A Nurse Practitioner's View

With the passing of the recent historic health insurance reform, the focus has turned (see here and here and here ) to how will the system deal with the influx of approximately 31 million newly insured seeking access to care. All of these articles address the current shortage of primary care physicians in some way and creates a sense of urgency for patients to try and secure one before access becomes crippled (as it has in Massachusetts). What these articles fail to address is the true potential that NPs and PAs have to pick up this slack. There is this incorrect assumption that NPs, facing the same barriers in primary care, are flocking to lucrative specialties. Fortunately for patients, this is not the case. A recent survey by Advance for Nurse Practitioners, reveals that most of the NPs polled work in predominantly primary care or primary care-type settings. Also a very informal survey of the NPs that I know has a similar result. So what does all this mean? The good news is that

There are so many unknowns regarding both patients and providers with the passing of the recent monumental health care legislation. Thanks to a recent post on AJN's Off the Charts blog, they posted a link to a handy ANA chart comparing both versions of the legislation and what it means for nurses and nurse practitioners. Of course, this is subject to change somewhat based on the revisions that still need passing however, I would imagine that it will remain pretty close to this. It appears the biggest factor for NPs is the ability to lead the team of providers in Patient Centered Medical Home demonstration projects. Stay tuned for more on this white hot topic of reform......

The US Department of Health and Human Services just released " Initial Findings from the 2008 National Sample Survey of Registered Nurses ." There is some valuable and interesting information in the latest report (the last one was done in 2004). Of note: There were an estimated 3,063,163 living in the US as of March 2008 (of these, 2,596,599 were employed in nursing positions). The average age for all licensed nurses rose from 46.8 to 47 years and employed nurses rose from 45.4 to 45.5. There are 158, 348 identified NPs The number of NPs grew 12.1% over the last 4 years There were an estimated 28,369 RNs with a doctoral degree in 2008. This is an increase of 64.4% since 2000. The workforce is becoming more diverse. 6.6% of nurses are male (a small jump from 5.8%) but a higher percentage of recent graduates were male from previous (4.1 % prior to 1990 vs. 9.6% since 1990). Hispanics are the most rapidly growing group of registered nurses. These are just a few highlights fr

I have tried to refrain from taking the bait from some recent negative opinions regarding nurse practitioner delivered care. Quite frankly, the arguments are old and tired. My goal as a clinician is to deliver the highest quality, evidence-based, and culturally competent care that I am capable of. I refuse to pit NPs versus other professions. We all have our own slightly varied philosophies and approaches to delivering care. Some may prefer the approach of a DO while some choose to see a NP or PA or MD. I believe patients have that right. However, I cannot believe the nonsense and out of context rubbish posted on the AMA's "Virtual Mentor" in a column entitled, " The Primary Care Shortage, Nurse Practitioners, and the Patient-Centered Medical Home. " Oh, where to begin! The opinion piece begins with the patronizing idea that NPs are part of the solution but not THE solution to the primary care crisis in this country. Funny, but I couldn't find a single ref

The NY Times reports that the F.D.A. is cracking down on food manufacturer's health claims on their package labels. I have somewhat mixed feelings on this. On the one hand, if a purported health claim is enough to convince someone to make wiser eating habits, then that has to be a benefit (albeit to the financial advantage of the manufacturer). However, as we strive to incorporate scientific evidence into these health claims, they need to be accurate and actually based on good data. A lot of supplements and vitamins now shy away from clear health claims for fear of the same F.D.A.-type crackdown (though is simply adding the word, " may " to the claim enough? As in "Vitamin C may contribute to increased immunity," etc.) It seems as if the F.D.A. is willing to work with the manufacturers to convey accurate and scientific information that should satisfy the manufacturers while protecting and correctly informing consumers and this should be lauded.