1
00:00:00,320 --> 00:00:07,200
Speaker 1: M Bloomberg Audio Studios, podcasts, radio news.

2
00:00:08,160 --> 00:00:11,799
Speaker 2: Two years ago, John Canyon was working in Corpus Christi, Texas,

3
00:00:12,240 --> 00:00:14,080
Speaker 2: and he still remembers the day he got a call

4
00:00:14,240 --> 00:00:16,280
Speaker 2: that his seventy four year old dad had had an

5
00:00:16,280 --> 00:00:18,360
Speaker 2: emergency about four hours away.

6
00:00:18,760 --> 00:00:20,200
Speaker 1: My mom called me and told me to him a

7
00:00:20,239 --> 00:00:23,000
Speaker 1: dad fell and that they had went to the urgent

8
00:00:23,040 --> 00:00:27,040
Speaker 1: care and they texted me the x ray read and

9
00:00:27,040 --> 00:00:29,040
Speaker 1: they said they saw a nurse practitioner there and they

10
00:00:29,040 --> 00:00:30,240
Speaker 1: said he had broken ribs.

11
00:00:30,600 --> 00:00:34,000
Speaker 2: The nurse practitioner sent John's dad home, but John was

12
00:00:34,000 --> 00:00:36,960
Speaker 2: skeptical that his dad wasn't sent to the er. He

13
00:00:37,040 --> 00:00:39,760
Speaker 2: knew broken ribs at that age could be dangerous, so

14
00:00:39,880 --> 00:00:42,440
Speaker 2: John shared his dad's X ray results and the fact

15
00:00:42,479 --> 00:00:45,080
Speaker 2: he was sent home with a trauma surgeon he knew

16
00:00:45,200 --> 00:00:46,120
Speaker 2: to get his take.

17
00:00:46,479 --> 00:00:48,280
Speaker 1: I showed him the report. I'm like, I can't believe this,

18
00:00:48,360 --> 00:00:49,800
Speaker 1: and he goes so I can't believe it either. He

19
00:00:49,840 --> 00:00:51,120
Speaker 1: needs to go. He needs to be admitted.

20
00:00:51,360 --> 00:00:53,480
Speaker 2: John got in touch with his parents and he told

21
00:00:53,520 --> 00:00:56,880
Speaker 2: them his dad needed a second opinion. He needed to

22
00:00:56,920 --> 00:00:59,960
Speaker 2: go to the emergency room. So John's dad headed to

23
00:01:00,120 --> 00:01:03,480
Speaker 2: the er and got checked out by another nurse practitioner

24
00:01:03,720 --> 00:01:03,960
Speaker 2: and the.

25
00:01:03,960 --> 00:01:06,360
Speaker 1: Emergency department did test. They did a cat scan ofis

26
00:01:06,440 --> 00:01:09,040
Speaker 1: chest and said he had multiple rib fractures and a

27
00:01:09,080 --> 00:01:11,320
Speaker 1: pulmonary contusion, and then discharged from home.

28
00:01:11,760 --> 00:01:14,280
Speaker 2: But back at home, his dad only got worse.

29
00:01:14,640 --> 00:01:18,360
Speaker 1: So he three days later, he's in severe pain, goes

30
00:01:18,400 --> 00:01:21,000
Speaker 1: back to the emergency department. They found that they had

31
00:01:21,000 --> 00:01:24,120
Speaker 1: a ruptured spleen and ended up being life flighted to

32
00:01:24,160 --> 00:01:24,880
Speaker 1: San Antonio.

33
00:01:25,959 --> 00:01:28,640
Speaker 2: John says his dad eventually got great care at the

34
00:01:28,640 --> 00:01:31,760
Speaker 2: trauma center and ended up being okay, But he says

35
00:01:31,800 --> 00:01:34,440
Speaker 2: the way this went down with his dad, two medical

36
00:01:34,520 --> 00:01:38,160
Speaker 2: visits without the right diagnosis should never have happened. His

37
00:01:38,240 --> 00:01:40,640
Speaker 2: dad's life should have never been put at risk in

38
00:01:40,640 --> 00:01:44,240
Speaker 2: this way. And John would know because he's been a

39
00:01:44,319 --> 00:01:47,000
Speaker 2: nurse practitioner for nearly twenty years.

