A Nurse Practitioner's View

I frequently peruse the local NP job offerings and am constantly amazed at the lack of knowledge regarding NP practice within these postings. Below are a few of may favorites: "NP or RN needed" - umm , do you know that there is huge scope of practice difference?!?! Not to put down any of our RN sisters & brothers (after all, we are all RNs first!) However, the scope of practice of each is very different. "Work under the supervision of..." - Get the terminology correct. If you are in NY State (as I am) NPs work in collaboration with our physician colleagues. I can't imagine that this would be a terribly supportive environment. "Competitive Salary" - $35 -40/hour or $60,000 - $70,000/year is not competitive at all, it's insulting. "Must be a team player..." - The word "team" is thrown an awful lot. In the true sense of the word, it would mean that you are an individual grouped with similar individuals for the purpose of a co

There is a physician blogger that uses every opportunity that he can to minimize , patronize and belittle the NP role and he is at it again . I refuse to leave a comment on his blog since others who have induce a tirade of back and forth nonsense that gets no where. He can track back to my post and maybe read this blog and maybe gain some relevant insight into NP practice. I must now return to counting tongue blades since that is as complex as this nurse practitioner gets. One, two, seven....damn!

My informal salary survey had 6 respondents (thank you for responding!) You can see the actual results on the right hand side of my blog. Interestingly, 3 of the 6 respondents reported salaries in the $70 - $79,999 category. I know for certain in the NY metropolitan area that salaries are a bit higher than that. One may look at this and say "I can make more money as an R.N." and that would be true. In my experience with my colleagues, NPs don't mainly become NPs for the financial incentives. It is about taking on patient care from a unique perspective - a perspective that synthesizes nursing and medicine, that sets out to be culturally competent, that strives for evidence and that focuses on the whole person. There are still many out there who do not (nor care to) understand NP practice. I maintain that we are not "physician wannabes" and bring something inherently unique and valuable to patient care. Thanks again for responding!

Hi, I see a lot of inquires for NP wages. Please take my informal salary survey on the right of the page. Of course, there are many variables to consider such as benefits, bonuses, hourly vs. salaried, etc. I'd just like to get an idea of what others are making and will report on the results. The survey will be up for a week. Thanks, Stephen

A NY Times article refers to a new study from the BMJ involving the prescribing of placebos to patients. Many ethical dilemmas are raised with this practice. The "placebos" referred to in this study weren't placebos at all, they were either vitamins or different classes of pain management medications. Wiki defines Placebo as: ... a substance or procedure a patient accepts as medicine or therapy, but which has no specific therapeutic activity. Any therapeutic effect is thought to be based on the power of suggestion . The word placebo is Latin for I will please. Prescribing placebos is only part of the game. There is also the ordering of expensive lab work and diagnostic tests that go hand in hand with the powers of suggestion. I try to be mindful of the tests that I order and explain the risks and benefits of such tests/treatments. Sure, there have been times when I've contemplated creating my own "S- Pak " in the hopes of creating a magic treatment. But

On October 24, NOW on PBS will explore a projected nursing shortage that could impact quality of and access to care for millions of patients. Be sure to tune in! Below is the press release: Show will highlight Innovative solutions in New York City and elsewhere NEW YORK, September 26 – A U.S. government study projects that by the year 2020, there will be a nationwide shortage of up to one million professional nurses . The nursing shortage is already placing strains on the entire medical system. On October 24, 2008, the Emmy Award-winning newsmagazine NOW on PBS will examine the root causes of this crisis, and innovative efforts to reverse the trend. Even though qualified nurses are in high demand and hospitals are offering attractive incentives, many are leaving the profession. Even more alarming: few are choosing to teach the next generation of professionals. As a result, tens of thousands of applicants are being turned away from the nation's nursing schools. The production is sup

A New Jersey jury recently awarded $400,000 to a deaf patient because her physician refused to provide a sign language interpreter throughout their visits. The patient ultimately switched physicians since the steroids she was receiving caused facial edema. The new rheumatologist subsequently took her off steroids and was able to explain that the edema was a side effect of the steroids and not from her illness. This case presents many ethical dilemmas for the practicing clinician. I have seen other blog posts related to this case. The knee-jerk reaction talks about moral obligations and financial implications for the physician to hire an interpreter that would result in a net loss for the visits (the visits were reimbursed at $49 and the interpreter would cost about $150-200/hr). Those angles miss the point. Where is the culturally competent care? Cultural Competence is defined as: (via wiki) ... an ability to interact effectively with people of different cultures. Cultural competenc

