Saturday, December 31, 2011

2011 Reflections

I'm aware that many people roll their eyes at another "year in review" blog post but it's been some time since my last post here and I think it is a good way to end the year.

2011 was an important year for me professionally as I completed my DNP back in May. It was a grueling 3 years (that I mostly chronicled here on this blog) and in my mind was the right choice for me at this point in my life. I approach clinical problems and scenarios through an alternative perspective and I have really embraced this philosophy. I hope to apply some of this new wisdom to the health care system and patients alike.

Because I'm a glutton for punishment, following the completion of the DNP, in the Fall, I enrolled full-time in one of the University Based Training programs that was part of the American Recovery and Reinvestment Act's HITECH Act. Technology has always been my passion and I am so interested in the integration of information technology and health - it is really the future of health care. Thus far, I have completed 1 semester and have 1 more semester to go which is slated to start in January. This has been an enormous amount of work on top of a full-time job and family stuff but I am certain that this post-grad certificate along with the DNP is where I want to be professionally.

In August, I also starting blogging over at Online Nurse Practitioner Programs. I've been posting about 2 entries a week about all things NP-related. It has been a fun experience to blog professionally and I look forward to continuing to expand my professional social media activities (i.e. Linked In & Twitter - feel free to connect with me there too.)

In November, I ran for and won the Chair-elect position for the Nurse Practitioner Association of New York. This is a 3 year term that starts in January 2012 as Chair-elect, 2013 as Chair, and 2014 as Past-Chair. I am looking forward to serving the organization and hope to further strengthen membership and and reduce the practice barriers in NY so that NPs can care for patients consistent with our training and education.

I was recently notified that I won the American Academy of Nurse Practitioners 2012 State Award for Excellence in New York State. I am so surprised and honored to receive this distinction!

Whew! And that is on top of balancing a family including three children (7, 5 and 2 years old) and the full-time job in occupational health. I lost a very close aunt to lung cancer earlier this month and there is no other way to put it that cancer just sucks. All of this has been challenging and has caught up to me to make it overwhelming at times. I am actively trying to find balance in both my personal and professional lives. It will be something I work on in 2012!

So thats a look back at 2011 and I am looking forward to 2012. I wish all my readers a Happy, Healthy, and Prosperous New Year!

Monday, November 28, 2011

Seeking NP Stories

I am posting this for a colleague who plans on writing a book about nurse practitioners.  


Seeking nurse practitioners of all specialties to submit stories about the experience of being a nurse practitioner. The NP may live in any geographic area.

This may include stories about the role of NPs, patients, circumstances or the health care system.

Selected NPs will be confidentially interviewed and audiotaped if agree to be part of the project.

Please contact mga11@caa.columbia.edu

Thursday, November 10, 2011

Nurse Practitioner Evidence

The latest nurse practitioner study conducted at Loyola found that "...the nurse practitioner reduced ED visits by improving the continuity of care and troubleshooting problems for patients."

These are the type of studies that need to be done. I am sick of the studies pitting nurse practitioners against physicians. The "us" versus "them" mentality is old, tired, and doesn't even belong in today's argument. The time has come to move past this and figure out a way to make the most out of available resources while ensuring that each profession practices to the extent of their education, training, and scope. Do we really need another study to show that NP practice is just as good or better than physicians or do NPs make more referrals or would NPs order more tests to arrive at a diagnosis? Please, this rhetoric is insulting to the entire US health care system.

In my opinion, nurse practitioners are not interchangeable with physician practice. We are different yet have many overlapping qualities. I have heard the argument that NPs practice medicine. Again, there are overlapping qualities but we are not analogous. How could we be when we are educated in varying models and practice settings for different lengths of time? We all deserve to be caring for the right patient at the right time and in the right setting. There are critical care NPs that do things that I cannot and I may be able to better care for a primary care patient in my setting. 

As states realize that NPs can be part of the solution to the provider shortage and reduce practice barriers, I believe we will see increasing pressure concerning NP practice. NPs have a 40+ year history of providing culturally competent, evidence-based, cost-effective and high quality care. If someone wants to waste valuable resources researching this (again), then the turf battles will continue. However, my colleagues and I, as well as the many other stakeholders, would love to see more evidence proving how NPs increase the quality of care and reduce costs in this wasteful health care system of today.

Monday, November 7, 2011

Guest Post: Keeping Your Brain Fit After 65: 5 Important Memory-Boosting Ingredients Found in Common Foods

Eat your fish, it’s good for your brain.” This is what every mother said to get the kids to finish their meal. As we age, there are many physiologic mechanisms that occur making memory a thing of the past. While remembering something your wife said thirty years ago is still there, what the heck did you do with your car keys? Here are five tasty ways to encourage memory after age 65, or before. 