40
00:01:47,200 --> 00:01:48,720
Speaker 1: You know, he shouldn't have been sent home from the

41
00:01:48,840 --> 00:01:51,800
Speaker 1: urgent care. The person there didn't understand the severity of

42
00:01:52,080 --> 00:01:54,760
Speaker 1: rib fractures, and an elderly person, and the person in

43
00:01:54,800 --> 00:01:58,360
Speaker 1: the emergency department who should have known that didn't know that,

44
00:01:58,480 --> 00:02:01,400
Speaker 1: and also discharged him home when he should have been admitted.

45
00:02:01,440 --> 00:02:03,760
Speaker 2: Then what went through your mind when you first heard

46
00:02:03,760 --> 00:02:05,320
Speaker 2: that recommendation to send him home.

47
00:02:05,640 --> 00:02:08,639
Speaker 1: They didn't know what they were doing. They were obviously

48
00:02:08,680 --> 00:02:12,040
Speaker 1: not trained well enough, and they needed more training and

49
00:02:12,760 --> 00:02:17,000
Speaker 1: frustration and agitation and putting someone's life at risk unnecessarily.

50
00:02:21,080 --> 00:02:24,640
Speaker 2: Today on the show, a Bloomberg investigation into the increasing

51
00:02:24,680 --> 00:02:28,360
Speaker 2: reliance on nurse practitioners and American healthcare and what the

52
00:02:28,440 --> 00:02:31,040
Speaker 2: rapid growth of the profession has meant for their training

53
00:02:31,600 --> 00:02:35,240
Speaker 2: and their patients. I'm Sarah Holder, and this is the

54
00:02:35,280 --> 00:02:43,519
Speaker 2: big take from Bloomberg News. So, in the world of nurses,

55
00:02:43,639 --> 00:02:47,040
Speaker 2: there are many different types, and as Bloomberg investigative reporter

56
00:02:47,160 --> 00:02:50,799
Speaker 2: Polly Massen's explains, the kind most people think of are

57
00:02:50,880 --> 00:02:51,880
Speaker 2: registered nurses.

58
00:02:52,400 --> 00:02:54,680
Speaker 3: So a registered nurse, for those who might not know,

59
00:02:54,840 --> 00:02:57,680
Speaker 3: is what you'd most closely associate with, a bedside nurse

60
00:02:57,760 --> 00:02:59,800
Speaker 3: or a nurse that you might encounter in a hospital.

61
00:02:59,800 --> 00:03:02,959
Speaker 3: So somebody who you see when you're receiving care in

62
00:03:03,000 --> 00:03:05,720
Speaker 3: a hospital environment is most typically going to be a

63
00:03:05,760 --> 00:03:06,600
Speaker 3: registered nurse.

64
00:03:07,080 --> 00:03:10,520
Speaker 2: But the story Polly and Bloomberg's Caleb Melby have reported

65
00:03:10,600 --> 00:03:13,520
Speaker 2: out over the last six months is about a different

66
00:03:13,560 --> 00:03:16,200
Speaker 2: type of nurse, the nurse practitioner.

67
00:03:17,520 --> 00:03:21,840
Speaker 1: So a nurse practitioner is probably somebody that listeners have

68
00:03:21,919 --> 00:03:24,639
Speaker 1: been seen more and more in their interactions with healthcare

69
00:03:24,680 --> 00:03:27,280
Speaker 1: in the US. That's a registered nurse who went and

70
00:03:27,320 --> 00:03:30,560
Speaker 1: got an advanced degree and an additional license.

71
00:03:30,960 --> 00:03:34,320
Speaker 2: The nurse practitioner or NP degree is a newer, more

72
00:03:34,320 --> 00:03:37,760
Speaker 2: advanced nursing license. It was created at the University of

73
00:03:37,800 --> 00:03:41,440
Speaker 2: Colorado in the nineteen sixties. Back then, much like today,

74
00:03:41,520 --> 00:03:44,480
Speaker 2: there was a shortage of doctors, and the idea was

75
00:03:44,680 --> 00:03:47,680
Speaker 2: to alleviate some of the pressure on doctors by creating

76
00:03:47,720 --> 00:03:50,520
Speaker 2: a pathway for people with a nursing background to level

77
00:03:50,600 --> 00:03:51,360
Speaker 2: up their skills.

78
00:03:51,760 --> 00:03:55,280
Speaker 1: Nurse practitioners can see patients the way doctors do. They

79
00:03:55,320 --> 00:03:58,000
Speaker 1: can assign care regimens the way doctors do. They can

80
00:03:58,040 --> 00:04:01,240
Speaker 1: prescribe medications in many cases is the way doctors do.