Here is an article about a drive through flu shot clinic in Pennsylvania. The service is targeted at Seniors and health officials devised a system regarding which lane you drive up to and other logistics regarding the vaccination. At first, I thought it was another gimmick. However the more that I thought about it, it does make sense. I've had a few requests over the years to vaccinate seniors in the drive-by fashion. This always put me in a difficult situation -- not because of the actual injection -- but what happens if there is a reaction and how can I ensure that they wait the recommended 20 minutes post vaccination without driving off into the sunset? From a public health perspective, it makes complete sense. High-risk patients should get the immunizations and we must examine new ways to make this happen. We certainly can't visit them all in their homes. As long as there is a well-thought out system with policies and procedures in place, ideas such as this will prompt us

Here is a great post from a medical student about retail clinics. Here is someone who clearly understands the need the clinics are filling and more importantly (in my opinion), how nurse practitioners are part of that solution. It's good to see such an un -jaded perspective and how we can all work together in today's complex health system.

Today's WSJ Health Blog writes about the infection, Clostridium difficile (C. diff), and how it's becoming known as the 'new' MRSA . The blog writes: The dark irony is that, because C. diff typically kept in check by the healthy bacteria that live in the digestive tract, people often get C. diff infections after treatment with antibiotics (which kill both harmful and healthy bacteria). It amazes me to this day, how many people come into the office demanding antibiotics for what are mostly viral infections (which of course, antibiotics do not help). I hear the same stories from my colleagues. Usually, once the side effects are rationalized, most people understand the consequences and we decide that antibiotics aren't indicated for this illness. Of course, this approach takes time and unfortunately, it's much easier to write the script for the antibiotic and not have to take more time out of one's busy schedule to explain this. Just as unfortunate, is that

On Friday night, September 5 th , the three major networks aired the telethon, Stand Up To Cancer . It is estimated that they raised over $100 million dollars which according to their website: ...will support research projects conducted by interdisciplinary, multi-institutional translational and clinical research "Dream Teams" and high-risk Innovative Research Grants from which ideas for new Dream Teams may arise. The funds will be administered through the American Association for Cancer Research ( AACR ) , the largest scientific organization in the world focusing on every aspect of high-quality, innovative cancer research. This is an amazing cause and could've even had a larger impact had it been on more networks and if it aired on a night other than Friday. The show featured patients battling cancer as well as celebrities and their cancer stories. The show followed actress Dana Delany for her annual breast exam. I was stunned and pleasantly surprised to see the exam p

Politico.com reports on a new Obama ad that uses a Planned Parenthood nurse practitioner narrator. The ad happens to be about the pro-choice vs. pro-life debate. The nurse practitioner says: "“Let me tell you: If Roe vs. Wade is overturned, the lives and health of women will be put at risk. That's why this election is so important,” says the nurse-practitioner who narrates Obama’s ad. “John McCain's out of touch with women today. McCain wants to take away our right to choose. That's what women need to understand. That's how high the stakes are.”" While my intention is not to turn my blog into a political forum, this certainly is a poignant event for nurse practitioners - to be featured in the national spotlight by the Democratic Presidential Candidate of the United States. It is, however, on a polarizing topic that may further shape individuals views of nurse practitioners either positive or negative. I have been unable to hear the ad for myself so if anyone

As nurse practitioner-staffed retail clinics continue to open and expand (despite what many recent reports say otherwise), they continue to fall victim to physician-centric comments undermining the competence and professionalism of other health care providers. Am I surprised? Not at all. It has all come to be so routine now. Take for example, a recent article written in the Topeka Capital Journal . The end of the article quotes a pediatrician's take (by the way, the American Academy of Pediatrics opposes the use of retail clinics - whatever that means) on why one shouldn't use retail clinics. The article goes on to say: As for people who don't have insurance, Cain said there is always a place for them. "We have plenty of places for people to get care," Cain said. When looking for a physician, Cain advised finding someone who has flexible hours and cares about patients. "I would find a doctor who can provide you with a good medical home," she said. "

