A Nurse Practitioner's View

I believe it is important to look back at the challenges and successes of the outgoing year to set goals and plan for the new year. I partly attribute this to my DNP program as we have been required to reflect on each semester and completed year of the program. To say that health care was a hot topic in 2010 certainly is an understatement. We witnessed the passing of historic legislation that will help shape how care will be delivered in the years to come. I am hopeful to see better coordinated and more efficient care with an emphasis on preventative services and screenings. I am hopeful that all of the members of the multidisciplinary team refine and hone their collaborative skills so that we may better communicate and work together to provide the best possible care to our patients. 2010 saw nurse practitioners thrust into the spotlight as one possible solution for the influx of newly insured patients coming into the system. The discussions have been interesting to follow and it is ap...

The healthcare system of today is so complex yet so dysfunctional that I believe the time has come to educate and train the NP providers of tomorrow in a way that is reflective of that complexity. We have done a good job up to this point but need to bring that to the next level. Residency. I'm not necessarily referring to the typical residency training of physicians which takes place in hospitals but a residency-type of program in an out-patient setting (ironic that we use the term residency). We realize that healthcare is not exclusively delivered in hospitals. It takes place in independent providers offices, in community health centers, in mobile health vans, and in retail settings. It takes place in people's homes and places of employment. It takes place in many of the health decisions that we make on a daily basis. I found this NP residency program in Connecticut that claims to be the first NP residency in the US. The programs admits 4 NPs each year and trains them to ha...

North Carolina Nurse Practitioner Fights for Change Pediatric nurse practitioner Sandy Tripp has decided to do something about the childhood obesity crisis. She is reaching out to health care providers, public school administrators, and politicians to try and initiate change in Beulaville, North Carolina. As part of her efforts, she has been giving presentations in local schools. Her slide show features pictures of acanthosis, clogged arteries, fatty liver disease, and Blount’s Disease. She tries to educate students and staff about nutrition and the importance of exercise. She is also trying to persuade schools to offer their students fewer hot dogs and French fries and more broccoli and carrots. She is working to get a la cart offerings and vending machines removed from schools completely. She’s even trying to recruit Jamie Oliver, the international go-to guy for changing menus in schools! Tripp already has one politician on board, North Carolina House Representative Stephen LaRoque, ...

Why You Should Consider Becoming a Certified Registered Nurse Anesthetist Many registered nurses can tell you about the stress that comes with a profession where being overworked and under appreciated comes with the job. However, there is one nursing specialty where nurses report high levels of satisfaction with their jobs, their patients, and their salaries- Nurse Anesthesia. A Certified Registered Nurse Anesthetist is a registered nurse who has completed his or her Masters of Science in Nursing degree specializing in anesthesia. Today, between sixty and seventy percent of anesthetics are given by Certified Registered Nurse Anesthetists, according to the American Association of Nurse Anesthetists. Thanks to the high skill level required by the position, Certified Registered Nurse Anesthetists are highly independent, very well paid, and in demand all over the country. Certified Registered Nurse Anesthetists say that the field requires a lot of upfront commitment to receive the training...

On this unofficial Facebook " Unfriend Day " I thought I'd take brief stock of the different social networking platforms geared to nurse practitioners. There are a plethora of sites out there with varying degrees of engagement & activity. This list below is by no means meant to be exhaustive, it is just a sample of what I have come across: Clinician 1 NPs 2 NPs FaceBook (the many pages dedicated to different advanced practice nursing groups) LinkedIn (NP groups) Advance for NPs & PAs The American Academy of Nurse Practitioners (has a networking site that is difficult to find) The ENP Network Many NPs on Twitter Allnurses NP Central Listserv NP blogs These sites are primarily geared to the NP with the hopes of networking with fellow NPs . I have personally been a part of every one of these sites - more so as a lurker - to see what my NP colleagues are talking about and discussing. It's rare that I feel compelled enough to comment about an issue (well, I...

The Pros and Cons of Legal Nurse Consulting I’ve spent years pursuing different avenues in the health care industry. I spent my high school years studying to become a CAN, I was at one point a EMT, and I eventually turned to alternative practices like massage therapy, herbs and general fitness and nutrition. Not long ago, though, I heard a term that was relatively new to me – legal nurse consulting. My aunt told me about her pursuit of a legal nurse consulting certification. Her goal was to pass the certification exam and open her own business, partnering with lawyers around the country to help them understand medical charts and the medical profession as a whole. Sounds great, right? I’m wondering if it really is. I urge anyone who is considering legal nurse consulting to consider the pros and cons. While it is certainly an admiral and profitable career path, it may limit your future choices. First of all, legal nurse consulting is not a get-rich-quick solution to your problems. If you...