1. Vitamin B12


Cyanocobalamin (B12) is an essential coenzyme required in many bodily activities. It is necessary to make the heme part of hemoglobin and it is also an integral part of nerve repair. A deficiency leads to pernicious anemia. Subclinical vitamin B12 deficiency can cause pain, electric shock feelings, sleep disturbance, depression, fatigue and memory loss. 


Your body needs a chemical called intrinsic factor to absorb B12 in the gut. Production of B12 declines with age, so foods containing B12 are essential to provide optimal absorption. B12 is found in meat, fish and dairy. Because of the fat issue in red meat, and calories in milk, fish is a great source of B12. See, mom was right!

2. Phytofoods


Many studies have demonstrated that one of the biggest effects in post-menopausal women is a decline in memory. Many men experience a decrease in testosterone production called the male climacteric. Estrogen and testosterone are in the same metabolic loop: one can be converted into the other depending on sex genes. Foods containing phytoestrogens are beneficial to both men and women providing hormonal stimulation that increases visual special memory. Ever wonder why rabbits eat clover? It is very high in phytoestrogens. Foods high in these beneficial nutrients are: soy beans, oats, barley, lentils, yams, rice, apples, carrots, pomegranates, wheat germ, ginseng, bourbon, beer, and fennel.

3. Phenol and Phytoalixin


Phenol and phytoalixin’s are chemicals that certain plants release in response to stress or damage. In humans they have been found to do many positive things. One significant positive effect is a neuroprotective action. It has been shown to decrease the plague formation associated with Alzheimer’s disease and improve other degenerative neurological conditions. They also have anti-aging properties. Several studies have suggested marked improvement in memory in test subjects supplemented with these chemicals. They are found in the skins of red grapes, blueberries, and other fruits. Unfortunately, red wine does not contain a large amount of these protective substances. 

4. Quercetin

Quercetin is a naturally occurring compound that is found in many plants. A flavonoid, it works directly on neurons and increases synaptic conduction resulting in faster and better connections in the brain. Common foods containing high levels of this substance are onions, fruits, vegetables, leaves, and grains. Onions have long been used in India as a folk remedy to treat memory loss. 

5. Omega Three Fatty Acids

Omega 3 fatty acids have been touted as a treatment for high cholesterol, metabolic syndrome, and a variety of other age related processes. Omega 3 fatty acids have a significant effect on brain function, specifically memory and mood. Foods containing this are fatty fish like salmon, (Mom’s still right), the oils from nuts, olive oil, beans, and squash.


There are other ways to improve cognitive function like getting off the couch and using your mind. Practice may not make it perfect, but it helps. All the training and mental effort can’t help a brain that is missing essential chemicals required to provide memory. Give your brain the building blocks it needs and maybe you’ll find your keys more easily!

Author Bio: 
John writes for Assisted Living Today, a leading source of information on a range of topics related to elderly living and retirement care and facilities, such as memory care.

Wednesday, October 26, 2011

Potpourri & an Election

I have certainly been keeping myself busy these days! First, I have been immensely busy at my clinical site. Hundreds of flu shots have been given in the last few weeks and I have been inundated with the change of season upper respiratory infections and allergies in what seems like everyone has (really, the care is largely supportive and conservative. I am a big fan of saline nasal irrigation!) 

Second, school work continues in the Office of the National Coordinator for Health Information Technology post graduate certificate program as Clinician Leader that I am enrolled in. I am considered full-time and plan on finishing up in May 2012. The amount of work has been intense (an intensity that I thought I was done with following completion of the DNP this past May!) The course work isn't as demanding as the DNP, but there is just so much of it that is condensed into a relatively short time frame. 

Third, I am running for Chair-Elect in the Nurse Practitioner Association of New York's (The NPA) election. Voting will begin next month and for the first time in many years, this is a contested election. It will be an interesting experience and am running against two other seasoned nurse practitioners for the position. (I am currently the Treasurer of the association). As any regular reader of my blog knows, I stand for transparency and accountability, with a sprinkle of common sense. My position statement is:

As your Treasurer, I’ve been responsible for guiding the Association through one of the most challenging economic times in our nation’s history. As a result, the Association enjoys financial stability to enhance member benefits and increase members.

In addition, our strong fiscal policies allows us to retain the best possible advertising and advocacy firms, as well as, professional staff, to ensure that our vision of barrier-free nurse practitioner practice in New York State is achieved. One of the greatest challenges we face are the often confusing and outdated laws that regulate nurse practitioner practice. The NP profession has and will continue to provide culturally competent, evidence based care that is of high-quality and cost-effectiveness. 

Unfortunately, these regulations don’t accurately allow us to provide the care that we were educated and trained for. Therefore, it is essential that we have these laws updated to allow us to care for our patients of today and tomorrow.