81
00:04:01,840 --> 00:04:06,840
Speaker 1: It is essentially a parallel path for nurses to act

82
00:04:07,080 --> 00:04:09,840
Speaker 1: as doctors often do in American healthcare.

83
00:04:10,560 --> 00:04:14,000
Speaker 2: From that first program at the University of Colorado, NP

84
00:04:14,040 --> 00:04:17,480
Speaker 2: programs started to spread across the country. By the end

85
00:04:17,480 --> 00:04:20,520
Speaker 2: of the nineteen seventies, there were about fifteen thousand nurse

86
00:04:20,520 --> 00:04:24,400
Speaker 2: practitioners in the US. Today, there are more than three

87
00:04:24,600 --> 00:04:28,440
Speaker 2: hundred thousand. The number of nurse practitioners is projected to

88
00:04:28,520 --> 00:04:32,280
Speaker 2: rise by forty five percent by twenty thirty two. It's

89
00:04:32,320 --> 00:04:36,039
Speaker 2: one of the fastest growing professions in the country. What's

90
00:04:36,240 --> 00:04:40,200
Speaker 2: driving that change and what's driving the growth in interest

91
00:04:40,279 --> 00:04:41,040
Speaker 2: in these programs.

92
00:04:41,360 --> 00:04:43,680
Speaker 1: There's a few things we're looking at here. First, the

93
00:04:43,800 --> 00:04:48,720
Speaker 1: need for more providers. The weights for doctors are constantly expanding,

94
00:04:48,920 --> 00:04:53,440
Speaker 1: they're growing, so we need more providers that patients can

95
00:04:53,480 --> 00:04:57,800
Speaker 1: see on a shorter timeframe. But there's also economic and

96
00:04:57,839 --> 00:05:01,719
Speaker 1: financial factors at play too. The time it takes to

97
00:05:01,880 --> 00:05:05,920
Speaker 1: become a nurse practitioner is shorter and more affordable than

98
00:05:05,960 --> 00:05:09,200
Speaker 1: it is to get a medical degree. They are cheaper

99
00:05:09,240 --> 00:05:14,839
Speaker 1: to employ for hospitals and other healthcare providers than doctors are,

100
00:05:15,360 --> 00:05:20,279
Speaker 1: and they are sometimes able to bill insurers at doctor

101
00:05:20,360 --> 00:05:24,839
Speaker 1: rates under certain circumstances. So there's these financial incentives where

102
00:05:25,200 --> 00:05:28,000
Speaker 1: you're getting your labor essentially at nursing prices and your

103
00:05:28,160 --> 00:05:33,120
Speaker 1: revenue at doctor prices, which makes this shift extremely exciting

104
00:05:33,200 --> 00:05:34,760
Speaker 1: to a lot of healthcare providers.

105
00:05:35,279 --> 00:05:37,400
Speaker 2: So there are a number of benefits to having more

106
00:05:37,480 --> 00:05:41,680
Speaker 2: nurse practitioners, shorter wait times for patients, better profit margins

107
00:05:41,720 --> 00:05:46,159
Speaker 2: for healthcare providers, and more career opportunities for registered nurses.

108
00:05:46,720 --> 00:05:49,480
Speaker 2: But how has it been possible for a new category

109
00:05:49,520 --> 00:05:52,880
Speaker 2: of healthcare professionals to grow so quickly? Where are they

110
00:05:52,920 --> 00:05:57,160
Speaker 2: all getting trained? The answer, in part is the introduction

111
00:05:57,360 --> 00:05:59,960
Speaker 2: of a new way to get a nurse practitioner degree

112
00:06:00,560 --> 00:06:02,880
Speaker 2: called direct entry programs.

113
00:06:03,400 --> 00:06:07,120
Speaker 3: So for a direct entry program, you don't necessarily need

114
00:06:07,160 --> 00:06:09,840
Speaker 3: any experience, and in fact, some of those programs are

115
00:06:09,839 --> 00:06:13,600
Speaker 3: actually designed for folks who do not have any experience.

116
00:06:14,320 --> 00:06:17,480
Speaker 3: So in those cases, you don't necessarily need any experience

117
00:06:17,560 --> 00:06:20,240
Speaker 3: or estally any education experience, and you don't necessarily need

118
00:06:20,240 --> 00:06:23,680
Speaker 3: any work experience. With non direct entry programs, they do

119
00:06:23,800 --> 00:06:25,320
Speaker 3: expect you to have studied nursing.

