Definition of Acute vs Primary Care
Posted about 10 years ago by Joscelyn Vanduren
In terms of the acute care vs. primary care definitions, Maureen Cahill from the National Council of State Boards of Nursing offered these definitions:
There are many definitions - here are examples Acute care = a patient receives active but short-term treatment for a severe injury or episode of illness, an urgent medical condition, or during recovery from surgery that occurs in addition to the day to day health care provided by and overseen by a health care provider.
Primary care = Primary care is the day-to-day health care provided by and overseen by a health care provider. Typically this provider acts as the first contact and principal point of continuing care for patients within a health care system, and coordinates other specialist care that the patient may need
The scope of practice defines the boundaries of the license (in Alaska's case authorization) held by the practitioner; that is, the procedures, actions, and processes contained within the role for which the practitioner has received the education, training, licensure (authorization), and, if required, the certification needed to practice. "Scope of practice is founded in state law with the intent to protect the public."
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This may come back to haunt us. Thankfully there are educational programs that prepare FNPs for ER work. What about inpatient? Many rural hospital have FNPs doing inpatient and ER. Personally I believe this ivory tower educator definition is hurting the NP profession.
This is a little confusing. If my patient comes in to see me and is having an acute exacerbation of her/his Asthma and needs urgent care, am I covered as a primary care provider?
That definition does not describe any reality of Family Practice likely in ANY setting. In my 16 years of Primary Care, 10 in rural setting in Norther New Mexico, the reality is DAILY acute evaluations, triage, urgent care, emergent care and packaging folks for helicopter pick up or ground ambulance pick up for tertiary facility care. This description best not be used to describe anything we in the field are doing. I am not clear if we are asking Ms Cahill to define this for actional reasons or just academic. We should make sure that this is just academic but in no way practice related. Most Nurse Practitioners in real life do ACUTE management frequently. Our insurance covers us for this acute management. I was trained to do this care, I'm good at it and I trust the National Boards of Nursing will be able to get up to speed on the reality of advance practice nursing in the real world. That very attitude is as much holding advance practice nurses back from practicing to the extent of our education and training as any state legislative body.
I am an FNP student in CA who recently joined The Alaska NP Association (so hopeful to get out of CA again!) I am currently writing a critique on Barbara Safriet's piece "Health Care Dollars and Regulatory Sense". It was written in 1992. In it, she discusses the reality of nursing shooting ourselves in the proverbial foot by too many definitions,committees, boards and the like. It's strange to me that a article written 14 years ago remains so true today. I guess it is true that the more things change, the more they stay the same. It amazes me that there is one American Medical Association that speaks for physicians, and a multitude of organizations that speak for nursing. We might have better luck and be able to speak with a stronger voice if we were under one umbrella. Then when somebody proposed a definition that would change our practice, we could raise a united voice that would be heard and matter. Easier said than done, I am sure.
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