If elected, I will work tirelessly to enhance communication and transparency within our association in part by taking advantage of new technologies. My goal is to empower members so that we are the ones shaping and defining our profession. 

If there are any members of the NPA reading, I would appreciate your support in this election. (If you aren't a member and practice as an NP in New York, now would be a great time to join.

I will also be traveling to the NPA's Annual Conference this week and am looking forward to a great program. 

Lastly, I've been regularly blogging (about 2 posts a week) at Online Nurse Practitioner Programs.com since August. Feel free to check that site out as well (if you haven't gotten enough of me already :)

Other than that, I am just trying to maintain balance between my professional life and personal one. My blog has always allowed me to reflect on professional issues, which I fully intend on continuing. It is quite therapeutic. 

Wish me luck and I will be sure to post updates! 

Tuesday, September 27, 2011

Instant Lab Results

I recently blogged about the prospect of patients getting access to their laboratory results before the ordering clinician signs off on it. This certainly is a patient-centric approach but is it a wise one?

I am mostly in favor of this however, many details still need to be worked out. In our forthcoming electronic health records world, this may be the tip of the iceberg related to patient-centricity and access to their record.

I'd love to hear your thoughts and concerns.

Wednesday, September 14, 2011

Brief Update

Hello,

I just wanted to provide a brief update as to what I've been up to for the last few weeks. After completing my DNP this past May, I was actually feeling a bit melancholy thinking that my days of a "student" were officially over. Well, not so much! Since my passion is technology, I happened to be researching Health Information Technology (HIT) and found these University-based training programs set-up by the Office of the National Coordinator (ONC) under the HITECH Act. These programs train either health professionals on the IT side or IT professionals on the health side. Even better, there is grant that helps to pay for the majority of tuition fees!

I've always had a passion for technology yet, have been all self-taught with no formal training. The program that I applied to and was accepted offers a clinician leader track. It's been about 3 weeks and the hybrid program is intense! (I thought I was done writing papers, etc!) Thus far, it really is a wonderful program. I've met key HIT policy people and have gained great perspective into the push for all things related to electronic health records. I will be taking 18 credits over the course of the next 2 semesters (can anyone say glutton for punishment?!?)

I'm sure I will be focusing my next few posts here on HIT. There are many smart people in Washington that are working on these implementation initiatives (meaningful use, etc) and I am confident that we will see the successful transition from paper-based record keeping to sophisticated and intuitive electronic health records. This holds the potential of improving the quality of care by adding decision support logic while driving down costs by eliminating waste and duplication. Stay tuned.

Also be sure to check out this site (onlinenursepractitionerprograms.com/blog), where I am also blogging.

Monday, August 22, 2011

Additional Nurse Practitioner Blog

Hi All,

Please check out my new blog at Online Nurse Practitioner Programs! Also, like this new page on Facebook to automatically get new updates. I am very excited to further expand my blogging and audience in this new forum!

Not to worry, I will still continue to regularly update this blog with all things related to nurse practitioner practice.

As always, thanks for reading.

Stephen

Thursday, August 18, 2011

More on Private Nurse Practitioner Practices

A lot of nurse practitioners are finding my blog through searches regarding opening up a private practice from this January blog post. (I refuse to use the word independent since no clinician practices within a vacuum and requires multidisciplinary support to care for the whole patient). I happen to have a dear friend and colleague, Dr. Joy Elwell, FNP, DNP, who has her own private practice. I asked her a few questions regarding her experience and she was gracious enough to sit down and answer them for me and my readers. 

1. Why did you decide to open your own practice? 

Well, first, my experience was a bit unique, since I had my own practice within an institution, i.e. I worked for an institution and was able to see my own patients at that site. I decided to leave and open a free-standing practice in the community because at this point in my career, I believed I could serve the community better by being self-employed. I also believed that I would have greater satisfaction from my work by being self-employed. I can say, after being self-employed for a year, that both of these are true.

2. What are (were) the biggest challenges? 

Finances are always a challenge, regardless of the business. However, I had an established patient base who followed me to my present location. I was also already credentialed by insurance companies, so I did not have to wait very long to start receiving reimbursement. I also had a business plan, which was part of the curriculum in my DNP program, and that served me very well. Things like setting up payroll, direct deposit for employees, tax payments were challenges because we, as clinicians, are used to others taking those responsibilities. When it's your business, you are responsible for it all.


3. What are some of your successes? 

My practice is growing, Patients refer their families and friends. New patients tell me that employees at the insurance companies tell them, "Go to Joy Elwell; she'll treat you right". Last week a provider representative from a Managed Medicaid insurer walked in with a quality bonus check for $500. He said he wanted to hand-deliver it. And, I am able to practice the way I was educated and trained to; I can give each patient the time needed to provide quality care. 

