More on Classic Manuscripts

Donna G. Nativio, PhD, CRNP, FAAN

W e are pleased to continue our salute to classic manuscripts in this issue of the Journal. “The Burlington Randomized Trial of the Nurse Practitioner” was initially published in the New England Journal of Medicine in 1974. In the early seventies, the notion of substituting nurse practitioner for physician in primary health care delivery was being widely discussed. This was a change from the earlier years of the nurse practitioner movement when we were careful to avoid the idea of substitutability. The suggestion that, in fact, that’s where we were headed grew out of the experience of physicians and nurse practitioners working together. We had long known that not every patient seeking care needed to see the physician. What was newly recognized (and reported anecdotally) was that in some instances even requiring oversight was not a good use of physician time and could disrupt the continuity of care delivered by the nurse practitioner. Physician/nurse practitioner teams reported that patients were satisfied with the care of the nurse practitioner; they appreciated knowing that physician consultation was available but seldom asked for it.

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The doubters argued that the quality of care would suffer and that patients would not select a practice where care was not exclusively from the physician. The Burlington study was among the first to be published that provided quantitative clinical evidence that nurse practitioner care was both safe and effective. In addition, the sample was large enough (296families received nurse practitioner care, 521 physician care) to allow detection of small differences in the variables under study. Pre and post measurements of the physical, emotional, and social status of the patients showed no difference between physician and nurse practitioner care. Ninetysix percent of the nurse practitioner’s patients were satisfied with their care compared with 97% in the physician group. During the study, 0.9%of the physician families and 0.7% of the nurse practitioner families left because of dissatisfaction. Because of the addition of the nurse practitioner, the family practices involved in the study were able to expand their caseload by 22%. However, this was not a financial boon. Gross revenue dropped by 5%because reimbursement was not available for the services of an “unsupervised nurse.” But that’s another editorial. . .

JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS

More on classic manuscripts.

More on Classic Manuscripts Donna G. Nativio, PhD, CRNP, FAAN W e are pleased to continue our salute to classic manuscripts in this issue of the Jou...
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