Promoting the Profession to the Public



Promoting the Profession to the Public





According to studies of patient satisfaction, patients who have seen NPs like NPs. But not everyone has seen an NP. People who are healthy and rarely visit any healthcare provider may not have experienced care given by an NP. Those who have had a long relationship with a physician may not have experienced the care of an NP.

NPs have had little if any exposure on television or in movies. There are no NPs on primetime television. There are no equivalents of “Grey’ Anatomy” doctors for the NP profession. These TV characters, doing their work on the air week after week, have given the general public a sense that they know what physicians do.

There are no well-known figures in literature or in the popular culture who are NPs. Children do not grow up reading books about NPs. There are no NP dolls. No movies have been done about NPs or having NPs as central characters. There are no NP senators or congressional representatives. Fortunately, no NPs have become prominent for their misdeeds.

No advertising campaign keeps NPs in the public eye in the way that advertising keeps Coca-Cola in the public eye. The American Medical Association (AMA), on the other hand, budgets millions for major public relations (PR) efforts.

NP organizations and NP business owners are just beginning to realize that organized PR campaigns are needed. NPs who want to see the passage of legislation favorable to NPs’ practice and NPs who have their own practices and want to see them thrive will want the public to have an opinion about NPs, and will want that opinion to be favorable. NPs have made great progress on a one-on-one basis. Perhaps the main way the public will understand what an NP does is by experiencing the care. Those who have not experienced the care of an NP can be encouraged, through PR efforts, to seek the care of an NP.



Public Relations Steps

There are systematic ways of raising public awareness about NPs. Marketing, public relations, and sales all have the same process: (1) develop a message; (2) determine whom the message should reach; (3) determine the best way to disseminate the message; (4) disseminate the message; and (5) evaluate the success of the effort and fine tune the process.

The steps in a PR strategy for NPs are:



  • Set a goal.


  • Develop a plan.


  • Develop a budget.


  • Work the plan.


Setting the Goal

A likely PR goal for NPs is to establish NPs as experts on primary care. The ultimate goal might be getting primary care provider (PCP) status for NPs. An alternative goal for an individual NP with a private practice may be getting patients to come in the door.


Developing the Plan

Whatever goal is selected, the plan will revolve around establishing NPs, or the NP, as a high-quality professional who gives primary care. The most effective forms of publicity will be those that show the expertise of NPs in a way the public can understand. NPs can convey expertise in a number of ways:



  • Providing high-quality care to each patient, one-on-one.


  • Suggesting word of mouth when a friend or family member has a good experience of care.


  • Including testimonials from patients in brochures, promotional videos, or paid advertising.


  • Arranging for articles by NPs on health topics in local newspapers.


  • Arranging for radio or television talk show appearances by NPs.


  • Arranging for advice from NPs to be included in newspaper or magazine articles on health topics.


  • Speaking on healthcare topics at community forums.


  • Serving on healthcare advisory boards in the area and nationally.


  • Endorsing as an association particular sets of preventive care guidelines and standards.

A simple PR plan that focuses on a series of news releases is described in Appendix 13-A.



Developing the Budget

PR can be done with a million dollar budget or with a hundred dollar budget. Either way, there must be a budget, or nothing will happen. The majority of a PR budget will go toward services. The researching and writing of news releases, the searching for names and addresses of editors, and the follow up with telephone calls will consume the most monetary resources.

Even a small NP organization should count on spending $15,000 to $18,000 a year on PR. Where will the money come from, other than dues? Money could be generated from other business ventures. One job of a PR professional could be to promote an NP educational conference that would have a registration fee and would presumably turn a profit. Another job of a PR professional would be to develop written materials— brochures and fact sheets on NPs—that could be sold to individual NPs and practices and distributed to patients.


Working the Plan


Proactive PR

In a proactive PR plan, an NP organization would seek to generate articles or television pieces about NPs or to showcase the expertise of NPs, not in response to some attack on NPs, but as a regular, systematic promotion of NPs. For example, an NP organization might arrange for an article to appear in the local newspaper giving an NP’s advice for staying well in flu season. The article serves three purposes: keeps NPs in the news in a positive light, demonstrates the information an NP can offer, and gives people useful information. The article satisfies the needs of NPs, the needs of readers, and the needs of newspaper editors to run informative articles.