4. What advice do you have for someone contemplating opening a practice? 

Write a business plan. If you can, build a patient base before you open. Avoid signing a "non-compete" contract with an employer. Be creative with space. Office rentals can be expensive; if you can obtain space in a school, or a church, consider it. I have a colleague in Arizona who has been given free office space in a firehouse. Be prepared to wait awhile to start being reimbursed by insurers. If you practice in a state requiring a mandatory collaborative practice agreement, take care with the financial arrangements. If you must pay the collaborating physician, a flat fee is always better than a percentage of your earnings. Develop relationships with as many physicians as possible. Network. In New York, with the constraint of the mandatory collaborative practice agreement, the NP must be prepared in case something goes wrong with that agreement. Consider signing agreements with 2 physicians. It is essential to protect the practice.

5. How much time did it take you to be up and running? 

It took 4 months, from the point that I found the office space which met my requirements, to the completion of the lease, and renovations, that I was ready to open.

6. Describe the credentialing process.

The credentialing process is fairly straightforward. Contact the insurer. Ask for a credentialing packet. Do NOT ask if the insurer credentials NPs. Why? Sometimes misinformed employees will say "no", when they in actuality do credential NPs. Be prepared to provide copies of numerous documents, including your RN license, NP certificate, diplomas, DEA certificate, proof of malpractice insurance, and collaborative practice agreement. I keep folders with multiple copies on hand, ready for this process. There is also an online service, which is free, through the Council for Affordable Quality Healthcare (CAQH). The Universal Provider Datasource is a part of CAQH's credentialing application database project that seeks to make the provider credentialing process more efficient for providers as well as healthcare organizations. You will still need to have documents on hand to update your profile, but insurers will be able to verify and update your documents through CAQH. Check it out at https://upd.caqh.org/oas/.


7. Did you consider any other models of practice (i.e. private pay only, concierge, etc)? 

I rejected of these models. First, 85% of the population is insured, and many pay significantly for their insurance. So, to be private pay only would cost me patients. I philosophically disagree with the concept of concierge care, so that is not something I would pursue.

And last but not least, can you provide a brief Bio? 

A Family Nurse Practitioner with nearly 30 years of experience in nursing, Dr. Elwell holds a Bachelor’s degree in Nursing from Long Island University,  a Master’s degree as a Clinical Nurse Specialist from Lehman College,  a Post-master’s Certificate as a Family Nurse Practitioner from Pace University, and a Doctorate of Nursing Practice at Rush University.

Dr. Elwell designed, implemented, and directed the Primary Health Care Center at Concordia College, Bronxville, NY, where she served students, faculty, their families, and the community for 18 years. In 2010, she opened a community-based, NP-directed primary care practice in Scarsdale, NY.

Having taught in both undergraduate and graduate nursing programs, Dr. Elwell is a member of the faculty of Frontier Nursing University, Hyden, KY, teaching nurse practitioner and midwifery students. 

She is the Government Affairs Chair for The Nurse Practitioner Association New York State, the Region 2 Director for the American Academy of Nurse Practitioners. She was selected as a Fellow of AANP in 2011. Dr. Elwell has worked to eliminate barriers to NP practice and increase access to health care. She was recognized in 2007 as “NP of the Year” by The Nurse Practitioner Association New York State. Additionally, she is a member of The North American Menopause Society and Sigma Theta Tau.

She serves the congregation of Village Lutheran Church, Bronxville, NY as Parish Nurse Practitioner.

Dr. Elwell lives in Eastchester, NY with her husband, Tim Elwell, and their 3 children, Diana, Ryan, and Ian. 

Friday, August 12, 2011

How Not to Advertise a Career in Nursing

I receive countless spam e-mail messages to my many e-mail addresses. The screenshot of the one that I received below is definitely one of the most bizarre and struck a nerve.


Really, this is not a way to advertise a career in nursing. It's unclear to me how or why doctors specifically, are in need of people like me. Perhaps the inference is that doctors tell nurses what to do and nurses are there to serve at their beck and call. We all know that the profession of nursing has a whole science unto itself and that nurses are front line care givers, influencers and advocates in the world of patient care. Sandy Summers is a nurse who runs the The Truth About Nursing website and she dedicates the whole site to correcting the vast negative portrayals of nurses in the media and in entertainment. I can envision her targeting this type of inaccurate portrayal due to the poor choice of wording.

I did not click on any of the links for fear of it taking me to some weird phishing site or to some inappropriate site. The e-mail address originates from Germany which also adds to the bizarreness. 

My hope is for those who are truly considering a career in nursing, they have the chance to explore the many wonderful opportunities within the profession and that targeted advertisements accurately portray the profession and encourage individuals to become a part of it rather than be dissuaded.

Sunday, July 31, 2011

File This Under Random

I check out many health-related websites on a daily basis. I click on links from Twitter and Linked In and see the entrepreneurial ventures of fellow health care professionals. One of the things that irks me of late is the random stock image of health care "professionals" posted throughout websites (for example see below).