CareFirst Insurer Expands Role of Nurse Practitioners, IOM Recommends Same Last week, CareFirst BlueCross BlueShield, an insurer in Baltimore, Maryland, announced that it would enable nurse practitioners to serve as primary-care providers in Maryland, Northern Virginia, and the D.C. area. In response to both the physician shortage, which is expected to take a turn for the worse in the coming years, and to the health care reform law, which will produce an huge spike in insured patients by 2014, CareFirst made the decision to grant more authority to nurse practitioners. As quoted in a recent FierceHealthCare article , CareFirst Senior Vice President for Networks Management Bruce Edwards noted: "With these developments ahead and an existing need to expand access to these services, allowing nurse practitioners to practice independently as primary-care providers is a logical move to serve our members better." The CareFirst decision to rec...

Just wanted to update anyone following me as I am finishing up the DNP (graduation is May 2011!) The work is intense. Trying to juggle school, work and family life, is a challenge. However I know that it is already worth it. My perspective on my practice has changed for the better and I now incorporate evidence-based practice and culturally competent care in all of my interactions. My group of four are knee deep into the data analysis/synthesis of our systematic review. The statistical portion is mind numbing after looking at all of these clinical trials and trying to synthesize them into something that will make sense. We are also incorporating non randomized controlled trials (RCTs) into our write up which brings additional challenges in answering our clinical question (focused on diabetes and group medical visits). We have been busy reading and re-reading clinical studies, crunching numbers, e-mailing study authors (many who don't actually write back to you), making forest plot...

5 Ways to Make Your Life as a Nurse Easier It’s a profession that most people find daunting and challenging, which is why they choose to give it a miss. Not everyone is cut out to be a nurse because it involves long hours, grueling work, and a fair amount of emotional stress. But on the plus side, it’s a calling that warms your heart and makes you a better person. You see so much suffering and pain that you’re grateful for the healthy life that you and your family have, and you develop your kinder side because of your interaction with your patients. Even so, it’s a stressful job, and if you don’t make the effort to make your life easier, you’re likely to burn out. So here they are, a few tips on how you can make your life as a nurse easier and more relaxing: · Leave the office behind when you go home: As a nurse, you see so much going on in hospitals and in the lives of patients. You’re busy running around tending to them and taking orders from and following th...

The big news this week in the world of nurse practitioners and health care was the release of the Institute of Medicine's (IOM) Report, " The Future of Nursing: Leading Change, Advancing Health ." It's a logical read and echos what NPs, patients, and some other professions have been saying for years: let NPs do the work they are already educated and trained to do without arbitrary and archaic state and/or federal barriers. This is not a "scope of practice" issue, it is allowing us to practice to the full extent of our education. For example, when I reflect back on my NP education, there was no course entitled, "How to sort of take care of chronic conditions but when you get in over your head, make sure you have your collaborating physician's number on speed dial." We were taught to function as primary care providers that included acquiring the knowledge base to evaluate, diagnose and treat our patients and their conditions using the skill sets ...

I recently ordered an ECG along with routine blood work for a patient who needed a pre-op workup. I received the ECG results today with the interpretation by the cardiologist. I thought it was funny and sad that he felt the need to cross out the default "Dr." preceding my name on the report. Of course, I am not a "doctor" as in physician, nor do I ever purport to be. I will soon have my doctorate in nursing practice (7 months to go!) but that will have no impact on how I interact with my patients or colleagues. I wish reports, and even prescription bottles for that matter, correctly referred to the credentials of the ordering clinician. Our patients should be able to identify their clinician without further confusion. But until then, I guess providers will self enforce who gets to be called "Dr." I can't help but to imagine a rogue pharmacist crossing out the "Dr." on every prescription label for prescriptions that are written by non-physicia...

I've precepted many NP students during the years and usually had pretty rewarding experiences. (There was that one student that just didn't get it...I guess I can save that one and how I handled it for another post!) I like to think of precepting as a two-way street: my student is getting the hands on experience of patient care with guidance while I can further hone my precepting skills. Precepting a student is not simply telling them how to treat a condition or how to prescribe a medication. It is helping that student critically think to formulate differential diagnoses and treatment plans. Precepting can often be overlooked as part of the education and training of health professionals yet it is a critical part of acquiring the necessary skill set of patient care. I think back to my experiences as a student and have found supportive clinicians that helped to shape me into the clinician I am today (I was precepted by a Doctor of Osteopathic Medicine, an OB/GYN, a family nur...

"Hey, How are you doing today?" This is supposedly the way that many nurse practitioners (and physician assistants) introduce ourselves to patients according to Gary Larkin, M.D. who recently conducted a study published in the American Journal of Bioethics entitled, "Patient willingness to be seen by physician assistants, nurse practitioners, and residents in the emergency department: Does the assumption of assent have an empirical basis?" This study is a thinly veiled turf attack on both nurse practitioners and physician assistants. From the beginning of the article, the authors write: "...physician substitution has often been covert in the emergency department (ED), confusing patients as to provider identity and appropriate scope of practice. This confusion may be heightened as junior doctors and nonphysician clinicians alike wear the same long white coats and Littmann stethoscopes as experienced physicians." I retrieved the article myself to unde...