A message about NP expertise in primary care could be disseminated on television, in newspapers and magazines, at health fairs, by word of mouth, and through advertising. It is generally agreed that television stories and newspaper articles are an effective way of getting a message to a large segment of the population with little expenditure.

When developing a PR plan, NPs need to keep in mind that newspapers and television station owners need readers (or viewers) and advertisers. An NP may not be able to offer to a newspaper advertisers but can offer readers if the NP is providing information on a topic of interest to many people. Health, and particularly primary care, is interesting to many people.

To generate an article in a newspaper or website, the following things have to happen:



  • Generate an idea for an article.


  • Generate the information to be conveyed.


  • Write the news release.


  • Identify the appropriate vehicle for the article.


  • Identify the decision maker (editor) who can ensure that the article will get into the paper or on the website.



  • Give the editor the name of a contact if the editor wants more information.


  • After the release is sent to the editor, follow up by telephone call.


  • Arrange for more information to be given to the editor, or arrange for accompanying photograph or art.

A statewide media campaign would involve something like sending a news release to every newspaper in the state once a month. When the process described above is done 12 times a year and multiplied by 50 or 100 newspapers, it is close to a full-time job.

Each NP organization and each private practice needs a person designated to handle PR. PR services may be purchased or performed by a volunteer NP. Obviously, a volunteer is less expensive, will know more about NPs than a PR professional, and will be motivated. However, a volunteer probably will have a job as an NP, and the volunteer PR efforts may not get the regular attention that is needed. Further, when NPs organize into associations and there is a treasury, it makes sense for all NPs to share in contributing to PR efforts, and that is best done by purchasing PR services rather than imposing on one NP to do the work.


Reactive PR

Public relations is reactive when it is in response to a particular event or criticism. For example, if a physicians’ group came out with a statement that only physicians should be PCPs, the rebuttal of an NP organization would be reactive.

The keys to effective reactive PR are speed and a consistent and logical message. Therefore, NP organizations should have a set of “talking points” ready for use in the event that a speedy reaction is needed. Talking points are a PR method for ensuring that a spokesperson for a group has something to say and that the message is consistent with the group’s goals. For examples of talking points for NP organizations, see Appendix 13-B.


The Substance of the Message

When NPs are asked how NPs differ from physicians and why NPs should be incorporated into payment systems, NPs must be ready with hard facts and data that answer the questions.

Compare the following two statements: “Nurse practitioners are good listeners and are safe and effective providers of health care” and “A health services research team studying 799 episodes of otitis media and sore throat in a Columbia, Maryland HMO found that NPs were more effective at resolving the problem. And NPs’ care was 20% less expensive than MDs’.” Which statement will more effectively persuade business people and lawmakers that NPs are value-added providers? The second statement is what an NP will want to tell an insurance executive, an employer, or a congressperson. NPs know that the first statement is true, but everyone else wants hard facts and numbers.



Supporting Data

Two recent studies and several not-so-recent studies found NPs to be as good as or better than MDs as PCPs. These studies should be on the tip of the tongue of anyone trying to “sell” the concept of the NP as the preferred healthcare provider.1


Study 1: NPs Match MDs on Primary Care Tasks

Hall et al. set up audit criteria, with input from the practitioners being studied, and then audited charts of 426 MDs and NPs in 16 ambulatory care practices.2 The researcher looked at eight tasks: (1) follow up of a low hematocrit to detect patients with anemia caused by colorectal cancer or other serious gastrointestinal disease; (2) screening for cancer using breast examination and Pap smears in women; (3) follow up of a high serum glucose to detect and treat diabetes; (4) monitoring of patients on digoxin to detect drug toxicity or symptomatic relapse; (5) follow up of a positive urine culture to treat persistent bacteriuria; (6) compliance with the American Academy of Pediatrics standards for screening and immunization of infants; (7) assessment of the risk of dehydration in children at the start of an episode of gastroenteritis; and (8) monitoring and follow up of children with otitis media to detect and treat failure to resolve the middle-ear effusion.

