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Point and Counterpoint |

Rebuttal From Ms BlumenthalRebuttal From Ms Blumenthal FREE TO VIEW

Nancy P. Blumenthal, MSN, ACNP-BC
Author and Funding Information

From the University of Pennsylvania Lung Transplant Program; and the Doctor of Nursing Practice Program, Yale University, West Haven, CT.

CORRESPONDENCE TO: Nancy P. Blumenthal, MSN, ACNP-BC, University of Pennsylvania Lung Transplant Program, 3400 Spruce St, Philadelphia, PA 19104; e-mail: nancy.blumenthal@uphs.upenn.edu


FINANCIAL/NONFINANCIAL DISCLOSURES: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(3):597-598. doi:10.1378/chest.14-2839
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The question is not, as Drs Pastis and Strange1 have suggested, about the best interest of the medical profession; rather, it is about what is in the best interest of the patients. A decade ago, Barber and colleagues2 published their experience in developing the first nurse-led bronchoscopy practice in the United Kingdom. Inspiration to establish this practice was drawn from concerns about inconsistency and rapid turnover of medical trainees, the multiple competing priorities of attending physicians, and the business practicalities associated with facilitating interventional techniques. In other words, they were seeking to optimize quality, access, and cost in the bronchoscopy suite. The curriculum and practical training were deemed to be “safe, well supervised, rigorous and formal.” Eight months after the program was completed, an audit was performed to evaluate the first nurse bronchoscopist’s safety and efficacy. With no adverse events and a 95% histology hit rate, findings compared favorably with published physician bronchoscopists’ results and the standards set forth by the British Thoracic Society. Regardless of the bronchoscopist’s discipline, these findings are consistent with the advice from Ernst and colleagues3 who suggested that procedural volume would beget safety and mastery.

Limiting health-care resources is impractical and unnecessary. Restricted supply and increased demand serve only to inflate the procedure cost. An abundance of evidence assures that nurse practitioners practice safely, effectively, and with good patient satisfaction scores.4-6 As Fairman and colleagues7 note, “Fighting the expansion of nurse practitioners’ scope of practice is no longer a defensible strategy. The challenge will be for all health care professionals to embrace these changes and come together to improve US health care.”

Lastly, as health care becomes patient centered rather than physician centered, it is time to dispense with the egocentric terms “nonphysician” and “physician extender.” The correct term is “nurse practitioner.” After all, the title and right to practice are hard-earned and intentionally pursued by the people who are revolutionizing the American health-care system.

References

Pastis NJ Jr, Strange CB. Counterpoint: should nurse practitioners perform transbronchial biopsies? No. Chest. 2015;147(3):596-597.
 
Barber PV, Martin J, O’Donnell PN. The development of the first nurse-led bronchoscopy post in the United Kingdom. Respir Med. 2004;98(6):504-508. [CrossRef] [PubMed]
 
Ernst A, Silvestri GA, Johnstone D; American College of Chest Physicians. Interventional pulmonary procedures: guidelines from the American College of Chest Physicians. Chest. 2003;123(5):1693-1717. [CrossRef] [PubMed]
 
Broers C, Hogeling-Koopman J, Burgersdijk C, Cornel JH, van der Ploeg J, Umans VA. Safety and efficacy of a nurse-led clinic for post-operative coronary artery bypass grafting patients. Int J Cardiol. 2006;106(1):111-115. [CrossRef] [PubMed]
 
Henderson A, Andrich DE, Pietrasik ME, Higgins D, Montgomery B, Langley SE. Outcome analysis and patient satisfaction following octant transrectal ultrasound-guided prostate biopsy: a prospective study comparing consultant urologist, specialist registrar and nurse practitioner in urology. Prostate Cancer Prostatic Dis. 2004;7(2):122-125. [CrossRef] [PubMed]
 
Moote M, Krsek C, Kleinpell R, Todd B. Physician assistant and nurse practitioner utilization in academic medical centers. Am J Med Qual. 2011;26(6):452-460. [CrossRef] [PubMed]
 
Fairman JA, Rowe JW, Hassmiller S, Shalala DE. Broadening the scope of nursing practice. N Engl J Med. 2011;364(3):193-196. [CrossRef] [PubMed]
 

Figures

Tables

References

Pastis NJ Jr, Strange CB. Counterpoint: should nurse practitioners perform transbronchial biopsies? No. Chest. 2015;147(3):596-597.
 
Barber PV, Martin J, O’Donnell PN. The development of the first nurse-led bronchoscopy post in the United Kingdom. Respir Med. 2004;98(6):504-508. [CrossRef] [PubMed]
 
Ernst A, Silvestri GA, Johnstone D; American College of Chest Physicians. Interventional pulmonary procedures: guidelines from the American College of Chest Physicians. Chest. 2003;123(5):1693-1717. [CrossRef] [PubMed]
 
Broers C, Hogeling-Koopman J, Burgersdijk C, Cornel JH, van der Ploeg J, Umans VA. Safety and efficacy of a nurse-led clinic for post-operative coronary artery bypass grafting patients. Int J Cardiol. 2006;106(1):111-115. [CrossRef] [PubMed]
 
Henderson A, Andrich DE, Pietrasik ME, Higgins D, Montgomery B, Langley SE. Outcome analysis and patient satisfaction following octant transrectal ultrasound-guided prostate biopsy: a prospective study comparing consultant urologist, specialist registrar and nurse practitioner in urology. Prostate Cancer Prostatic Dis. 2004;7(2):122-125. [CrossRef] [PubMed]
 
Moote M, Krsek C, Kleinpell R, Todd B. Physician assistant and nurse practitioner utilization in academic medical centers. Am J Med Qual. 2011;26(6):452-460. [CrossRef] [PubMed]
 
Fairman JA, Rowe JW, Hassmiller S, Shalala DE. Broadening the scope of nursing practice. N Engl J Med. 2011;364(3):193-196. [CrossRef] [PubMed]
 
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