An article about physician assistants and nurse practitioners appears in the NY Times Jobs section. The article does a very good job of explaining both professions though I would disagree with a few of the statements. Another important difference is that P.A.’s are generalists, while nurse practitioners train in a specialty like family medicine or women’s health. As a result, P.A.’s can switch fields more easily . - I would say that isn't necessarily true. Since the majority of NPs are trained in family health, I think it's just as easy for these FNPs to transition into different roles. To patients, the two roles can seem very similar. Salaries can be similar, too. The average total income for physician assistants in full-time clinical practice is about $86,000, according to the P.A. academy. The average total income for nurse practitioners is $92,000. - average salary of $92k? I think that sounds pretty high. Most of the NPs that I know are in the $70 - $90k range and I

Today's New York Times has an article about the Medical Home concept. These projects are becoming more popular as insurers are deciding to cover the costs. The article refers to a patient who visited his very busy physician that missed a stroke diagnosis because of a hurried exam. While mostly inexcusable, it provides a real life example of the issues occurring every single day due to the system's lack of access, communication, reimbursement, and high-quality. While the article doesn't make specific reference to NPs , Senators from New Mexico, Iowa, Alaska and Maine recently discussed expansion of Medical Home projects to include NPs , and other non-physician providers of primary care to lead medical home demonstrations. Senator Bingamin of New Mexico sums it by saying: Furthermore, nurse practitioners epitomize the delivery of high quality, cost-effective primary care that is crucial to the medical homes model. Senator Murkowski of Alaska adds: Nurse practitioners funct

Medgadget recently had the opportunity to interview the president-elect of the AMA, a cardiologist. Someone obviously with the finger on the pulse of primary care. One of the hot topics that he was asked about was the bleak outlook on primary care. This is from the interview: Q: Here's a question from one of our editors, Nick Genes. He's a resident of emergency medicine at Mount Sinai in New York. Many pundits and experts believe that the US government will improve access to primary care (one way or another) in the next 2-5 years. The Massachusetts experiment suggests there will not be enough primary care doctors to cover the increased demand. Already, primary care doctors are overworked and under compensated, with many leaving the field or choosing specialty training instead. How is the AMA planning to respond to this challenge? A: ... We continue to mention the importance of trained primary care, and I should also mention the AMA created the scope of practice partnership, b

Picture this: hundreds of patients braving the elements, lining up for access to a free healthcare clinic, dozens of healthcare professional volunteers offering their time to provide medical, dental and vision services and thousands of dollars in donated medical supplies. Sound like a medical corps serving a third world country? Guess again. Its happening in Tennessee, Virginia and Kentucky. Tonight, 60 Minutes ran an updated story about Remote Area Medical (RAM) . This is an amazing volunteer organization started by Stan Brock. His original intention was to help injured and sick people in desolate parts of the world. Now, a large part of the people being helped are right in our own backyard. What does that say about the state of healthcare today? The news piece also highlights NP volunteer Teresa Gardner providing women's health services to those in need. She counsels and treats a patient that hasn't followed up in 3 years status post cervical cancer surgery. Sadly, these s

Hi All, I will be on vacation for the next week! So, I won't be posting. I know I know for all of the few readers out there you'll just have to find another way to spend your time! :-) In the meantime, here is a nice press release from the AANP regarding their recent conference that was attended by more than 3000 NPs. Stephen (Image via flickr)

I thought that I'd start this post with a definition of collaborate (via Merriam-Webster On-Line) : Main Entry: col·lab·o·rate Pronunciation:\kə-ˈla-bə-ˌrāt\ Function: intransitive verb Inflected Form(s): col·lab·o·rat·ed; col·lab·o·rat·ing Etymology: Late Latin collaboratus, past participle of collaborare to labor together, from Latin com- + laborare to labor Date: 1871 1 : to work jointly with others or together especially in an intellectual endeavor Working jointly with others or together. Isn't that what most providers do when caring for our patients? NPs collaborate with physicians, other NPs, physical therapists, pharmacists, nurses, etc. Physicians also collaborate amongst themselves and with other members of the health care team. I bring this up because the majority of states require a collaborative relationship between an NP and MD. (Conversely, some states use an independent practice model while others use a supervisory one). The regulations among models can vary sig

Nurse Practitioner Carla Mills has written a book entitled, " A Nurse Practitioner's Guide to Smart Health Choices ." I have read excerpts from the book and intend on picking it up. Carla injects sound advice into managing chronic illnesses and a guideline for maintaining good health. This could be a great starting point to assist us with motivating our patients onto a healthier lifestyle. It's great to see a true wholestic approach to disease management, health maintenance and promotion. Check it out!

