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A spate of collaboration efforts is taking place across the nation in which doctors are employing NPs and advanced practice nurses to contribute to the workload at hospitals, outpatient settings and geriatric centers.

At the Milton S. Hershey Medical Center at the Pennsylvania State University College of Medicine in Hershey, Pa., three nurse practitioners work in collaboration with physician teams in both the inpatient and outpatient settings. The nurses educate patients about health care concerns, from the importance of receiving flu shots to conducting breast exams and, sometimes, see their own patients for acute care issues. Among this group of MDs, NPs and other health care professionals, working together side by side has done nothing but benefit the patient population, according to Tom Weida, MD.

"It works out very well," said Weida, associate professor and medical director of Penn State's University Physician Group, Fishburn Road Family Practice. The help of NPs improves the efficiency of the practice, he said. "They can help us meet patient access demands better. It can allow better patient access for the community."

Weida also has found that hiring the NPs, who are women, helps improve the comfort level of female patients when it comes to gender-related health issues.

"The nurse practitioners are female, so the female patients are more inclined to get Pap smears and breast exams than they are with male physicians," he said.

Not only that, but the NPs at Hershey Medical Center have a strong interest in patient education, which they bring with them when seeing patients, Weida said. "They educate patients on prevention and lifestyle changes," he said. As a result, patients are more likely to consult with physicians after having been educated by the NPs. "It helps improve a lot of patient care. It opens up the discussion for topics in lifestyle changes and prevention with the doctors," he said.

Weida's team is not the only one to place NPs in collaborative roles with doctors. A spate of collaboration efforts is taking place across the United States in which doctors are employing NPs and advanced practice nurses to contribute to the workload at hospitals, outpatient settings and geriatric centers. Many health care professionals believe that such a relationship improves the efficiency and quality of care, as well as lowers the cost of patient services by having nurses conduct incidental services, thereby allowing the doctors to use their time more wisely.

Harborview Medical Center in Seattle employs NPs in a range of settings, including urgent care clinics, short-stay and limited-stay units, as well as in acute and critical care service teams, including neurosurgery. According to Cathy Ivers, recruitment and retention specialist at Harborview, a network of NPs and physician assistants was put into place to improve the quality of care within a large medical team.

"High activity was the driver for the programs here," Ivers said. "[We developed the programs out of] a concern about maintaining quality of life and navigating the system. They are an adjunct to an already stretched system in place."

The NPs improve the workflow and communication among the health care teams, Ivers said. "Nurses are great communicators. They are used to dealing with a multitude of service issues to help a patient get out of the hospital. We recognize those services as making a real contribution."

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