Attempts to define the role of the nurse practitioner as a new health care provider raise questions about the traditional health care division of labor. In order to determine nurses' and physicians' conceptions of the NP's role, parallel surveys were conducted among registered nurses and primary care physicians in southeastern Pennsylvania (including Philadelphia). Respondents (679 nurses and 597 physicians) indicated their opinions on the issue of autonomy for NPs and on the issue of specific tasks appropriate to the NP's role. There were significant differences between nurses and physicians with respect to both of the issues under consideration, but there were also important dif- ferences within each of these groups. Nurses were more likely to assert that an NP might practice independently, and also had a higher conception of the NP's capabilities. Physicians who were interested in employing a nurse practitioner had opinions which were closest to those of nurses. These findings suggest that conflict between nurses and physicians might be minimal as long as the nurse practitioner movement remains relatively small, but that there may be latent conflict inherent in any large scale attempt to change the health care division of labor at the present time. (Am. J. Public Health 68:1090-1096, 1978 of a survey of nurse practitioner preparatory programs which describes them as reflecting "the broadest possible range" with respect to program content.'0 While some types of nurse practitioner, such as nurse-midwives and pediatric nurse practitioners, have enjoyed a relatively long tradition, there is still a good deal of flux and ambiguity in the field in general.The issue of professional autonomy-particularly the proper relationship of NPs to physicians-has been raised in several attempts to gain legislative sanction for increased independence for these new health care providers. Virtually all states still perpetuate "the traditional view that in the overlap between medicine and nursing the nurse acts in a dependent capacity,"11 but this issue is far from settled, and questions about the proper measure of autonomy for nurse practitioners continue to be raised.Previous research on the NP's role has fallen into two basic categories-case studies of the division of labor be-
Objective: There are known disparities in access to and utilization of pediatric health care and mental health care. Unmet health-related social needs, particularly food insecurity and housing instability, have previously been associated with poorer health and mental health outcomes as well as reduced utilization of preventive care. The relation between health-related social needs and pediatric mental health care utilization, however, has been largely unexplored. Method: Using a cross-sectional design with retrospective data extraction through a large, urban medical center's clinical data warehouse, this study investigated whether parent-reported unmet health-related social needs were associated with differences in the relationship between parent-reported child psychiatric symptoms and pediatric mental health care utilization. Additionally, the association between pediatric mental health care utilization and visiting an on-site food pantry, offered to address food insecurity, was assessed. Results: Consistent with the hypotheses, parent report of higher child psychiatric symptoms was associated with more pediatric mental health care utilization (rate ratio [RR] ϭ 1.17, p Ͻ .001), and as parents reported more unmet health-related social needs, this relationship weakened (B ϭ Ϫ.015, p Ͻ .001). Although the use of the on-site food pantry had no effect on the relationship between reported child symptoms and pediatric mental health care utilization, the use of the food pantry did independently correspond to an increased rate of mental health care visits (RR ϭ 2.25, p ϭ .002). Conclusions: These findings suggest that screening for and addressing unmet health-related social needs may be an important part of the effort to reduce pediatric mental health service disparities.
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