Comparing nurse-practitioners and physicians: a stimulation study on processes of care

The question "where is the 'nurse' in the nurse-practitioner" is addressed by comparing processes of care employed by nurse-practitioners (NP) and physicians (MD) in the overall management of commonly occurring problems in primary care practice. Subjects in a nonrandom sample of 15 NPs and 11 MDs independently described their proposed management of two pediatric and two adult hypothetical cases. NP and MD responses were compared to identify differences in the inclusion of explicit process criteria items in the following categories: problem assessment, diagnostic plan, therapeutic plan, health education, follow-up. The differences between NPs and MDs were almost entirely in the NPs' more frequent inclusion of expressive "caring" functions which have traditionally been the focus of nursing practice. The extent to which "care" as well as "cure" process variables affect outcome measures is discussed with regard to testing the effectiveness of the "care" component of health services, regardless of the professional identity of the provider.