The WSJ Health Blog posted yesterday: " Some Nurses Land Higher Salaries Than Primary Care Doctors. " The gist of the article is that a recruiting firm averaged a nurse anesthetist's salary to be $185k/year opposed to $172k/year for family physicians. Now, I'm not sure if that is a blow to the sad state of primary care in this country or is a blatant smack at nurses. Is it heresy that nurses can make more than physicians? I just get the overwhelming sense from the article and its anonymous comments that the nursing profession (and its many specialties) is undervalued, poorly understood and should be akin to the handmaiden image. Why does it always have to be us vs. them?! Ugh.

Recently , a panel of AMA delegates vehemently opposed the idea of using secret shoppers to evaluate customer service of medical practices. For those of you unaware of what a " secret shopper " is (via Wikipedia ): Mystery shopping is a tool used by market research companies to measure quality of retail service or gather specific information about products and services. Mystery shoppers posing as normal customers perform specific tasks -- such as purchasing a product, asking questions, registering complaints or behaving in a certain way -- and then provide detailed reports or feedback about their experiences. According to the article, "the secret shopper concept is not being proposed to evaluate clinical skills but the way medical professionals manage relationships with patients, from the process of making appointments to such things as explaining billing practices." Of course, this shouldn't interfere with real patients and take up valuable resources. I'm

It looks like our Australian nurse practitioner colleagues endure similar baseless attacks on quality of care from the physicians they work with. See the article in The Australian entitled, "Bypassing GPs put lives at risk." "Things will be either missed, as in not detected, or there will be a misdiagnosis, as in something in error," Dr. Capolingua of the Australian Medical Association said." The easiest thing is always to play the quality card. Scare the public into thinking they will be misdiagnosed or will get inferior care by NPs, though nothing has proven that. Our Canadian friends subscribe to these tactics too. Right on queue, the Ontario Medical Association chimes in NP quality of care: "It's a delicate balance: Sure, we want to increase access to health care, but not if it dilutes quality of care. Nurses play a vital part in health care -as a team. You can't replace a doctor with a nurse." Nurse Practitioner scope of practice doe

Benjamin Brewer, M.D. writes a regular column in the Wall Street Journal entilted, "The Doctor's Office." Yesterday, he wrote the article, " Primary Care Has Rewards Despite Hassles ." I suppose the article is intended to give you the warm and fuzzy's about what it should be like being a primary care physician today - he talks of saving lives and delivering babies. However, I guess Nurse Practitioners are among the "Hassles" that he speaks of: "The future competition from retail clinics, various physician extenders and the opening of 200 Ph.D. nursing programs that will churn out "doctor nurses" is just a symptom of our health system's ills, not necessarily a cure for them." By the way, those programs are Doctor of Nurse Practice (DNP), not PhDs. I don't believe any of those "hassles" purport to be the cure-all for the ills of the healthcare system. They are however, an attempt to address many of today's dy

One has to hand it to Massachusetts for tackling escalating health care costs head on. A bill, that has passed the Senate and will soon be introduced into the House (as reported by The Boston Herald ): "... calls for creating a statewide, electronic medical records database, allowing patients to choose nurse practitioners as primary-care providers, and prohibiting pharmaceutical company sales agents from offering gifts to physicians." Allowing patients to select NPs as their primary care providers will serve as additional entry points into an already over-burdened primary care system. In addition, the bill will enable patients to experience high-quality, cost-efficient and patient-centered care directed by Nurse Practitioners.

