Melanie Cole (Host): Members of the MIT Traditional Health Plan are required to use an MIT Medical care provider and students are strongly urged to select a PCP at MIT Medical as well. Welcome to Conversations with MIT Health. I'm Melanie Cole. My guest is Maureen Johnston. She is MIT Medical chief of nursing. Welcome to the show, Maureen. Tell us what is a nurse practitioner?

Maureen Johnston NP (Guest): Hello, Melanie. So, a nurse practitioner is a registered nurse who has taken advanced education and usually the requirement is a masters degree and then they have to undergo further certification toward taking a further exam which actually means that they are confident to work out in some practice level and nurse practitioners are becoming very popular and they are able to, there are new licences, the licence to diagnose, to perform physical exam, to order tests, write prescriptions, to provide really all the services that our primary care MD provides.

Melanie: So, how will they differ from an MD?

Maureen: In certain settings, Melanie, there is a very little difference for example in the primary care environment, where a lot of the care is about preventive care, about managing chronic disease, and about really trying to make people well, and to manage their illnesses as they arrived. There is very a little difference. I think where I see the greatest difference is MDs are probably becoming more specialised and many of them are going into the kind of speciality as urology or surgery and indeed medicine is becoming much more complex and specialized, so I think that there’s a gradual shift in where MDs are practising and where MDs now are finding new opportunity.

Melanie: So, Maureen, if you would reiterate for us. What services does a nurse practitioner offer and certainly an M.D. would offer these as well, but there are advantages to using a nurse practitioner may be you might spend a little more time with the patient. What other services, counseling, nutrition, and tests you mention prescriptions, what are the services do you offer?

Maureen: Nurse practitioners have rightly got the reputation of providing holistic care and that is where because of the nursing background, they are very interested in the patient as a whole person and that their training is very much about looking after the physical, mental, and emotional wellbeing of the patient because of course these things are all connected and medical training is very much more focused on disease process and I think therefore patients really appreciate and studies have shown that the patients have really a higher level of satisfaction in their interaction with nurse practitioners, so I think because I feel that there is some more connection to the whole caring process, why nurse practitioners are completely confident in doing the technical side of the patient’s care, they also have I think a lot more interest in helping the patients to understand that it’s not just to see progress, but also how the patient is coping.

Melanie: Well, certainly people have come to rely on their nurses for that extra bit of TLC that sometimes we may not feel that we get from a doctor. What training does a nurse practitioner have that prepares her for that?

Maureen: In addition to usually an undergraduate degree, nurse practitioners take on a masters degree or sometime higher or sometimes they go to a doctoral level, so they do a lot of academic extra study and they also then have to do a certain amount of hours during that course where they are clinically supervised, so that they become confident in all the activities of doing a good physical exam or taking a history and physical, so they are supervised until they actually pass a certification exam and then at that stage they actually work with us collaborating physicians who helps them grow in their experience to becomes like a mentor to them for a certain period of time.

Melanie: What if the cases more complicated and they need to see a specialist. Does the nurse practitioner Maureen follow them with this process?

Maureen: Well, a nurse practitioner if he’s working in a primary care setting will of course follow exactly the same path as an M.D. would, as the doctor would and that they referred to the specialist. However, some nurse practitioners have actually become specialist and therefore sometimes a nurse practitioner is referring to a tertiary level NP and that’s nurse practitioner may be an orthopedic NP, it could be a surgery nurse practitioner, some nurse practitioners are underneath it and then we have dermatology NP, cardiology NP, so in fact like nurse practitioners are pretty much following the trend of the doctors in terms of not only that they become good general practitioner, but they are very often going into the specialities.

Melanie: And if they go into the specialties Maureen then they are working with a physician in that specialty or do they typically have a practice on their own.

Maureen: This is like a very timely question that you raise because in certain states, nurse practitioners are completely autonomous and they have a licence they must keep up. They have to get at least certified every five years and they are totally responsible for their own practice. In some states and one of them is Massachusetts, there is still a requirement for nurse practitioners to have a relationship with the physicians which is called a collaborating or supervising physician and we still do like I review all records together or practice of the M.D. and this is sort of undergoing a probably changed and if not there is a bill of the state house of Massachusetts which is asking for nurse practitioners to autonomy and that they can totally work on their own independently.

Melanie: Do you think there is reticence on people’s part. Have you found that as the chief of nursing for MIT Health that people are more wary of nurse practitioners or are they more comfortable with nurse practitioners?

Maureen: Quite honestly I think Melanie sometimes, although this rule has been in existence since the late 1960s, I think some times people are still a little bit curious as to what is a nurse practitioner and can they diagnose, can they order tests, you know can they prescribe medications and still I think the more often I see patients coming in contact with nurse practitioners, I very definitely hear patient saying can I have that nurse practitioner as my primary care provider, the only other hindrance that gets in the way is sometimes the health plan do not cover nurse practitioners as primary care practitioners and that is another kind of political issue that is definitely coming to the forward in that you know under the affordable care act where primary care is going to sort of be common and nurse practitioners really do have to get covered as primary care provider with the health plan so that has to become a global aspect.

Melanie: So, Maureen in just the last minute for us please, gives us your best advice why students will use a PCP as their primary care provider, a nurse practitioner. Give us your best advice.

Maureen: Well, I am slightly biased Melanie, but I would just say that you know for I think all our primary care providers at MIT are wonderful that really doesn’t matter whether they are MDs or NPs and I think that for the patient feeling comfortable and feeling confident that they have met somebody who personally a good fit for them is really important and I think you know that nurse practitioners all I can say is if you’re looking for somebody who is going to be really good partner to you as a patient in terms of dealing with all aspects of your health, nurse practitioner do tend to be I think much more connected to the patients and that partnership and to feeling confidence and trust and I think that is really important aspect of healthcare a room for taking a nurse practitioner perhaps more than an MD.

Melanie: Thank you so much Maureen Johnston, Listeners can visit Health.mit.edu for more information and to get connected to one of our providers. That concludes this episode of Conversations with MIT Health. Please remember to subscribe, rate and review this podcast and all the other MIT Health podcasts. . I'm Melanie Cole. Thanks so much for joining us today.