Support Staff, RN, MSN, PNP

October 2005 -- This month's Child magazine includes a lengthy piece about the results of a large reader survey, Sandra Y. Lee's "What Makes a Great Pediatrician." Sadly, the story reflects the magazine's physician-centric vision of health care and its overall lack of respect for nurses. In particular, the piece effectively reinforces the apparent views of many survey respondents that pediatric nurse practitioners (NPs) are "support staff" who perform routine tasks and act as marginal fill-in personnel for pediatricians.

Rather than simply ignoring pediatric nurses, as Child generally does, this long piece includes one paragraph summarizing the "mixed feelings" of its 1,200+ parental survey respondents to the "trend toward more nurse-practitioners and physician assistants examining children and answering questions." More than half (54%) of the respondents were reportedly "sometimes bothered that they couldn't speak directly with the doctor," as opposed to what one memorably termed the "support staff." Another respondent noted that "[s]ometimes when you call for a sick child, the nurse calls you back. I'd prefer that the doctor called back." However, the piece does note that some parents liked having the non-physician practitioners in a group practice with physicians because, as UCLA pediatrician Susan B. Tully explained, such practitioners often have more time for patients and are "trained to handle the routine aspects of well visits." We wonder how a pediatric NP might have described the advantages of her own practice. But we suppose that, as "support staff" whose main contribution is having lots of time for routine tasks, an NP would not have been as qualified to describe her own care as a physician is. Indeed, like most of the magazine's health articles, this one is full of expert comment from various named physicians, but not one nursing expert is mentioned. The overriding assumption of the piece is that every child must have a pediatrician; the only question is how to choose the right one.

It is unfortunate that so many readers of Child regard masters-prepared, autonomous pediatric NP's as "support staff," and that they are evidently unaware that extensive research shows that NP care is at least good as that of physicians. In fact, given nurses' holistic care model, extensive clinical knowledge, and obvious skill in patient interactions, many informed parents prefer NPs. (Ironically, the article itself suggests that poor communications skills are a major issue for pediatricians, and one they are taking steps to address.) The "routine aspects of well visits" are a small part of NP care, just as they are a small part of pediatrician care. Of course, pediatric NP's have nursing expertise and knowledge that physicians do not have. What could account for such uninformed views on the part of so many parents who are concerned enough about child-rearing that they read parenting magazines? Could survey respondents' lack of awareness of pediatric NP skill have anything to do with the fact that their favorite parenting magazine's "editorial advisory board" includes 13 physicians and, as far as we can tell, no nurses?

The Center expresses its condolences to the readers of Child magazine.