120
00:06:25,640 --> 00:06:27,760
Speaker 1: And I will say too, there's something of a debate

121
00:06:27,800 --> 00:06:30,839
Speaker 1: within the nurse practitioner community. You will talk to some

122
00:06:30,920 --> 00:06:34,080
Speaker 1: of these nurse practitioners who were urns for decades before

123
00:06:34,080 --> 00:06:36,599
Speaker 1: getting their degree, and they will say that experience is

124
00:06:36,880 --> 00:06:40,039
Speaker 1: very important, that makes you a much better nurse practitioner.

125
00:06:40,360 --> 00:06:43,520
Speaker 1: And then there's others who will say, well, actually, the

126
00:06:43,839 --> 00:06:48,080
Speaker 1: job of diagnosing and prescribing that is at the core

127
00:06:48,120 --> 00:06:51,280
Speaker 1: of the nurse practitioner's job, doesn't really happen for you

128
00:06:51,320 --> 00:06:53,600
Speaker 1: as an RN. So maybe as an RN you're getting

129
00:06:53,800 --> 00:06:56,039
Speaker 1: that patient facing time and you're getting a sense of

130
00:06:56,080 --> 00:06:59,520
Speaker 1: how the hospital works, but you're still not accounting for

131
00:06:59,760 --> 00:07:03,080
Speaker 1: those huge new responsibilities you're taking on, and.

132
00:07:03,040 --> 00:07:07,600
Speaker 2: Those responsibilities are huge. In their reporting, Polly and Caleb

133
00:07:07,680 --> 00:07:09,640
Speaker 2: came across a lot of stories, like the one John

134
00:07:09,680 --> 00:07:14,160
Speaker 2: Canyon shared about his father. Some of them had different endings.

135
00:07:14,600 --> 00:07:18,000
Speaker 3: The case of Tiffany Dunbar is I think we can

136
00:07:18,040 --> 00:07:19,640
Speaker 3: all agree as a tragic one.

137
00:07:21,400 --> 00:07:24,040
Speaker 2: Tiffany Dunbar was a mother of three and she was

138
00:07:24,080 --> 00:07:28,400
Speaker 2: pregnant with her fourth child. She was experiencing discomfort and spotting,

139
00:07:28,520 --> 00:07:32,120
Speaker 2: which are symptoms of an ectopic pregnancy. So she scheduled

140
00:07:32,120 --> 00:07:34,960
Speaker 2: an appointment at a women's wellness center at a hospital

141
00:07:35,000 --> 00:07:35,400
Speaker 2: in DC.

142
00:07:35,920 --> 00:07:38,320
Speaker 3: That was somewhere that she had had a medical doctor

143
00:07:38,400 --> 00:07:41,280
Speaker 3: in her life, and she had had three children already,

144
00:07:41,400 --> 00:07:43,520
Speaker 3: so she was pretty familiar with that clinic and with

145
00:07:43,600 --> 00:07:44,280
Speaker 3: women's care.

146
00:07:44,920 --> 00:07:47,320
Speaker 2: She met with a nurse practitioner who had a bachelor's

147
00:07:47,360 --> 00:07:50,600
Speaker 2: and a master's degree from the University of Cincinnati Nursing School.

148
00:07:51,200 --> 00:07:54,640
Speaker 2: The university advertises the master's program as one hundred percent

149
00:07:54,760 --> 00:07:58,440
Speaker 2: online Lawyers for the Healthcare Center said in a filing

150
00:07:58,560 --> 00:08:01,200
Speaker 2: that Dunbar was told to come back for additional testing

151
00:08:01,720 --> 00:08:03,840
Speaker 2: and that since she agreed to come back, the NP

152
00:08:03,920 --> 00:08:06,360
Speaker 2: didn't want to frighten her with a prospect of dying.

153
00:08:07,200 --> 00:08:10,120
Speaker 2: But not long after her appointment with that nurse practitioner,

154
00:08:10,480 --> 00:08:15,040
Speaker 2: Dunbar's right filopian tube turned inside out, causing massive internal bleeding.

155
00:08:15,760 --> 00:08:18,920
Speaker 2: She died of an ectopic pregnancy while on vacation with

156
00:08:18,960 --> 00:08:20,360
Speaker 2: her family in California.

