinimetric instrument. The results of this study showed that midwifery patients had more optimal care processes (less use of technology and intervention) with no difference in neonatal outcomes, even when preexisting risk was taken into account.
Role of Nurse Practitioners in Caring for Patients With Complex Health Needs. (2020) The objective of this study was to estimate trends in the percentage of Medicare beneficiaries cared for by nurse practitioners from 2012 to 2017, to characterize beneficiaries cared for by nurse practitioners in 2017, and to examine how the percentage of beneficiaries cared for by nurse practitioners varies by practice characteristics. Researchers concluded that nurse practitioners are caring for Medicare beneficiaries with complex needs at rates that match or exceed their physician colleagues. The growing role of nurse practitioners, especially in health care systems, warrants attention as organizations embark on payment and delivery reform.
The Burlington Randomized Trial of the Nurse Practitioner: Health Outcomes of Patients. (1974) A sample of 1,598 families were randomly allocated, so that two-thirds continued to receive primary care from a family physician and one-third received care from an NP. Four outcome measurements (i.e., mortality rates and physical, emotional and social function) were applied to patients in the trial to observe clinical effectiveness and safety. Results demonstrated comparable outcomes. Mortality rates had no significant differences between the two study groups. The measurements of physical, emotional and social function in both groups had similar levels after one year of care.
Nurse Practitioners and Physician Assistants in Acute and Critical Care: A Concise Review of the Literature and Data 2008-2018. (2019) This was a review of the literature published on NP and PA utilization and outcomes in intensive care units and acute care settings over the 10-year period between 2008 and 2018. More than 50 individual studies and reviews were identified. The authors conclude, “Overall, the studies demonstrate impact of the APP role through improved patient flow and clinical outcomes including reducing complications and improved patient care management with reduced time on mechanical ventilation, increased use of clinical practice guidelines, improved laboratory test use and increased palliative care consultations, among other areas of impact.”
Health Care Dollars and Regulatory Sense: The Role of Advanced Practice Nursing. (1992) The full Summer 1992 issue of this journal was devoted to the topic of advanced practice nursing (APN), including documenting the cost-effective and high-quality care provided, and to call for eliminating regulatory restrictions on their care. Safriet, the author, summarized the U.S. Office of Technology Administration study concluding that NP care was equivalent to that of physicians and pointed out that 12 of the 14 studies reviewed in this report, which showed differences in quality, reported higher quality for NP care. Reviewing a range of data on NP productivity, patient satisfaction and prescribing, Safriet concludes, “APNs are proven providers, and removing the many barriers to their practice will only increase their ability to respond to the pressing need for basic health care in our country.”
