Rx for America

ABC News recently sat down with President Obama for their "Prescription for America" forum. You can read the transcript here. It is a wonderfully transparent and thorough conversation on the major issues of health reform today. They address the primary care and nursing shortages, comparative effectiveness, putting an emphasis on prevention/wellness and even discuss nurse practitioners and physician assistants as being part of the solution.

I truly believe we will see steady, incremental progress regarding health reform because all of the stakeholders are/will be part of the process. This has started with a dialogue where respect for each other is paramount. We all know that it is rare for everyone to agree and that's ok. But if we can respect one another's views and roles we are well on our way to addressing this ailing system.

This is a prescription that must be 'dispensed as written.'

Primary Health Care Defined

Once again, a debate is reignited about physicians versus nurse practitioners over at A Happy Hospitalist's blog. I'm not getting into a contest of who is smarter than who. I have always acknowledged that a physician's education is longer than that of a nurse practitioner's. My education and training has prepared me for a career in primary health care - a field that I am passionate about, am constantly trying to increase access to and one that I'm good at. Primary care is part of that vision of primary health care. There are many definitions of what "primary health care" is and the one that I use is not made up by me in my fairy tale world - it is the one that the World Health Organization defines as:

• reducing exclusion and social disparities in health (universal coverage reforms)
• organizing health services around people's needs and expectations (service delivery reforms)
• integrating health into all sectors (public policy reforms)
• pursuing collaborative models of policy dialogue (leadership reforms); and
• increasing stakeholder participation

I believe in treating people equally and fairly. I don't treat them as disease, illness, number or an inconvenience in my day. I provide culturally competent and evidence-based practice. I recognize that an individuals culture may have an impact on a prescribed treatment or intervention.

I don't pass myself off as a physician. New York State says that I have showed competency as a nurse practitioner in Family Health, have thus received certification with prescriptive privileges and ultimately national board certification. I'm not making it up as I go along. I don't know it all and am honest and open about that. But I'd be damned if I send a patient back out there without a plan or without collaborating with other members of the health care team. Maybe the word "independent" is the issue. I say, anyone who thinks they practice anything independently will not get very far. The health care system is just that - a system. A system that relies on one another, of different disciplines in the common interest of patients. No one discipline "owns" health care. Would that word "autonomous" be less threatening? I'd be happy to use that describing my practice if we can ultimately work together and make a damn difference in the work that we do.

My education, that is on-going and what I consider life-long, hasn't prepared me to be a physician. As an NP, my education and practice is blended of both nursing and medicine. If/when I am sick, I seek care from a team of providers that is best prepared to assess and treat me in a partnership at that particular time and place.

Maybe I am still too idealistic after 10 years of NP practice. But you know what, that's the stance that I'd rather take than complaining about patients, the staff that I work with and our payment structure (not that some of those issues aren't worth complaining about).

So for now, I choose to focus my energies on trying to improve this health care system and finding ways to ensure health for all.

Smoke 'em if you got 'em

Today, legislation has passed Congress and is on its way to President Obama that will allow the F.D.A. for the first time to regulate tobacco products. This truly is a huge step. As a health care provider, I see the harmful effects of cigarette smoke, not only on my patients, but on their families and on unsuspecting members of the community. Just recently I spoke with a patient that at one point in his life was smoking 4 packs a day. He now enjoys regular trips to his pulmonologist and annual arterial blood gas draws from his wrist - not fun nor painless. (If you ever thought having blood drawn from a vein is uncomfortable, as is the case with most labwork, drawing blood from an artery is a completely different ballgame).

Unfortunately in this legislation, nicotine (the highly addictive "feel good" substance found in cigarettes) isn't banned altogether but some chemicals in tobacco products are and there are restrictions put on advertising.

It still amazes me whenever I fly and see the no-smoking light above my seat that at one time smoking was allowed on airplanes. Talk about second hand smoke in a closed vessel! You can make a similar argument when it comes to restaurants and bars where in most places it is now banned.

Of course, we still have a long way to go when it comes to incorporating healthier evidenced based practices in our lives. Smoking causes cancer and other chronic respiratory problems. This legislation, once signed by President Obama, will be a major step in the right direction.

A Conversation of One

I love this. Fellow blogger (and I mean fellow only that he blogs, not that I can ever approach the level of "care" that he provides) just loves to rant about NPs. We aren't smart enough, we don't know what we don't know, provide good "nursing education" to our patients, we believe what we do is "good", are good at kissing boo-boos and holding hands, is at it yet again. (I think when his traffic is down, he decides to post about NPs and how "inadequate" he "thinks" we are to drive his blog traffic up.) It's really interesting - he harps on about how bad NPs are (i.e. we are mindless monkeys that can code a good level 5 visit) - he even has an "anonymous" NP post comments that claims their education didn't prepare her for the real world.

I am so over it. I've left respectful comments on his blog only to get shot down. He continues to denigrate NP practice and gets his fellow "colleagues" to add further belittling comments. It must be nice to hide behind his "happy" exterior without fear of ramification. I guess that's why some choose to blog anonymously - say whatever you want yet show up at work the next day and put on a good face to all of the NPs and nursing staff and they have no idea that you threw them under the bus in one of your many blog posts.

The sad thing to me is that I enjoy most of his humor and posts. I'm sure he is a relatively good guy. Well anyway, that's the difference - some choose to hide behind an exterior and say whatever is on their mind. Some others choose to be a real person with no hidden agenda and not hide behind the anonymity that the Internet affords. I suppose that is the beauty of anonymous blogging. Nonetheless, I hope he continues dialoguing with himself and continues to be 'happy.' At least I have a clear conscience when I post.....

May the Schwartz be with you...

Representative Allyson Schwartz along with nearly 100 cosponsors recently introduced House of Representatives Bill 2350, Preserving Patient Access to Primary Care Act of 2009. The legislation will improve access to primary care and increase the number of primary care providers in part by allowing the Nation's nurse practitioners to lead the Patient Centered Medical Home.

Here is the full text of the Bill.

This has the potential to be monumental legislation for our nation. In addition, an unprecedented number of physician (American Academy of Physicians & American Academy of Family Physicians) and nurse practitioner organizations (American College of Nurse Practitioners & National Association of Pediatric Nurse Practitioners) are supporting this bill. Though it seems that the AAFP is begrudgingly "putting up" with the inclusion of NPs as evidenced by AAFP Chairperson Jim King, M.D.:

The legislation also would allow nurse-practitioner-managed practices to serve as medical homes, as long as they meet the same standards applied to physician practices. Not surprisingly, this has prompted concern from the AAFP."We have some concerns with the way that the legislation includes nonphysician providers in a role similar to that of physicians, especially in the implementation of the patient-centered medical home," King said. "Without data showing the comparability of nonphysician providers to primary care physicians -- whose training and experience are much more intense and extensive -- it is a risk to allow these providers to deliver these services without the standard level of supervision."

These guys continue to play the turf war and it is getting so very tired. Nurse Practitioners want to partner and collaborate with physicians. When they throw around terms like "supervision" it becomes clear that they are only concerned about being the captain of the ship rather than working with everyone to support the efforts of having enough primary care access in this country. We need to have the right provider caring for the patient at the right time and place.

Nurse Practitioners are ready to step up and offer an out of the box solution to address our shortage of primary care. NPs need no further formalized training or education (yet we all know that you must be dedicated to lifelong learning in this field).

Please encourage your Representatives to support this legislation. We can't afford a ripe opportunity for meaningful health reform to pass us by....