This woman has been featured on more websites that I can count. It's not that I doubt her professional credentials - she seems to at least have a legitimate Littman-type stethoscope and upgraded smoke finished clipboard. But is it that hard to post a picture of actual clinicians today? When we talk about patient-centered care, I believe patients deserve to see an actual image of their provider rather than the random clip-board touting, lab-coat wearing stock image that graces so many websites. I hope this woman is at least getting royalties from gracing so many sites! 

So please, if you have a website and are a healthcare professional or entity, please use your actual photo rather than the one above - it helps regarding credibility. Patients know much better than that. 

Wednesday, July 20, 2011

Preventative Health: Is it Really Preventative?

Lately, there has been increased emphasis on "preventative" care in the US now that there are some mandates under the Affordable Care Act. There is even the U.S. Preventative Services Task Force (USPSTF) which is a panel of private sector experts who recommend evidence based preventative screenings for certain conditions based on factors such as age and gender.

As a family nurse practitioner, I base a large part of my practice on wellness and prevention in addition to episodic (or "sick") care. I believe in "wholistic" care - that is, care of the whole person including mental and physical states. Though lately, I question whether if "preventative" is really the best moniker for this type of care. Prevention assumes that one can completely avoid health conditions by subscribing to certain recommendations, screenings and/or tests. Is it naive or even obnoxious to think that we can prevent disease and illness? I have seen many patients follow all the recommendations only to end up with some other life threatening malady. Of course, we cannot avoid all sickness and illness as there are inherent non-modifiable risk factors (such as age, gender and heredity) that hold the potential to affect one's health. 

I am not necessarily disputing any evidence or recommendations that have been introduced but the false sense that we have the ability to "prevent" an illness or disease from happening in the first place. This can lead to unrealistic expectations and negative backlash. Yes, we be able to detect an early cancer prior to it's spread or immunize individuals against certain infectious diseases. But prevent altogether? Sadly, I don't think so - in fact, I know so. 

That's why I am using the term pro-active health rather than prevention. There are actions that individuals can take to lower their risks from disease and illness and I believe that is taking a pro-active part in one's health. We do this in the hopes of longevity, wellness, disease avoidance and early detection (if illness is identified).

Perhaps I am more hung up on terminology in my new post doctoral reflective state. I believe in open and transparent communication with my patients and other members of the care team. I don't want to purport to my patients that we can cure and prevent all illness. We can however, instill evidence based methods to increase patient activation, patient engagement, and ownership of one's health and behaviors to take a pro-active approach and present realistic expectations based on the available data. 

I'm curious to know what you think. Am I too fixated on the words (and the resulting expectations from that title) or are we possibly setting patients up for let-down and failure if they do encounter illness after following all recommendations? Please feel free to comment below.

Tuesday, July 12, 2011

That's What I Call Access to Care!

I am a huge baseball fan and my favorite team is the NY Yankees. Star third baseman Alex Rodriguez was recently diagnosed with a slight meniscus tear of his right knee. He has played through some pain over the last few weeks and was given conservative treatment by the Yankee training staff up until the point that it didn't really improve. Check out this timeline of events:

Friday 7/8/2011 - MRI reveals meniscal tear. I presume the team physician recommends surgery.
Sunday 7/10/2011 - A Rod gets a second opinion on SUNDAY with Dr. Lee Kaplan of Miami.
Monday 7/11/2011 - A Rod has successful surgery and is expecting 4 - 6 weeks of rehabilitation.

That is what I call access to care! From MRI to second opinion to surgery was a cool 72 hours (I surmise that he also needed a pre-op clearance thrown in there as well).

Yes, he is arguably one of the greatest players to ever play the game and is also the highest paid player but it is amazing how anyone can get a second opinion with an Orthopedist on a Sunday and have elective surgery the next day!

When we talk of health disparities, this is a prime example of what is wrong with our system. No, I don't expect a consultation to surgery time period of 72 hours, I just wish I can get some of my patients to just see an Orthopedist in the same month.

Wednesday, June 29, 2011

Calling All Shoppers - Redux Again!

I had no sooner finished blogging about the announcement regarding the governmental plan to utilize mystery callers to assess access to primary care offices to find out that the survey has been put on an indefinite hold.

Being a conceptual proponent of this research, I am disappointed that the administration backed down from the seemingly large physician backlash. Then again, as I stated in my last post, will this really tell us anything that we didn't already know? If you have any doubts, just try calling any office on a Friday afternoon, stating that you are a new patient and would like to come in on the same day for an appointment because you suspect pneumonia - oh, and that you have no insurance. Maybe the proper thing to survey is how long it will take to be hung up on or laughed at.....

