Pediatrician or nurse practitioner?

What is the difference between a pediatrician and a nurse practitioner? I'm in the process of selecting a new pediatrician and was told that he has a nurse practitioner who sees patients. Should I be concerned when I take my daughter to see the nurse that she is not getting the best care possible?

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Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

Nurse practitioners have been in existence since around the late 1960's. The original reasons for their coming into being were essentially to provide health care to populations that were under served. Since that time, however, the role of the nurse practitioner has evolved quite a bit.

A nurse practitioner as described by the American Academy of Nurse Practitioners (NP) is a registered nurse who has advanced education and clinical training in a health care specialty area. NPs are primary health care providers who provide nursing and medical services to individuals, families and groups, emphasizing health promotion and disease prevention. Services include conducting and interpreting appropriate diagnostic and laboratory tests, prescription of pharmacologic agents and treatments and non-pharmacologic therapies. Teaching and counseling individuals, families, and groups are a major part of NPs' activities.

The regulations and restrictions placed on NPs are through the Nurse Practice Act of the state in which they work. In some states, NP practice is completely independent, others require proof of a collaborative MD only for prescriptive practice privileges, some require proof of a collaborative MD for licensure at all, and an isolated few states still do not have specific nurse practitioner licensure or recognize practice of nurse practitioners. Therefore, the amount of autonomy an NP has is primarily dictated both by the state and the place in which they work. Doctors have limits on what procedures hospitals will allow them to do based upon their individual experience. NPs have these same restrictions whether they primarily work in the hospital or in a doctor's office.

Most NPs are also nationally certified in their specialty area which includes such pediatric specialties as Pediatric Nurse Practitioner (PNP) and Neonatal Nurse Practitioner (NNP). There are many pediatricians who collaborate in the care of children with PNPs. Some PNPs focus their time on well-infant and child care. However, others have found specific niches in the office taking care of children with chronic diseases such as asthma. Still others divide their time much as the pediatrician does seeing both well and ill children.

Studies have shown that PNPs have the expertise to handle most of the healthcare needs in a typical pediatric practice. Just as everyone has their personal preferences in doctors, parents have individual preferences concerning their child's healthcare provider. Some parents simply prefer to have their children seen by a pediatrician because of their medical expertise. Others find that PNPs do a better job at taking the time to teach parents about well-child care and certain disease processes. I think it is impossible to generalize about either profession. There are good and not-so-good PNPs, just as there are good and not-so-good pediatricians. I suggest you talk about your concerns with the pediatric office. Ask if the nurse practitioner practices with or without consultation with the pediatrician and how long has she been a PNP. Just like picking a doctor, see if you know anyone who has have their children seen by the nurse practitioner. A good office will address your concerns and allow you to see the provider or providers with whom you are most comfortable.

. Finally, I urge you to give the PNP a chance as you may find she provides your daughter excellent health care and good experiences each time she comes to the office.

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