USA Today reports on a newly proposed drug labeling system that will attempt to enhance information about the effects of medicines used during pregnancy and breast-feeding. The following is from the FDA's press release : "With this proposal, FDA's goal is to help women, their physicians and their pharmacists have better information about the effects of prescription medicines so that pregnant women, nursing mothers, and breast-feeding infants will benefit," said Rear Admiral Sandra Kweder , M.D., Center for Drug Evaluation and Research, FDA. "This proposal would help make drug labeling a better communication tool, and would potentially have a huge impact on public health and well being for women." The proposal would eliminate the current pregnancy categories A, B, C, D, and X and replace them with a consistent format for providing information about the risks and benefits of medicine use during pregnancy and lactation. The USA Today article goes on to say th

There have been 2 recent articles (one in a Boston publication and one in an upstate New York publication) about the concept of the medical home. This term is thrown around an awful lot these days and means much more than just a solo or group of primary care providers. This is a patient-centered approach to care that uses a coordinated effort by a team of health care professionals focusing on preventative health services right through hospitalizations. You can see the wikipedia definition of medical home here . Professional organizations such as the AAFP , AAP , & ACP (among others) have even adopted formal policy statements on this. One of the main reasons that this concept hasn't gone anywhere is because the coordination of this type of care (the phone call consults, e-mails, paperwork, etc) hasn't traditional been reimbursed by insurance companies. These new pilot projects are attempting to remedy that. Also encouraging is that NPs are being utilized in this model and

Here is a comprehensive article written in the Physician's News Digest entitled, " Growing role of nurse practitioners ." This balanced article gives a synopsis of the current state of the profession and where we might be headed. Also written this past week was an article about nurse practitioner-staffed retail clinics in Atlanta.

Here is a great little post about the use and overuse of antibiotics from an ER physician blog, entitled, " We are so screwed ." We all know that it is easier to write a script for someone demanding antibiotics rather than explain the risks, benefits and commitment of taking antibiotics. It is so important to not give in. I'll never forget the patient that I saw with a 1-2 day history of nasal congestion and very mild symptoms. I went into my whole routine of explaining why I felt her condition was viral and antibiotics weren't necessary. After that whole little dialogue, I asked her if she had any questions and she says, "Uhh, can't I just get a Z-Pak?" What??? Were you even listening for the past 3 minutes??? (FYI, I did not write for the Z-Pak.) I'll never understand the rationale of wanting to take a medication that isn't clearly indicated, can cause gastrointestinal issues, can be expensive and is usually a commitment for 10 days (that's

Once again, an article about retail health appears on the WSJ Health Blog site and the discussion ends up being about NPs versus MDs . Under that thread, a whole firestorm is set off when someone by the alias of "real doctor" claims that patients have returned to his office following visits to the retail clinics because they "were not treated appropriately." I certainly felt the need to respond to this arrogant attack on NPs and did so as "Real Nurse Practitioner." So what follows is the typical rhetoric from purported physicians and includes: if you want to be a doctor go to medical school, being a doctor means that you have to spend 11 to 15 years of post graduate training after high school, wearing a stethoscope and a white coat doesn't make you a doctor and the list goes on. NPs don't become NPs to "play" doctor. This is a profession that was borne from a need of primary care and pediatrician shortages in under-served areas. In 1

An article about nurse practitioners from Pennsylvania's timesleader.com appears on their website today, " Popularity of practitioners growing ." The article discusses an NP practice in Kingston Pennsylvania, Women to Women, that specializes in women's health. It's great to see more and more NP practices gaining headlines. It's also great to get support from our elected leaders such as PA Gov. Ed Rendell. He was integral in expanding the NP role in Pennsylvania in the hopes of making health care more accessible. It certainly seems like they are well on their way. Patients that utilize our services appreciate the access, the patient-centered approach and the high-quality care that NPs are known for. It's also encouraging that other members of the health care team are becoming increasingly aware and accepting of our roles on the team in an attempt to fill in the many gaps in health care.

Today's Newsday featured an article that included attributes to look for when choosing a primary care physician (I added the word "provider" :-). Long Island Nurse Practitioner Peggy O'Donnell was interviewed for the article and added some sound advice: "Certainly you want somebody who's not going to only speak in lay language but do reflective listening. You really have to have someone who hears what you're saying to them." There are many practical and common sense tips for patients. Clinicians should also be able to reflect on the advice from the article. It serves as a great reality check for us to ensure that we are properly in touch with our patients' reasonable questions and concerns.