157
00:08:20,680 --> 00:08:24,080
Speaker 3: Her death was ruled as catastrophic by the medical examiner

158
00:08:24,120 --> 00:08:24,920
Speaker 3: on the autopsy.

159
00:08:26,080 --> 00:08:28,440
Speaker 2: In the court case that followed, a jury found that

160
00:08:28,480 --> 00:08:31,280
Speaker 2: the nurse practitioner and the center failed to meet the

161
00:08:31,360 --> 00:08:34,559
Speaker 2: national standard of care and their treatment, and that Dunbar's

162
00:08:34,559 --> 00:08:38,839
Speaker 2: death was completely avoidable. The center appealed the decision, noting

163
00:08:38,880 --> 00:08:41,400
Speaker 2: that Dunbar agreed to those follow up visits but didn't

164
00:08:41,400 --> 00:08:44,520
Speaker 2: follow through, and the case was ultimately settled out of

165
00:08:44,520 --> 00:08:50,400
Speaker 2: court before a judge could make a ruling. Dunbar's case

166
00:08:50,520 --> 00:08:53,400
Speaker 2: is only one of many similar stories Caleb and Polly

167
00:08:53,440 --> 00:08:57,040
Speaker 2: came across where the difference between life and death hinged

168
00:08:57,080 --> 00:09:00,480
Speaker 2: on a nurse practitioner's judgment. They wanted to dig deeper

169
00:09:00,559 --> 00:09:03,360
Speaker 2: into what kind of training nurse practitioners were getting to

170
00:09:03,400 --> 00:09:07,680
Speaker 2: prepare them for those kinds of decisions. What they found

171
00:09:08,120 --> 00:09:19,120
Speaker 2: after the break. Patients in the US are increasingly relying

172
00:09:19,160 --> 00:09:21,800
Speaker 2: on a vast network of nurse practitioners to get their

173
00:09:21,840 --> 00:09:26,200
Speaker 2: medical issues diagnosed and treatments prescribed. But there's another factor

174
00:09:26,240 --> 00:09:29,560
Speaker 2: that's driven this recent explosion of nurse practitioners, a for

175
00:09:29,720 --> 00:09:34,240
Speaker 2: profit industry of nurse practitioner education programs that are accepting

176
00:09:34,280 --> 00:09:37,959
Speaker 2: students at record rates. The biggest players on the NP

177
00:09:38,160 --> 00:09:42,680
Speaker 2: education scene are Walden University and Chamberlain University. They're both

178
00:09:42,679 --> 00:09:45,600
Speaker 2: owned by a for profit company based out of Chicago,

179
00:09:46,320 --> 00:09:49,680
Speaker 2: ad to Lim Global Education. But you might know ad

180
00:09:49,679 --> 00:09:53,040
Speaker 2: to LIM better by its former name DeVry, So.

181
00:09:52,960 --> 00:09:56,680
Speaker 1: When we talk about nurse practitioner education, many times we

182
00:09:56,720 --> 00:10:00,600
Speaker 1: are talking about ad t LIM and its properties in

183
00:10:00,720 --> 00:10:02,040
Speaker 1: Chamberlain University.

184
00:10:03,440 --> 00:10:06,679
Speaker 2: Devrai rebranded to ad Tillem in twenty seventeen as it

185
00:10:06,720 --> 00:10:11,360
Speaker 2: faced lawsuits and government scrutiny over how it advertised its programs. Today,

186
00:10:11,640 --> 00:10:14,800
Speaker 2: those two leading NP schools under ad Tolum's umbrella are

187
00:10:14,840 --> 00:10:18,400
Speaker 2: responsible for training a growing number of nurse practitioners each year.

188
00:10:19,040 --> 00:10:22,319
Speaker 2: But unlike for doctors. There's no one standard for how

189
00:10:22,400 --> 00:10:25,360
Speaker 2: nurse practitioners need to be trained, and a lot of

190
00:10:25,480 --> 00:10:30,080
Speaker 2: NP training programs have an emphasis on online courses. Another

191
00:10:30,120 --> 00:10:33,439
Speaker 2: big difference is in how nps get on the job experience.

