Article critique – Nurse-Managed Health Care Critique

Hansen-Turton, T. & Bailey, D.N. (2010). Nurse-managed health centers: Key to a healthy future. American Journal of Nursing, 110(9), 23 – 26, doi:10.1097/01.NAJ.0000388257.41804.41

A challenge facing the healthcare sector in the US is expanding access to quality care to the uninsured and underinsured population. Such a challenge as argued by Hansen-Turton and Bailey (2010) necessitated the enactment of the Patient Protection and Affordable Care Act and its signing into law in March 2010. Even with the passage of the legislation that seeks to enhance access to care, the authors note of the logistical challenge in achieving such higher access due to a dwindling supply hence shortage of primary care physicians. Accordingly, the authors argue for use of nurse-managed health centers (NMHCs) and Nurse-Managed School-Based Health centers (NMSBHCs) to alleviate the challenge and enhance access to care.

In support of their claim, the authors present literature that identifies two benefits of NMHCs and NMSBHCs. Firstly, the authors point out that such institutions have achieved an equal level of quality in care provision as physician-supervised models. In some cases, the authors note that nurse-managed institutions have better patient satisfaction rates than institutions with a physician-supervision model. Secondly, as pointed out by the authors, nurse-managed models of care provision attract lower costs compared to “physician’s office or an urgent care facility” (p. 23). Accordingly, such nurse-led institutions would offer high quality care in a cost effective approach thus improve the access of care to a larger population. However, the challenge for such institutions as noted by the authors is the lack of adequate funding since some fail to meet requirements for funding from the federal government. Thus, the authors argue for a need to amend federal funding approach to allow inclusion of nurse-managed institutions.

Although the authors present a credible solution, various aspects limit the extent of the article’s evidence. Firstly, author bias may have led to the authors’ preference for nurse-led institutions thus affecting the discussion they present in the article. This arises since both authors are leaders with the National Nursing Centers Consortium (NCC), a group that champions the interests of nurse-led healthcare institutions in the US. Accordingly, the authors for instance do not discuss the concerns raised by physician groups that argue for confining aspects such as sole provider status at medical homes to physicians. A second aspect that could limit the effectiveness of proposed solutions regards the quality of care. Although the authors argue that nurse-led institutions offer equivalent and at times higher level of care compared to physician-supervised care, differences in education, certification and accreditation process among various states limits such a contention (Keough et al., 2011). Accordingly, to ensure that a high quality of care is maintained throughout the US, firstly a standardization of nurse programs, certification and accreditation process is needed.

Hansen-Turton and Bailey present a plausible approach to enhance the access of care in the population. The proposed solution of enhancing funding to nurse-led institutions would help to reduce the shortage of healthcare professionals created by relying on a small pool of physicians. By enhancing such funding, the government would enable the nurse-led institutions to facilitate access to care in a cost effective manner. This arises since the nurse-led models provide care at comparatively lower costs compared to physician-supervised models. Accordingly, the nurse-led model would enhance access to care to the uninsured and underinsured population by reducing the cost of providing care. However, to ensure that the quality of care provided remains unadulterated, there is a need to standardize nurse education, certification and accreditation programs across all states.


Hansen-Turton, T. & Bailey, D.N. (2010). Nurse-managed health centers: Key to a healthy future. American Journal of Nursing, 110(9), 23 – 26, doi:10.1097/01.NAJ.0000388257.41804.41

Keough, V. A, Stevenson, A. Martinovich, Z., Tanabe, R. & Young, P. (2011). Nurse practitioner certification and practice settings: Implications for education and practice. Journal of Nursing Scholarship, 43(2), 195–202, doi:10.1111/j.1547-5069.2011.01395.x

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