There are 2 notable articles that I've come across that highlight initiatives by nurse practitioners to deliver care to relatively under-served populations. The first is from a program out of Norwegian American Hospital in Illinois. Their "Care-A-Van" is a mobile unit, staffed by pediatric nurse practitioner Patricia Carr, that will visit area schools and provide the following services, all for free: ..."routine child immunizations, required physicals, hearing and vision screenings, pulmonary function testing, asthma assessments, childhood health promotions, in addition to injury prevention and education." What a wonderful opportunity for NP-directed care. The second article is about nurse practitioner, Melanie Ryan Morris, owner and operator of The Cure Health and Wellness clinic in Texas. "The clinic focuses in preventative health care for working-class patients -- both uninsured and insured -- and particularly women." The location of her clinic w

Here is a link to a Medical Economics column, " How I built a successful medical practice in under seven years." What struck me about the article is Dr. Kurt Hunter, a Wyoming physician, and the utilization of physician assistants (a total of 4) in his practice. Each PA sees about 40 acutely ill patients daily, and I see the more complicated cases—usually about 15 per day, with visits lasting 20 to 40 minutes. This sounds like a perfect scenario and a true team-oriented approach to primary care in this community. The physician should be taking on the more complex cases leaving the more routine cases to the PAs (though we all know, nothing is routine). Not surprisingly, other physicians in the blogosphere have criticized him for "giving away primary care to mid-levels" which just shows the stubborn mindset of some. According to the article, Dr. Hunter was also integral in supporting Wyoming legislation that increased the number of PAs that he can directly work with

There is lots going on in the world of health care lately and I wonder if we've reached the breaking point. We saw stories just this past week on insurance companies refusing to pay for hospital mistakes , on-line health records not having to comply with HIPPA laws, problems with access to health care and the primary care physician shortage , a move towards concierge medical practices (where physicians reject insurance companies and patients essentially pay a retainer to be a part of that practice), and finally, drug companies using ghost writers to make their studies appear better than what they actually are. Even more troubling is the lack of solutions to address all of the above. I constantly ask myself, when will this get better and what is it going to take? This a time when we need our elected leaders to take "ownership" of these issues and for some out-of-the-box solutions from the private sector. The status quo is no longer a viable option.

Here is a recent article written in the AMA newsletter entitled, " Advanced-practice nurses seek wider scope in 24 states : Physician leaders fear that expanding the range of services nurses can provide may threaten patient safety." It includes the same old rhetoric against NP practice that they've been using for at least the past 15 years. I found this old press release from the American Association of Colleges of Nursing in response to a December 1993 report from the AMA Board of Trustees questioning independent practice by advanced practice nurses. The response clarifies and corrects the erroneously written material. Sadly, 15 years have passed and we are in a no better, if not much worse, health care crisis. Instead of working collaboratively for a solution that will attempt to address the health care shortfalls, some choose to recycle old baseless, inaccurate arguments. (Image is Plato-raphael from wikipedia, " rhetoric .")

Syracuse, NY native Archie McEvers , NP, will appear in Sunday's annual Parade Magazine "What People Earn" insert. Archie was chosen from millions of submissions and joins celebrities appearing in the survey. Archie, who has worked at University Hospital in Syracuse for the past 20 years is quoted as saying, ".. I hope that people will at least recognize what a nurse practitioner is..." This coverage in the Health Care section of the Parade survey certainly helps! See below to view the news clip from the local Syracuse, NY station.

I came across this website of Healthy Trust Immediate Medical Care in Wheeling, Illinois. This appears to be an urgent care center. On a post from 4/8/08, they have an entry entitled, " The difference between Immediate Care and Retail Care ." Now, I understand that healthcare is a business and retail clinics can impede on urgent care centers. Most of the retail clinics that I am familiar with (at least the ones that are NP staffed) do not purport to be an emergency/urgent care clinic. But, once again NPs become the brunt of the argument against the clinics. Here are examples from their posting: "These centers are generally staffed with nurse practitioners not true physicians." I don't think NPs try to pass themselves off as "true physicians" or even false physicians for that matter. The vast majority of NPs are proud of the fact that we are nurses first and bring that added level of caring to our encounters. We also enjoy collaborating with physici

