Use of Physician Consultation by Nurse Practitioners in Community Health and Ambulatory Clinic Settings

Abstract

Little information is available concerning factors that influence pediatric nurse practitioners' (PNPs) use of physician (MD) consultation in their delivery of child health care. A study of 112 graduates of a major midwestern university PNP program was conducted to evaluate their practice roles; of the 70 PNPs employed as primary care providers, 52 (83%) responded to questions regarding their clinical practice and use of MD consultation. Differences in responses between practice settings related to MD availability at the site and to the level of wellness of the patients seen. The majority of PNPs managed patients without consultation when patients came for routine care or common problems and sought consultation if patients had acute or chronic illnesses. Most PNPs were satisfied with the amount and type of MD consultation; however, over 30% were dissatisfied primarily because consultants were not readily accessible. PNPs in community health settings had significantly less on-site availability and satisfaction with MD consultation when compared to PNPs in ambulatory clinic settings. PNPs in community health settings referred patients and used protocols more often to manage patients than PNPs in ambulatory or institutional settings. PNPs in all settings were more satisfied with a model of consultation where MDs are readily available and where collaboration could develop. These findings are useful in planning for more satisfactory practice arrangements and for improved mutual understanding of the use of MD consultants by PNPs, MDs, and administrators.