Tuesday, June 28, 2011

Calling All Shoppers - Redux

One of the recent stories that spurred a lot of discussion was in the NY Times, U.S. Plans Stealth Survey on Access to Doctors. It is an interesting concept that will help to try and quantify how difficult (or easy) it is for one to get into to see a primary care physician. They will also evaluate if the office staff will give preferential priority based on the "patients" stated insurance.

I applaud this move and believe it will produce some evidence as to how hard it is for new patient to seek care. Many physicians aren't too pleased with this survey as I would imagine it will tie up their resources. I blogged about this concept a few years ago when the AMA came out against the notion of "mystery shoppers."

Health care needs to be patient-centric as the retail industry is consumer-centric. Why should health care be any different conceptually? I hope that this experiment isn't more of an exercise on provider's offices (i.e. poorly trained or rude staff) rather than the issue of access to healthcare due to not enough primary care providers. I see this as an opportunity to document the need for more primary care providers including physicians, nurse practitioners and physician assistants - though do we really think there isn't a problem there already??

Wednesday, June 8, 2011

Mobile Health Technology


A little bit on technology and how it is impacting health and patients. As an admitted techno-geek, I am passionately following mobile technology and where it is popping up in health.


A cool app that I recently downloaded is Instant Heart Rate for my iPhone 4. This is a free app and requires no external hardware. According to their website, it works by placing your finger over the iPhone's camera and it "tracks color changes in the light that passes through your finger." I used it and found the readings to be fairly accurate. It is also available for Android as well.

The basic app is free and for a $0.99 upgrade it adds features allowing you to document what you were doing at the time of recording, viewing graphed results over time, and auto-posting the results to Twitter.

As a clinician, apps such as this can help patients keep accurate data to review with their providers at their visit. It is exciting to watch this technology develop. Today it is heart rate monitoring and ECG recordings with tomorrow bringing endless possibilities. It is certainly in clinicians best interest to be aware of these apps since patients are using them. Further, perhaps it is an opportunity for clinicians to become involved with this developing technology and help steer it to ensure evidence-based and clinically sound apps.

Wednesday, May 18, 2011

Is this Patient-Centered?

My physician's group utilizes an on-line patient portal to schedule appointments, view lab results, and to communicate with my provider. Fortunately, it is very rare that I need to actually schedule an appointment. I've only been a patient of the practice for just about 2 years and I thought I'd schedule my second annual physical. (In fact, I've been there once, a year ago, for a physical on a Saturday). Now, I do question the real value of the annual physical examination but as we all get a year older, there are certain screenings that are recommended.

Nonetheless, I fired up the handy patient portal web address and requested a physical examination for any early Saturday appointment in June or July. Since I do work Monday through Friday with my own patient load and responsibilities, I don't think I should need to take a day off to have a physical. The practice has Saturday hours and I thought this would be ideal for me and my schedule. This is the response that I got back from the office staff:

Dear Mr. Ferrara: We don't have our schedule in for June yet. Our schedule for Saturdays will go in at the end of May. I'm not sure which Saturday Dr. X will be working. We don't usually do physicals on Saturdays because it's a short day he likes to keep it open for emergency sick visits so if you could come during the week Dr. X is late on Monday nights. Thank you.

So what is one to do? I am extremely annoyed at this response. Mind you, I have absolutely no current medical issues, am not on any medications, have health insurance, and in all likelihood, I would be in the waiting room longer than I would actually be in with the clinician. They can even code higher for a physical than for a sick visit! I am not asking for any favors or special treatment, just to have a Saturday appointment - up to 8 weeks from now. Is that too much to ask? Apparently so.

And some wonder how to fix the many problems of the health care system today. How about we start with access and getting our foot in the door.



Friday, May 13, 2011

DNP Series: Published!

The systematic review that my colleagues and I have been working on (for what seems like forever!) was finally published in the Joanna Briggs Library of Systematic Reviews!

It is very gratifying to have an official peer-reviewed publication under my belt. The title of our Review is, "The effectiveness of group medical visits on diabetes mellitus type 2 (dm2) specific outcomes in adults: A systematic review."

The work that we studied on group medical visits (GMV) is truly interesting and can serve as a viable model to aide in type 2 diabetes management.

Graduation is just over a week away and we just have one more presentation standing in our way. I will be posting some of my reflections on the program and on the DNP in the weeks to come. For now, I will enjoy this moment!

Sunday, May 8, 2011

Poll Results on the NP Modernization Act in New York


Here are the poll results from the show New York NOW on the the NP Modernization Act Bill that has been introduced in the New York Legislator. I particularly like the comment from "Stephen" - for obvious reasons ;-)

Monday, May 2, 2011

National Health Service Corps

I was recently contacted by a member of the National Health Services Corps (NHSC) and asked to highlight their program here on my blog. It certainly sounds like a wonderful opportunity for NPs regarding loan repayment. So here it goes:

The NHSC is a federal program that offers primary care providers financial support in the form of loan repayment or scholarships so they can practice in underserved areas of the country without the burden of educational debt.