We find ourselves in the midst of a massive egg recall. Current estimates say that 500 million eggs have been recalled. The CDC is the place to go for the latest information on these recalled eggs and salmonella . Foodsafety .gov also is a great resource with updated information. Here is a link to the FDA site on how to identify if you are in possession of any of the recalled eggs. Food safety surveillance must be vigilant and people deserve to have access to reports, citations, and above all the ability to consume food that is safe from contamination. Who is to blame in all of this - governmental red tape, the food industry, the distributors, the FDA for lack of oversight? Politico has an article that suggests a slow moving Senate may be the culprit. Will this latest recall affect how/where you purchase food?

Here is an op-ed piece that I wrote some time ago that unfortunately didn't get published. However, this blog is a great place to put it! Patient-Centered Health Care Patient centered. To the average health care consumer, the notion that they themselves are the main focus of the care received is a no- brainer . However, the reality that exists in health care today is quite the opposite. More often, interacting with the current health care system is often a deeply dissatisfying and frightening experience, fraught with errors, miscommunication and waste. As a community-based nurse practitioner for 10 years, I practice within the fragmented confines of an inefficient and costly system and know how this current system is too often harming people. Fundamental reform is needed. According to the Institute of Medicine, care is often delivered in silos producing poorly coordinated and overly complex care. The current healthcare system is fraught with opacity and is unnavigable for most o...

The NY Times recently wrote about pharmacists expanding roles on the health care team. This is one example of a concept who's time has come that has the potential to make a significant positive impact on health care outcomes. Conceptually, this makes sense since as we all know, health care doesn't just take place in hospitals or in private offices. Patients are constantly making choices about their health in their everyday actions such as choosing what and when to eat. Pharmacies are located in the communities where people live and work and having access to a health care coach or guide in the form of a pharmacist (or other professional) gives people the opportunity to discuss their options and perhaps make better every day health decisions. Community health nurses have long known this as they visit patients in their homes and assess their living environment and offer recommendations that could eliminate safety hazards for partially paralyzed patients following a stroke for ex...

Here are some of my top read posts from the past. I hope you enjoy reading them. Collaboratus Provider Ratings Your Chart: Do you know what's in there?

Nope, not a post on the dysfunction of the health care system, just on the wonderful New York State politics at play. Today, accidental governor Patterson vetoed a bill that had passed both NYS Senate and Assembly that would have allowed NPs to sign DNR orders. There were apparently some language/technical issues with the Bill. However, the most disturbing piece here is the Governors complete and total lack of understanding what NPs do (no real surprise there). He was quoted, "Finally, I am not convinced that this is an appropriate function to be carried out by nurse practitioners. Decisions of life and death should be made by physicians, not nurse practitioners.” Not convinced?!? Didn't you just sign a bill that eliminated collaborative agreements between physicians and nurse midwives? (That would be life). Ever hear of hospice care? (That would be death). I wonder if he understands exactly who is spending time with hospice patients in their final days of life. It is the tea...

I recently wrote about my pursuit of the DNP and my rationale for it. As promised, here is the first brief installment of posts chronicling my final year of school (I actually have 10 months left now but who's counting!) Part of the final project is writing a systematic review. Since one of the principles of our program is evidence-based practice (EBP), our final project must be framed in the form of a PICO question. That is, Population, Intervention, Comparison, and Outcome. My group and I are still tweaking our question but it is centered on adults with type II diabetes. (Plus, I do need to maintain some level of suspense throughout these posts!) In order to gather the evidence, a comprehensive, systematic, and exhaustive search of the literature must be performed using key words and MeSH terms to narrow down the number of hits we get on our search. This is a critical part of any systematic review since the evidence gleaned will lay the groundwork for the review. We are searc...

I started to write this post and then said to myself, I'm not going there...its so passé. I saved it as a draft with little intention of completing it. Then I come across this " media kit " posted on the American Academy of Family Physician's (AAFP) website and just can't believe my eyes with their approach. They have set out to point out the obvious: NP education and training is different than that of physicians! Who knew?!?! I am so disappointed in the AAFP. Perhaps no other specialty works as closely together as NPs and family practice physicians. Up until now, I've generally come across very supportive family practice physicians of nurse practitioner practice. This is a slap in the face of sorts. And now the original post: Another day, another article about nurse practitioner's filling roles traditionally held by physicians, and another physician-centric theme by organized medicine. It's nice to read an article with some NP input and perspective....

How Hospitals Can Better Retain Their Nurses America is in the middle of a nursing shortage that is only expected to worsen as baby boomer nurses reach retirement age and a burgeoning population requires more healthcare. Here are just a few statistics that highlight the serious problems facing the healthcare industry: · More than 581,000 new nursing positions are expected to be created by 2018. This growth is much faster than any other industry, and there just aren’t enough nurses to fill the positions. · U.S. nursing shortage is projected to grow to between 260,000-500,000 by 2025. · Over the next 20 years, the average age of the RN will increase and the size of the workforce will plateau as large numbers of RNs retire. Because demand for RNs is expected to increase during this time, a large and prolonged shortage of nurses is expected to hit the US in the latter half of the next decade. · There are more than 100,000 vacant RN position...