Nurses' and Physicians' Performance on Clinical Simulation Test: Hypertension

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Abstract
The purposes of this study were to determine whether nurse practitioners with a master's degree (NPM), nurse practitioners with a certificate (NPC), and public health nurses (PHN) perform as proficiently as family practice physicians (FPP) in assessing and managing essential hypertension and whether the four groups use a psychosocial or pathophysiological model in providing care. Subjects included 30 FPPs, 30 NPMs, 33 NPCs, and 40 PHNs. A clinical simulation test required subjects to collect data, identify problems, interpret tests, and formulate care plans. Criterion test performance was established by eight expert nurses and physicians. Physicians and nurse practitioners were equally proficient, and public health nurses were significantly less proficient on only 3 of 11 test sections. Sharpest contrasts were in test interpretation, with FPPs clearly more expert. FPPs practice style was less psychosocial but not more pathophysiological than that of the nurse practitioners. The study suggests that, except for nurses greater use of a psychosocial model, expanded role nurses and physicians perform similarly in assessing and managing hypertension and that, with slightly more training, PHNs could perform comparably.