The NHSC is currently expanding to help meet the need for primary care professionals. The current application cycle for loan repayment closes on May 26th and applications are now being accepted for the NHSC scholarship program.

As the country faces a shortage of primary care providers, the NHSC plays a critical role in bringing primary care medical, dental and mental health professionals to communities in which people would otherwise have to travel miles for health care, or go without help. In return, the NHSC offers help in repaying loans. For example, clinicians who join the Corps can receive up to $60,000 for a two-year full time commitment and up to $170,000 to help back loans for completing a 5-year service commitment.

If you have any specific questions, contact me and I can put in you in touch with someone who would be able to answer them. There is a definite need for eligible providers and loan repayment helps those struggling financially. It's a privilege that primary care NPs (as well as PAs and other health professionals including physicians, dentists and more) are recognized for this important and meaningful program.

Thursday, April 14, 2011

Guest Post: 10 Free Online Tools for Nurse Practitioners

10 Free Online Tools for Nurse Practitioners

There are several online sites that offer a wealth of tools and resources for nurse practitioners-
-and many of them are free. Here is a list of 10 sites that advanced practice nurses might find useful.

NursingCenter.com - Created by nurses for nurses, this site is an excellent place to find professional resources, clinical information, and continuing education activities. Other features include free peer-reviewed journal articles, free eNewsletters, job listings, daily news, and a search engine that searched more 100 nursing-specific websites vetted by other nurses.

NP Central - This site is operated by a non-profit organization that supports the development and advancement of nurse practitioners. NP Central offers job listings, education information, a list of nurse practitioner organizations by state, and other helpful resources.

eMedicine - A branch of WebMD, eMedicine is a highly respected online medical resource. You can browse many topics related to medicine, surgery, and pediatrics, and they can also view slideshows and get up-to-date medical alerts and news.

Epocrates - This free iPhone (and iTouch) application is a trustworthy mobile drug reference. This application features pill identification, drug interactions, and a medMath calculator.

Healthline - Healthline offers valuable information on a variety of subjects from drug treatments and interactions to healthy living. This site also features several videos and articles on current health-related topics.

Med-Source - This user-friendly site features posts on numerous medical subjects, and it allows users to browse those postings by subject, making it simple to find helpful information.

MedStudentNotes.com - MedStudentNotes.com offers a variety of resources, including online dictionaries, journals, medical notes, university libraries, and much more.

Mednotes.net - This site offers a comprehensive collection of free lecture notes and study guides in nearly every medical science. The primary goal of Mednotes.net is to educate nurses and medical students and help them study and prepare for exams.

MedicalStudent.com - On this site, you can find a large selection of online medical textbooks, journals, and a list of professional organization links. You can also view a variety of case studies, patient simulations, and more.

Clinician 1 - Clinician 1 gives you: job listings geared to specialty, free continuing education, the latest news, must-see articles, money-saving and earning opportunities, enjoyable social interaction, informative posts, and thought-provoking dialogues. It’s the only online community for physician assistants and nurse practitioners to connect, consult and converse on personal and professional levels.

Guest post from Bailey Harris. Bailey writes about health insurance quotes and related topics for www.healthinsurancequotes.org.

Sunday, March 20, 2011

DNP Series: Down the Stretch

It's been a while since I last posted and it's because I've been somewhat bogged down with the last few projects for school. To briefly update: We completed our systematic review and meta-analysis on the effectiveness of group medical visits for patients with type 2 diabetes (specifically the ABCs: Hemoglobin A1c, Blood Pressure and Cholesterol[LDL]). We have received peer-review feedback and have edited and resubmitted and are anxiously awaiting their response. We implemented an actual group medical visit model in our clinical agency site and are gathering data and tweaking accordingly via the PDSA cycle. Plus, I am trying to get motivated to work on the last individual paper which must be submitted for publication to a peer-reviewed journal (rough draft is due this Friday and I don't have much thus far - which completely explains why I am blogging right now!) Finally, we are working on our final presentation for the group medical visit project.

Whew! We are also getting ready for graduation which is very exciting. As the first DNP cohort, we are discussing things like whether to rent or purchase cap and gowns (I'm renting), nursing pins (probably not going to get), and all other things related to commencement. All of us are pretty much fried on this nearly 3 year journey and cannot wait to formally apply our new knowledge to our patients and to the health system alike.

As of today, there are 63 days until graduation (but who's counting)! Now it's off to procrastinate some more on this final paper and hopefully get something written that makes decent sense. Wish me luck!