The findings: NPs’ performance was comparable or superior on seven of the eight tasks. Female MDs were better at cancer screening for women, but male MDs were worse at this than NPs. The sample of male “nonphysicians” was too small to make any generalizations about and was therefore excluded from the results.


Study 2: NPs Are Cost Effective

Salkever et al. compared NPs and MDs on cost and effectiveness.3 To study costs, Salkever paid observers to time NP and MD visits with patients. The research team then analyzed costs of office space, costs of follow-up visits, and costs of ancillary services and drugs ordered by the providers. To study effectiveness, the researchers randomly surveyed patients regarding problem severity and changes in problem status after treatment. The researchers then computed the cost per episode of care for two conditions, sore throat and otitis media.

The findings: NPs were 20% less costly in their care.4 NPs were at least as effective as MDs at resolving the problem.3,p152


Study 3: NPs Get to the Root of the Problem

Avorn et al. asked 799 MDs and NPs to consider the following case vignette and answer two questions:5


Case vignette: A man you have never seen before comes to your office seeking help for intermittent sharp epigastric pains that are relieved by
meals but are worse on an empty stomach. The patient has just moved from out of state and brings along a report of an endoscopy performed a month ago showing diffuse gastritis of moderate severity but no ulcer. Is there a particular therapy you would choose at this point, or would you need additional information?

Questions: What more do you want to know? What would you do?

The findings: Nurses were far more likely to collect more historical information about the patient before deciding upon therapy. The NPs asked an average of 2.6 questions about the patient as opposed to 1.6 for physicians. A third of physicians (and 19% of NPs) chose to initiate therapy without any additional information. Nurses were far more likely to ask about the patient’s diet and psychosocial information (but less likely to ask about alcohol intake). NPs were more likely to suggest nonprescription approaches to therapy, such as a change in diet or counseling to help the patient deal with stress. NPs were far less likely than physicians (20% versus 63%) to recommend a prescription drug.6 NPs were much less likely to state that a prescription drug would be the single most effective therapeutic intervention for this patient (12% versus 46%).7

No analysis of cost of therapy was done. However, when the cost of MDs’ treatment plan—prescription medication, but no counseling about unhealthy lifestyle—is compared with NPs’ treatment plan—no prescription, but counseling regarding aggravating factors—the NPs’ treatment plan certainly shows itself to be the more economical approach to care.


Study 4: Patients Are Satisfied with NPs

Medical Economics, a magazine written for physicians, conducted a survey of patient satisfaction with NPs and MDs.8 Patients were as satisfied with NPs as with physicians.


Study 5: Patients Are Satisfied with NPs

Harrocks et al. systematically reviewed randomized controlled trials and prospective observational studies and found that patients were more satisfied with care by a nurse practitioner, that there were no differences in the health status of patients treated by nurse practitioners versus medical doctors, and the quality of care was in some ways better for nurse practitioner consultations.9


Study 6: NPs Are More Successful at Getting Patients’ Blood Pressure Down

Mundinger et al. conducted a randomized trial comparing outcome measures for care provided by nurse practitioners and medical doctors. Among other things, Mundinger
found a statistically significant difference in the diastolic value of patients treated for hypertension by nurse practitioners. Nurse practitioners’ patients had a lower diastolic blood pressure after treatment than physicians’ patients.10


Further Data on the Value of NP Practice

A survey study (N = 3257) comparing OB-GYN practices that used nonphysician providers with physician-only practices found that patients preferred the “collaborative” practices.11 Of the nonphysician providers, 45% were NPs, 19% were midwives, 16% were PAs, and 9% were CNSs. Reasons for preferring practices with nonphysician providers were:



  • The patient got an appointment faster.


  • More time was spent with the provider.


  • More health information was given.


  • More diet information was given.

Patients felt that nonphysicians were less rushed in their care. However, patients believed that physicians provided more complete information.

For a quick reference to substantive arguments supporting NP practice and citations for the arguments, see Exhibit 13-1.

Sep 9, 2016 | Posted by in NURSING | Comments Off on Promoting the Profession to the Public

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