A Nurse Practitioner's View

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...