An article was written in The Baltimore Sun about Rite Aid's plans to open physician-staffed retail clinics in the Baltimore & Washington, D.C. Bravo to the author for presenting balanced information regarding NP practice. There are even quotes from Mary Jo Goolsby, director of research and education at the American Academy of Nurse Practitioners: "We're part of the health care team," said Mary Jo Goolsby, director of research and education at the American Academy of Nurse Practitioners. "Nurse practitioners take care of acute minor illnesses, but we also have long taken care of complex chronic conditions," such as heart disease and diabetes. "We have the ability to recognize when something else is indicated and know when further" care should be recommended, Goolsby said. "There is a huge body of evidence that has looked at the quality of care provided by nurse practitioners, and it's considerably demonstrated that we provide safe, ef

An article about retail clinics in Michigan appeared on today's Crain's Detroit Business website. For those of you not having the pleasure of reading the typical retail clinic article in mainstream media, I'll summarize 95% of them for you now: 1. They usually start out talking about the fast growth of retail clinics. Some even throw in a "joke" of getting a tetanus shot where you shop for toilet paper. 2. Sometimes they interview an actual patient seen in the retail health setting. The patient usually has sinusitis or streptococcal pharyngitis and remarks about the convenience of the clinic's hours, location, price, accessibility, etc. The patient's experience is positive and state they would return again in the future. 3. Here it comes: "Doctors feel threat, have concerns, are skeptical," etc. This is the part for good ole fashioned nurse practitioner-bashing. Here is my case in point: "Nurse practitioners play an important role in heal

Just when I thought that I've seen it all: An article appears about a physician and his 'new' practice, Wellnessmart . This is a retail-based practice where "...people walk in and get what they need." The article goes on to say: "The store doesn't sell vitamins or medication but markets preventive health services like screenings that may tell a 33-year-old man he has a 17 percent chance of a heart attack over 30 years. It sells annual checkups, weight management, vaccinations and travel immunizations." Hmm, screenings, weight management, vaccinations, health education?? Sounds a lot like nursing interventions to me. Would anyone accuse this physician of practicing nursing without a nursing license (as NPs are routinely accused of practicing medicine without a [medical] license)? If this seems similar to retail health, its because it's clearly lifted from that model: transparent pricing, no appointment necessary, vaccinations - just not episodic c

My attempts to start a healthy dialogue regarding NP practice and Dr. Bob's 4/1/08 diatribe have failed : "One nurse practitioner linked to yesterday’s post and attacked my formulation. At the risk of insulting her and her colleagues, I have worked with nurse practitioners and I believe that she and they overestimate their capabilities. The problem with mid-level providers comes from their lack of training in thinking about complexity. They do very well in routine care, but the big problems in medicine come from incomplete thinking about problems." Thanks for not insulting me. And oh by the way, I'm not a female. So much for a prime opportunity to discuss NP education and the like. So much for better understanding the working relationship between NPs and physicians. Oh well, I must return to counting tongue depressors now because that's about as complex as this clinician can get.

Today's Wall Street Journal Health Blog reports on nursing schools awarding Doctor of Nursing Practice degrees to already advanced practice nurses & nurse practitioners. This is certainly a hot topic within the nurse practitioner ranks and has stimulated discussions of the pros and cons. Of course, the article is not without the obligatory unsubstantiated and biased medical community comment: "Also, since these nurses with a doctorate can use “Dr.” some physicians worry that patients could become confused. “Nurses with an advanced degree are not the same as doctors who have been to medical school,” says Roger Moore, incoming president of the American Society of Anesthesiologists." Some within the medical community seem to think that this is nurses attempt to "fool" patients into thinking we are actually physicians. If the vast majority of us wanted to go to medical school, we would have. We are proud of the fact that we are nurses first and bring a "who

This is classic. On his blog, DB's Medical Rants, Dr. Bob, writes the following about the term 'primary care' and why it's a poor descriptor: "When suits, politicians, Wal -Mart and mid-level providers see the phrase primary care, they think “simple care.” They think of patients with one problem, like hypertension or even diabetes. They think of urinary tract infections, sore throats and upper respiratory infections. They think of ear aches and knee pain." See folks, us lowly "mid-levels" are grouped together with suits, politicians and Wal -Mart executives - quite the grouping! Second, Dr. Bob seems to think that we are incapable of treating anything that's not simple. Apparently, we focus on one thing only. We don't perform screenings, immunizations, mental health evaluations, make appropriate referrals, etc. Please. Why are you so sour Dr. Bob? Maybe you haven't had the opportunity to work with Nurse Practitioners and/or Physician Assi

