0
Correspondence |

ResponseResponse FREE TO VIEW

Nancy P. Blumenthal, DNP, 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, DNP, 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;148(2):e60-e61. doi:10.1378/chest.15-0801
Text Size: A A A
Published online
To the Editor:

Promoting the practice of nurse practitioners (NPs) does not diminish the role of physicians. Nor is there any evidence to support the suggestion that advancing the scope of NP practice threatens the health of the patients. Point of fact, beyond the previously referenced studies1 that describe the safe performance of invasive procedures by NPs, there is myriad evidence2-4 that speaks to the benefits of collaborative practice (also indicated in the first article of this debate).

Perhaps reassurance can be found in the review of a few of the salient points of the argument in favor of NPs performing transbronchial lung biopsies. Health care should only be delivered by clinicians who have been trained and credentialed according to professional standards set forth by their governing agencies. Mastery of skills is achieved through rigorous training, extensive practice, and vigilant support. Individualized and routine assessment by a clinical expert is essential to determine and maintain competency within the system wherein the provider practices. The guidelines defined by the American College of Chest Physicians (CHEST)5 provide the architecture for training and standards of competency appropriate to all bronchoscopists regardless of discipline. NPs and physicians adhering to every one of these qualifiers meet the standards to perform transbronchial biopsies.

Although this editorial was written with the American health-care system in mind, its premise could be expanded beyond the United States provided that the supportive structures are in place. Specifically, scope of practice, access to training and certification, and professional licensure would have to endorse the performance of transbronchial biopsies by advanced practice nurses.

Respondents to the debate have overlooked one of the most important benefits associated with the expansion of the role of NPs: partnership. Through collaborative practice we have the opportunity to deliver care that is informed by both medical and nursing science. The evidence2-4 supports that collaborative care is cost-effective and high quality. It is good for patients and practical for providers.

Fear mongering is uncalled for, unsubstantiated, and, frankly, works against the ideals of modern health care. Patients deserve better. It is time to get to work…together.

References

Blumenthal NP. Point: Should nurse practitioners perform transbronchial biopsies? Yes. Chest. 2015;147(3):594-595. [CrossRef] [PubMed]
 
Collins N, Miller R, Kapu A, et al. Outcomes of adding acute care nurse practitioners to a Level I trauma service with the goal of decreased length of stay and improved physician and nursing satisfaction. J Trauma Acute Care Surg. 2014;76(2):353-357. [CrossRef] [PubMed]
 
Hoffman LA, Tasota FJ, Zullo TG, Scharfenberg C, Donahoe MP. Outcomes of care managed by an acute care nurse practitioner/attending physician team in a subacute medical intensive care unit. Am J Crit Care. 2005;14(2):121-130. [PubMed]
 
Litaker D, Mion L, Planavsky L, Kippes C, Mehta N, Frolkis J. Physician - nurse practitioner teams in chronic disease management: the impact on costs, clinical effectiveness, and patients’ perception of care. J Interprof Care. 2003;17(3):223-237. [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]
 

Figures

Tables

References

Blumenthal NP. Point: Should nurse practitioners perform transbronchial biopsies? Yes. Chest. 2015;147(3):594-595. [CrossRef] [PubMed]
 
Collins N, Miller R, Kapu A, et al. Outcomes of adding acute care nurse practitioners to a Level I trauma service with the goal of decreased length of stay and improved physician and nursing satisfaction. J Trauma Acute Care Surg. 2014;76(2):353-357. [CrossRef] [PubMed]
 
Hoffman LA, Tasota FJ, Zullo TG, Scharfenberg C, Donahoe MP. Outcomes of care managed by an acute care nurse practitioner/attending physician team in a subacute medical intensive care unit. Am J Crit Care. 2005;14(2):121-130. [PubMed]
 
Litaker D, Mion L, Planavsky L, Kippes C, Mehta N, Frolkis J. Physician - nurse practitioner teams in chronic disease management: the impact on costs, clinical effectiveness, and patients’ perception of care. J Interprof Care. 2003;17(3):223-237. [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]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543