192
00:10:33,960 --> 00:10:36,600
Speaker 2: They need to log five hundred hours of clinical training

193
00:10:36,640 --> 00:10:40,440
Speaker 2: time before graduating. That's time shadowing a teacher, usually a

194
00:10:40,480 --> 00:10:43,920
Speaker 2: licensed nurse practitioner in the field, but it's still a

195
00:10:43,960 --> 00:10:46,880
Speaker 2: fraction of the three to seven years that doctors typically

196
00:10:46,960 --> 00:10:50,560
Speaker 2: spend in residency, and NP students are often left to

197
00:10:50,600 --> 00:10:53,400
Speaker 2: their own devices to find people willing to train them

198
00:10:53,440 --> 00:10:54,199
Speaker 2: at all.

199
00:10:54,360 --> 00:10:57,880
Speaker 1: They go out and they knock on doors, They drop

200
00:10:57,960 --> 00:11:00,720
Speaker 1: cookies off at offices. They do all sorts of stuff

201
00:11:00,720 --> 00:11:03,319
Speaker 1: to try to find those people, including paying them out

202
00:11:03,320 --> 00:11:08,680
Speaker 1: of pocket pain to be taught, including paying third party

203
00:11:08,760 --> 00:11:12,160
Speaker 1: matchmaking services to pair them with someone.

204
00:11:12,559 --> 00:11:15,160
Speaker 2: Caleb and Polly reached out to ad Talim, the company

205
00:11:15,200 --> 00:11:18,200
Speaker 2: behind some of the fastest growing nurse practitioner programs in

206
00:11:18,200 --> 00:11:21,160
Speaker 2: the country, to get their comment about how they ensured

207
00:11:21,200 --> 00:11:22,720
Speaker 2: students got adequate training.

208
00:11:23,000 --> 00:11:26,320
Speaker 3: Ad to Lim, a spokesperson told Bloomberg it wants to

209
00:11:26,360 --> 00:11:30,600
Speaker 3: support students who are not successful in identifying appropriate clinical sites.

210
00:11:31,240 --> 00:11:34,200
Speaker 2: The spokesperson also said in an email that ad talim

211
00:11:34,360 --> 00:11:38,079
Speaker 2: quote is committed to ensuring students graduate prepared to pass

212
00:11:38,120 --> 00:11:42,439
Speaker 2: required licensure and certification exams and enter the healthcare workforce

213
00:11:42,920 --> 00:11:46,840
Speaker 2: end quote. Caleb and Polly spoke to dozens of nurse

214
00:11:46,880 --> 00:11:49,760
Speaker 2: practitioners for the story who'd gone through a variety of

215
00:11:49,800 --> 00:11:53,000
Speaker 2: training programs, and many said they didn't feel like their

216
00:11:53,040 --> 00:11:54,840
Speaker 2: training set them up for success.

217
00:11:55,240 --> 00:11:58,160
Speaker 3: Some students didn't feel prepared, and in fact, some of

218
00:11:58,200 --> 00:12:01,120
Speaker 3: them hadn't actually been able to complete their clinical hours,

219
00:12:01,120 --> 00:12:03,360
Speaker 3: So of course they're not going to feel prepared. You

220
00:12:03,440 --> 00:12:04,560
Speaker 3: can't expect them to.

221
00:12:05,080 --> 00:12:08,600
Speaker 1: They get very frustrated that this is their experience, and

222
00:12:08,880 --> 00:12:11,080
Speaker 1: some of them get very scared about what it means

223
00:12:11,080 --> 00:12:13,640
Speaker 1: for them to go and practice on their own after

224
00:12:13,720 --> 00:12:14,839
Speaker 1: those experiences.

225
00:12:15,320 --> 00:12:18,760
Speaker 2: With their emphasis on online education and their challenging approach

226
00:12:18,800 --> 00:12:22,280
Speaker 2: to on the ground learning, nurse practitioner programs are facing

227
00:12:22,360 --> 00:12:26,439
Speaker 2: increased scrutiny from students, medical doctors, and a former NP

228
00:12:26,600 --> 00:12:30,600
Speaker 2: program administrator who raise concerns about student faculty ratios and

229
00:12:30,640 --> 00:12:34,120
Speaker 2: a lack of student support. When Caleb and Polly raised

230
00:12:34,160 --> 00:12:36,760
Speaker 2: some of these issues with the country's largest lobbying group,

231
00:12:36,800 --> 00:12:40,880
Speaker 2: for nurse practitioners. The association stress that nps are filling

232
00:12:40,920 --> 00:12:42,840
Speaker 2: a critical role in the medical system.