An article about the lack of physicians in rural upstate New York appears on the Albany Times Union website here , "An unhealthy situation for patients." Sadly, the utilization of nurse practitioners is not mentioned anywhere throughout the article. Don't get me wrong, yes we need more physicians in rural areas. Though, how innovative would it be to effectively use a resource that already exists, is willing and more than capable of alleviating the health care burden, than nurse practitioners. Lawmakers need to recognize this and support barrier-free nurse practitioner practice along with the offering of similar services as those focused on physicians. I hate to oversimplify things but according to my crude research: There are 19 physicians licensed in Schoharie county in upstate New York according to statistics from the State Education Department. There are 18 nurse practitioners licensed in the same county. If nurse practitioners were better utilized, the citizens of S

Dr. Steven Lamm, author of the book, The Hardness Factor , writes a column on the Today portion of msnbc.com about the different attitudes between men and women seeking health care. Dr. Lamm writes, "After three decades of treating both sexes, I have concluded that many men simply don’t think to put doctor visits on their “to do” lists. They look upon going to a physician as some undesirable form of pampering, no matter how sick they are. In general, men are not all that good at taking care of their health, probably because they have not grown up with periodic medical exams. " There is no doubt that women seek health care earlier and more often then men. As a former college health provider, I would easily see 4 female patients to every 1 male patient. While Dr. Lamm attributes this difference to the "traditional masculine pattern," to which I largely agree, I have additional food for thought. Perhaps men aren't encouraged enough to bring up their concerns or wh

Nurse Practitioner Jennifer Walsh recently conducted a preliminary study along with Dr. Wellington Tichenor on a bacteria found in tap water that may be linked to chronic sinusitis (a sinus infection generally considered to persist for 3 months or more). Their findings suggest a bacteria, atypical mycobacterium , found in tap water and not killed by chlorine, can be a contributing factor to chronic sinusitis when patients use tap water for nasal irrigation. Patients with sinus infections are often told to irrigate the nasal passages, and thus the sinuses, with a mixture of salt and tap water to assist in clearing secretions and congestion. Though more research is needed to further investigate this claim, perhaps we should suggest using a store-bought sterile preparation of saline in the interim. You can view the short piece by WABC 7 here and the link to Dr. Tichenor's website here . Congratulations Nurse Practitioner Walsh on your research!

Here is a well written article from today's Tennessean about Nurse Practitioners filling key rolls in primary care. To no one's surprise, The Tennessee Medical Association opposes this and even wants to add more barriers to nurse practitioner practice and therefore block access to affordable, high-quality care. They even find a way to throw retail clinics in the mix. My question is why do they feel a need to impose stricter limits on NP practice? Are there studies to show that NP-practice is unsafe or not as good as physician-practice? In fact, studies show the contrary. I like to think of myself as a person of proof. If you can show me other than anecdotal evidence, that NP practice needs limits rather than autonomy, I'd welcome the proof. I also don't want this to be a nurse practitioner vs. physician rant. We are all members of the healthcare team and need each other to collaborate and critically think when caring for patients. I certainly can't do it all by my

Welcome to my blog! I've pondered creating this for sometime now as I've searched the Web along with other blogs for current nurse practitioner-related content and have been unable to find much. This is my attempt to provide accurate and current information regarding Nurse Practitioner practice. My main goal is to start a healthy dialogue among nurse practitioners, other healthcare professionals and patients alike. There are a lot of misconceptions, inaccuracies and feelings about what nurse practitioners can/can't and should/shouldn't do. I've come across dozens of blog posts that are just plain wrong and hedge on bashing the profession. I hope to clarify some of these misconceptions in the hopes of providing the best barrier-free care possible to patients alongside other members of the healthcare team. For those of you unfamiliar with a Nurse Practitioner, lets start with a definition from the American College of Nurse Practitioners: "Nurse practitioners (NP