Advanced Practice Nurses: A Safe and Cost-Effective Option

The utilization of Nurse Practitioners in the United States has grown rapidly in the last thirty years and has gone a long way in improving care in and outside of hospitals. Nurse midwives practice in a variety of settings, providing specialized and effective care to the women they serve. Nurse Anesthetists also provide cost-effective care in many settings. Both provide an important service to at-risk populations and have excellent patient safety rates.

Nurse midwives in private practice have the opportunity to provide care in hospital settings, birth centers, and in client homes. They can practice in birth centers and clinics as well, providing wonderful continuity of care for those that they serve. Within birth centers, midwives have impressive results, boasting a combined intrapartum and neonatal mortality rate of only 1.6%, and a cesarean rate of 6.1% (“Midwifery”, 2012). This kind of care is extremely beneficial to our communities and cost-effective. Even when a woman decides to give birth in her home, a Certified Nurse Midwife (CNM) can provide this service, and continue to be involved in the case of a transfer to a hospital setting.

In hospital settings, CNMs work closely with physicians. Many CNMs work either in practice with other midwives or in doctors’ offices. They can administer certain medications to women in their care. In birth centers and homes, midwives are almost always the primary caregivers and rely little on physicians unless dealing with a high-risk pregnancy. In these settings they have the autonomy to practice within the guidelines of their accrediting organization, collaborating with other caregivers only as they see necessary for the care of their patient. In clinics, Nurse Midwives have the opportunity to provide a wide variety of clients with full gynecological care.

Reimbursement to Certified Registered Nurse Anesthetists (CRNAs) is important for ensuring cost-effective care to at-risk populations. Both Nurse Anesthetists and Nurse Midwives provide quality care while saving money for both private insurance and Medicare. The care they give is invaluable, though there are many issues and controversies concerning the utilization of CRNAs, including reimbursement and the need for oversight.

CRNAs are undoubtedly a cost-effective solution for many regions. Whether practicing in largely populated areas or rural areas, they can care for patients at a much lower cost than physician anesthetists. In rural areas particularly, CRNAs give invaluable care to a portion of the population that has no access to physician anesthesiologists, since rural areas have difficulty attracting such highly paid physicians. By helping to manage chronic pain and providing anesthesia services for surgical procedures, CRNAs cut down costs of transport to far-away facilities and even negate the need for some patients to enter skilled nursing facilities (Janice, 2012). It would be a no-brainer for insurance companies to reimburse this care. Ending reimbursement and compensation for CRNAs would end this care and cause issues for those in rural areas for no good reason, but it is happening anyway.

One of the current debates is whether or not CRNAs have the appropriate training to administer anesthesia without the supervision of a physician. Many argue that it is out of the CRNAs scope to participate in the many aspects of a surgical case. Despite this, there are enough published studies to confirm that the care that CRNAs give is safe and effective.

Nurse Midwives and Nurse Anesthetists are both cost-effective and are excellent at serving at-risk communities across the country. They are so cost-effective that it would be simply unreasonable not to utilize them more. Perhaps the issue so many people have with these professionals is that they are non-physicians doing “physician” jobs, and they are doing them so well! Advanced Practice Nurses face many obstacles, and struggle to be recognized as the effective care providers they are.  

References

Midwifery: Evidence-based practice: A summary of research on midwifery practice in the United States. (2012, April 1). American College of Nurse-Midwives. Retrieved from http://www.midwife.org/ACNM/files/ccLibraryFiles/Filename/000000002128/Midwifery%20Evidence-based%20Practice%20Issue%20Brief%20FINALMAY%202012.pdf

Janice, I. (2012, October 12). Ending Medicare reimbursements to nurse anesthetists could cut off care to thousands. MedCity News. Retrieved from http://medcitynews.com/2012/10/ending-medicare-reimbursements-to-nurse-anesthetists-could-cut-off-care-to-thousands/#ixzz2yuYUGKVA