233
00:12:43,120 --> 00:12:47,280
Speaker 1: The American Association of Nurse Practitioners told us something that's

234
00:12:47,320 --> 00:12:50,560
Speaker 1: fundamentally true, which is that millions of Americans are getting

235
00:12:50,679 --> 00:12:55,080
Speaker 1: their health care from nurse practitioners right now. The association

236
00:12:55,400 --> 00:12:59,959
Speaker 1: also believes that nurse practitioners are going to healthcare desert

237
00:13:00,600 --> 00:13:04,000
Speaker 1: in rural areas and in cities to not just make

238
00:13:04,040 --> 00:13:07,920
Speaker 1: sure that there's shorter wait times at any hospital, but

239
00:13:08,000 --> 00:13:12,360
Speaker 1: also increasing access broadly in these geographic pockets where it's

240
00:13:12,360 --> 00:13:14,080
Speaker 1: sometimes hard to come across care.

241
00:13:14,440 --> 00:13:17,040
Speaker 2: But the question Caleb and Polly were still grappling with

242
00:13:17,400 --> 00:13:20,679
Speaker 2: was whether the problems that identified with nurse practitioner training

243
00:13:20,880 --> 00:13:24,120
Speaker 2: were impacting the quality of that care. There isn't a

244
00:13:24,160 --> 00:13:27,520
Speaker 2: ton of reliable data out there on nps and patient outcomes,

245
00:13:28,040 --> 00:13:30,840
Speaker 2: but poll came across a working paper first released in

246
00:13:30,840 --> 00:13:33,760
Speaker 2: twenty twenty two that looked at over a million patient

247
00:13:33,800 --> 00:13:37,760
Speaker 2: records from forty four via system emergency rooms, and it

248
00:13:37,800 --> 00:13:39,280
Speaker 2: revealed a troubling trend.

249
00:13:39,760 --> 00:13:44,960
Speaker 3: Those researchers noted that on average, nps used more resources

250
00:13:45,360 --> 00:13:49,960
Speaker 3: but achieved worse patient results as compared to physicians. Now,

251
00:13:50,000 --> 00:13:52,120
Speaker 3: this is still a working paper that does still have

252
00:13:52,160 --> 00:13:54,080
Speaker 3: to go through the peer review process, which can be

253
00:13:54,120 --> 00:13:56,839
Speaker 3: really lengthy, but it is an interesting finding, and it's

254
00:13:56,840 --> 00:14:00,439
Speaker 3: particularly interesting because it does look at emergency where the

255
00:14:00,440 --> 00:14:01,960
Speaker 3: stakes are going to be the highest.

256
00:14:02,360 --> 00:14:05,560
Speaker 2: Polly says. The Association of Nurse Practitioners took issue with

257
00:14:05,600 --> 00:14:08,319
Speaker 2: that paper, in part because it was still being peer reviewed.

258
00:14:08,920 --> 00:14:11,600
Speaker 2: The lobbying group also shared another study that looked at

259
00:14:11,600 --> 00:14:14,800
Speaker 2: patients across five countries including the US, and found that

260
00:14:14,960 --> 00:14:18,320
Speaker 2: nps can actually improve patient outcomes in an er setting.

261
00:14:18,920 --> 00:14:21,360
Speaker 2: I asked Polly and Caleb what they thought the root

262
00:14:21,440 --> 00:14:24,120
Speaker 2: of the issue here was n Like most problems with

263
00:14:24,160 --> 00:14:26,840
Speaker 2: our healthcare system, there isn't just one answer.

264
00:14:28,200 --> 00:14:30,200
Speaker 3: I think it's everything that we've talked about kind of

265
00:14:30,240 --> 00:14:34,840
Speaker 3: compounded on itself. There's a doctor shortage, there's an increase

266
00:14:34,880 --> 00:14:38,600
Speaker 3: in these kinds of for profit educational programs, and there's

267
00:14:38,640 --> 00:14:42,760
Speaker 3: a completely logical, understandable desire to move away from bedside

268
00:14:42,840 --> 00:14:45,880
Speaker 3: nursing in some cases. So I think that all of

269
00:14:45,880 --> 00:14:49,960
Speaker 3: those things, combined along with the many, many eccentricities of

270
00:14:50,000 --> 00:14:53,720
Speaker 3: the American healthcare system, can cause this. I mean, the

271
00:14:53,840 --> 00:14:58,440
Speaker 3: reality is that we have a hugely unique, largely for

272
00:14:58,520 --> 00:15:02,240
Speaker 3: profit American healthcare sope, and it's going to sprout its

273
00:15:02,280 --> 00:15:03,800
Speaker 3: own very unique problems.

