Wednesday, April 9, 2014

April 2014 Updates & Interview at

Lots going on for nurse practitioners in New York these days! We are very excited to have the Nurse Practitiioners Modernization Act pass as part of the 2014-15 NY State Budget! This is a major step forward that eliminates the written collaborative agreement between a an experienced nurse practitioner and physician. We have been at work on this for a long time and it is an acknowledgement by stakeholders that nurse practitioners are key to increasing health care access across NY state. 

Also, check out my interview at They had asked me some thoughtful questions and I am glad to have the opportunity to answer them! 

That's all for now.....Hope everyone is well!  

Wednesday, January 8, 2014

Back in the Saddle

Wow - I randomly checked my blog and see that it's been THREE months since I last blogged! It's not from a lack of activity going on in the nurse practitioner world but more from having far too commitments than I have time for and unfortunately, my blogging has lagged behind a bit -- ok, a lot. While clinically, I am seeing tons of patients with nasty upper respiratory infections and good ole influenza (and the New York State mandatory mask requirement for health care workers if not vaccinated) is rearing it's ugly head.

Practically every day, we see more and more coverage of nurse practitioners in the mainstream media. These NPs are responding to health questions, giving advice on things from influenza vaccines to cervical cancer screening and opening up their own practices. That's not to say that the toxic and predictable vitriol against nurse practitioners has ceased though. If anything, it has been turned up even more. Yet, it's obvious that it is having less of an effect as stakeholders far and wide recognize the contributions of NPs and seek ways to reduce the arbitrary and outdated barriers facing nurse practitioners.

I believe (hope) we will see the discussions about nurse practitioners and other professions focus on patient outcomes rather than how many million hours of training one profession has over the other. Undoubtedly, 2014 will be filled with uncertainty and change with regard to health care. There is the obvious Affordable Care Act (ACA) that we all know about, there will also be the transition from ICD-9 to ICD-10 on October 1, 2014, and the meaningful use objectives of health information technology are still going strong. I also hope to have some regular blogging frequency with topics that are of interest. In the past, I've kept my topics focused on health policy, trends and, clinical content. I'm not sure what future direction I will take -- most likely it will be those topics and maybe some new. I am open to suggestions and would love to hear from you!

I've tried to update my blog roll with some newer NP blogs that I've come across. If you know of one that I don't have listed, let me know.

With that, I wish you a very Happy & Healthy 2014!

Monday, July 1, 2013

Encourage Members of Congress to co-sponsor the Home Health Care Planning Improvement Act of 2013

Encourage your Members of Congress to co-sponsor the Home Health Care Planning Improvement Act of 2013

Enactment of the Home Health Care Planning Improvement Act of 2013 will make it possible for NPs to provide necessary services for their Medicare patients by allowing them to certify that patients under their care are eligible for home health care services. Passage of this legislation will reduce Medicare spending by eliminating duplicative services while also improving the quality and timeliness of care for the beneficiaries who require home health services.

Here is the link to the Bill, H.R. 2504 - To amend title XVIII of the Social Security Act to ensure more timely access to home health services for Medicare beneficiaries under the Medicare program.

Take Action Now

Monday, June 17, 2013

Response to WSJ Article, "Should Nurse Practitioners Be Able to Treat Patients Without Physician Oversight?"

This post was written in response to the WSJs article, "Should Nurse Practitioners Be Able to Treat Patients Without Physician Oversight?"

As much as some would like you to believe that this is not about turf protection, make no mistake, it is exactly about protectionism and nothing in the interest of the patient. The latest buzz words are now “team-based care” where nurse practitioners, physicians, and other members of the health care team, are working for the common goal of better health outcomes while the inefficiencies of today’s healthcare system vanish. The problem with this presumption is that there is no defined model of team-based care.

So what then is team-based care? If you ask a physician what team-based care is, they would say it is where they are in charge of the team and tell what the other members to do. They hold the most hours of in-patient training and in doing so can care for every patient and every condition without anyone else telling them how to do it. Plain and simple. Captain of the ship.

If you ask a nurse practitioner about team-based care, they will refer to a theoretical model where all members of the team are active participants in the provision of care for that patient. True collaboration takes place where providers seek solutions collectively and the right provider is caring for the patient at the right time and place. Precious time is spent developing the communication strategies of the team, the team composition and conflict resolution.

To simply state that the “…University of Missouri Department of Family and Community Medicine conducted a recent study of all comparative research on the topic and concluded ‘substitution of physicians by independent nurses providing comprehensive primary care is not an approach supported by the literature’” is disingenuous at best. First, this purported study simply used the data from an established systematic review published by the Cochrane Library of Systematic Reviews – “Substitution of doctors by nurses in primary care” by Laurant et al. ( Because the American Academy of Family Physicians (AAFP) didn’t like the outcome of the peer-review process, they decided to fund a second review and essentially re-write the results so that it favored a fictitious outcome, thereby minimizing the contribution of NPs. To date, their “new” study has yet to be published in any peer-reviewed journal that I am aware of.