274
00:15:04,120 --> 00:15:06,920
Speaker 1: A bad reading of the story would be nurse practitioners bad,

275
00:15:07,240 --> 00:15:10,680
Speaker 1: which is not what the story says. The profession will

276
00:15:10,800 --> 00:15:14,640
Speaker 1: keep blooming. That will not stop. We are all going

277
00:15:14,680 --> 00:15:17,280
Speaker 1: to be getting more health care from more nurse practitioners

278
00:15:17,320 --> 00:15:20,720
Speaker 1: in the future, and the students and professors and nurse

279
00:15:20,760 --> 00:15:24,560
Speaker 1: practitioners we spoke to said there's things that need to

280
00:15:24,680 --> 00:15:30,120
Speaker 1: happen with our education to prepare us universally for those

281
00:15:30,120 --> 00:15:33,800
Speaker 1: increased responsibilities that they will be facing in the future.

282
00:15:34,360 --> 00:15:37,760
Speaker 2: John Canyon, the nurse practitioner we heard from earlier, says

283
00:15:37,800 --> 00:15:40,680
Speaker 2: his dad's experience not getting the kind of treatment John

284
00:15:40,760 --> 00:15:43,480
Speaker 2: thought he should have hasn't made him lose faith in

285
00:15:43,560 --> 00:15:47,920
Speaker 2: nurse practitioners themselves. After all, John is two decades into

286
00:15:47,960 --> 00:15:50,640
Speaker 2: his own career as a nurse practitioner, and he sees

287
00:15:50,680 --> 00:15:53,400
Speaker 2: what he trusts for his own care. But John has

288
00:15:53,440 --> 00:15:56,840
Speaker 2: also channeled his frustration into advocacy. It aims to push

289
00:15:56,840 --> 00:16:01,040
Speaker 2: the profession to improve its education standards and up clinical hours,

290
00:16:01,600 --> 00:16:05,040
Speaker 2: because otherwise he worries nothing will change.

291
00:16:05,280 --> 00:16:07,680
Speaker 1: At the end of this, my dad ended up being okay.

292
00:16:07,760 --> 00:16:09,720
Speaker 1: So while mom and dad were like, well, it's no

293
00:16:09,800 --> 00:16:11,440
Speaker 1: big deal, they were nice to us. So you know,

294
00:16:11,520 --> 00:16:13,240
Speaker 1: we don't want to and like, well, here's the thing.

295
00:16:13,280 --> 00:16:15,520
Speaker 1: If we don't, if we don't at least talk to

296
00:16:15,560 --> 00:16:18,360
Speaker 1: them and let him know what's going on and let

297
00:16:18,440 --> 00:16:21,240
Speaker 1: him know you're upset, then nothing will ever happen, No

298
00:16:21,280 --> 00:16:23,400
Speaker 1: one will ever get additional training. It'll continue to be

299
00:16:23,480 --> 00:16:30,440
Speaker 1: a problem.

300
00:16:30,520 --> 00:16:33,520
Speaker 2: This is The Big Take from Bloomberg News. I'm Sarah Holder.

301
00:16:34,120 --> 00:16:37,040
Speaker 2: This episode was produced by David Fox with Thomas Lou

302
00:16:37,120 --> 00:16:41,160
Speaker 2: and Alex Sugiura. It was edited by Aaron Edwards, Caitlin Kenny,

303
00:16:41,240 --> 00:16:44,360
Speaker 2: and Flynn McRoberts. It was fact checked by Thomas Lou

304
00:16:44,600 --> 00:16:47,800
Speaker 2: and mixed by Blake Maples. Our senior producers are Kim

305
00:16:47,840 --> 00:16:51,440
Speaker 2: Gittleson and Naomi Shaven, and our senior editor is Elizabeth Ponso.

306
00:16:51,920 --> 00:16:55,840
Speaker 2: Nicole bumsterbor is Our executive producer. Sage Bauman is Bloomberg's

307
00:16:55,840 --> 00:16:59,040
Speaker 2: head of podcasts. Thanks so much for listening. Please follow

308
00:16:59,080 --> 00:17:01,720
Speaker 2: and review The Big Take wherever you listen to podcasts.

309
00:17:01,840 --> 00:17:05,480
Speaker 2: It helps new listeners find the show. We'll be back tomorrow,