The next talking point is to highlight how NPs order more tests. There was one small study that observed this (well over 10 years ago), however the study did not focus on patient outcomes. Therefore, this has very little applicability to draw any significant conclusions about healthcare costs or anything else for that matter. 

Finally, nurse practitioners do not want to be physicians nor do we purport to be. NPs are not taking a “shortcut” to medicine or trying to fool patients into thinking we are something we are not. It is our goal to be recognized for the unique clinicians that we are – melding nursing and medicine together to care for the whole patient. Nurse practitioners are among the majority of providers caring for the health disparate and doing so in an evidence based, culturally competent, and high quality manner that NPs bring to every patient encounter. The pillars of health promotion, health education, wellness, and disease management make nurse practitioners uniquely qualified for the aging population. And when there is a patient with multiple health issues whose body and/or mind are not responding to the latest recognized treatment, it’s good to know that a physician is waiting for the handoff. Or are they? 

Saturday, May 11, 2013

A Great Time Saver

As the case for nurse practitioners is becoming increasingly obvious across the spectrum, predictably, the turf battles are rearing their ugly heads. Here is a blatant example of the rhetoric and follows a formula that I am going to reveal to spare any future time wasting reading them.

  • Refer to the physician shortage and mention "Obamacare" 
  • State the obligatory, "nurse practitioners are valued as part of the health care team" 
  • Point out the differences in education and training (for example, physicians have 1 billion hours of training where NPs have nothing even remotely close to that) 
  • Make the inference that quality of care will somehow suffer because of the differences in education/training (though there is not one shred of evidence that proves this)
  • Make sure NOT to mention anything about patient outcomes being the same or better when NPs are primary care providers
  • If there is mention of outcome studies, be sure to highlight how they are "old" studies with small numbers of patients
  • Conclude by saying something with the phrase "physician-led team"
There you have it! I hope with this post, I was able to save the reader time wasted reading the same old argument. 

As a bonus, for on-line stories that allow readers to comment, I am going to save you time from reading the barrage of denigrating comments by summarizing here:
  • Blah blah a medical student blah blah blah....physicians should stop teaching NPs/PAs etc
  • Blah blah blah...(make statement about NP education yet have no clue about it)...blah blah
  • And finally, state that NPs won't see the poor and underserved and prefer to practice in the "better" practices with insured patients 
Of course, this is not the sentiment of most and the one's who truly want to improve health care understand that. 

Tuesday, March 26, 2013

Health Policy Observations

My apologies in advance for this post as I'm sure it is a bit all of the place. I wanted to just jot down some of my thoughts on the "nurse practitioner vs. physician debate." There has been many articles recently written about this, so here are my thoughts: (these of course are my own thoughts and not representative of my affiliations)

  • Above all else, nurse practitioners want to practice at the "top of our licenses." That is, to our full education and training. Imagine having access to the most wonderful car in the world - that can not only take you to wherever you want to go, in great comfort and with with excellent gas mileage, but not having the keys to start it. That is the restriction of the collaborative agreement. NPs have the education and training to care for patients in their specialty. However, without a collaborative agreement with a physician, we can't use any of it. We are stuck in the proverbial parking lot without keys. 
  • Nurse practitioners DON'T want to replace or supplant any profession. Yet inherently, there is the insinuation of NPs "taking over" or "replacing" others. I guess I would be defensive if someone told me that I would be replaced by someone else too. 
  • Yes, we all get that physicians have more hours of training.
  • I laugh at the pilot and flight attendant analogies. 
  • We are not the enemy.
  • Collaboration is not a dirty word. I refer back to my post written nearly five years ago, Collaboratus. Working together in the interest of the patient. Novel concept? It shouldn't be. 
  • I really laugh at the "if you want to be called doctor, then go to medical school." I haven't heard that one before. 
  • When NPs practice, physicians aren't in the room watching over them waiting for them to make a mistake or miss something.
  • Who "owns" quality of care? Every single licensed provider has a vested interest in the quality of care they deliver. With more and more available data points, patients will judge and decide who provides their care. 
  • Decreased costs. There is an assumption that since NPs are paid less than physicians, then costs should go down. My counter for pay parity: patients are receiving treatments (with similar or higher quality) and THAT will decrease costs.
  • NPs can only take care of "simple" things. Not true. No condition is simple. We treat patients, not conditions. Nothing is simple and we recognize and understand that as we partner with our patients.  
Please no more "us vs them." Stakeholders far and wide agree, that the way we provide healthcare in this country must change. It will be much better for all involved if we go at it together. Ok, I feel a little bit better now.