Sunday, February 27, 2011

Target

Lately, it seems there is ratcheted up rhetoric on nurse practitioner practice making us prime targets for all things anti-NP. The WSJ reports on a study that examined the prescribing habits of NPs and whether there is Pharma influence on those habits. The study found that of the 263 surveyed NP respondents, 93% reported that free gifts had no effect on their likelihood to prescribe the medication that was being detailed by the representative. The study concludes that since many NPs had regular contacts with these reps in the form of face to face and industry backed lunches/conferences, there could be a degree of subconscious influence on prescribing habits - findings that are similar to prescribing habits of our physician colleagues.

As you can see in the comments section that follows the story on the WSJ, some are using this study to once again attack NP practice. The comments are laughable as the insinuation is that NPs aren't really educated on pharmacotherapy and therefore are likely to prescribe whatever medication that the really good looking sales rep sponsoring the free lunch is pushing.

I was curious as to why the author, a nurse practitioner, chose to focus on a fairly volatile topic of Pharma and NP practice. Some searching found that the author, Elissa Ladd, PhD, NP, is out to educate about some of the deceptive practices of Pharma. Here is a YouTube clip of her speaking about this and an on-line interview as well. She serves as the principal investigator of peRx, Prescribing evidence-based therapies. According to the website,

The program was developed to improve awareness of drug development and pharmaceutical marketing practices and to positively impact prescribing behaviors, specifically among advanced practice nurses. An innovative, multi-media, interactive web-based pharmaceutical curriculum has been developed that targets advance practice nurse students and other clinician audiences.

This looks like an interesting program comprised of 4 modules and is sponsored by The Consumer and Prescriber Grant Program. It is available for continuing education credit and I plan on soon completing them.

So here we have a Nurse Practitioner trying to promote evidenced-based practice (that should improve the whole prescribing community practices by focusing on the evidence) yet NPs as a whole are getting slammed as it presents an opportunity to take a shot.

Meanwhile, our NP colleagues (with physicians, patients and our health care allies) in Florida rallied yesterday to garner support for a bill that will allow them to prescribe controlled substances in the state. Florida is currently only 1 of 2 states that do not allow NPs to prescribed controlled substances. The quote that I love goes to Timothy J. Stapleton, executive vice president of the Florida Medical Association:

"Allowing unqualified nurses to play doctor and putting patient safety at risk is not in the best interest of our citizens.”

This one is so easy that it bears no further comment.

As more become aware of nurse practitioner practice, the attacks will also increase. I guess that comes with the territory. It's not really new though as this link to a NY Times article from 1988 referring to the legal recognition of NP practice in New York State also has it's share of opposition. You'd be hard pressed to know it was written nearly 23 years ago since the same arguments remain.

Friday, February 11, 2011

NP Ranked in Top 5 of "America's Most Loved" Health Care Provider

Congratulations to NP JoAnne Lutz of the Oregon Medical Group for being named in the Top 5 rankings of providers at DrScore.com. According to this press release, DrScore.com is "...an interactive online survey site where patients can rate their physicians, as well as find a physician based on their service level preference."

Steve Feldman, MD, founder of DrScore, states, "This year marks the first time a nurse practitioner has been in the top five runners up,” Dr. Feldman said. “This may reflect an important trend for medical practices as health care continues to evolve —everyone on the frontlines is vitally important in improving patient satisfaction.

Important trend indeed and some additional proof that NPs are highly regarding by their patients. It's also time to expand these rankings to other providers beyond physicians to include nurse practitioners and physician assistants to name a few.

Thursday, January 27, 2011

Snow Day

On my snowy commute into work this morning for what seemed like 100th snow-laden car ride of this winter, I chuckled when the radio newscaster urged people to stay home. As a healthcare professional, we rarely see a "snow day." Hospitals and clinics don't close.

So to all of my healthcare, EMS, police and fire (and anyone else needing to get to work) colleagues: Please stay safe out there when Mother Nature throws this nasty weather our way. Some people must get to work whatever the circumstances are.

Tuesday, January 11, 2011

Private Practice

There is an interesting trend that I'm observing and don't necessarily see how this is going to turn out. I'm seeing more and more nurse practitioner's opening their own autonomous practices. Many of these offices set out to offer care that is personalized, covered under insurance, and of course high-quality. I'm also seeing more NP specialty/sub-specialty practices such as house calls, incontinence, and women's health.

This is in a time when more physician practices are joining together in these conglomerations that aren't necessarily tied to hospitals. You'd be hard pressed to find a solo primary care physician these days yet nurse practitioner solo practices are popping up. The talk about the formation of accountable care organizations can be attributed to health care reform and the spurring of large multi-physician practices.

What to make of this? I honestly don't know. Many people and patients have said to me "you should start your own practice." Right now, that is not something that sounds very appealing to me. In my mind, I know how I would envision my own practice, patient flow, focus, etc. However, I hear the insurance company barriers, the paperwork hassles, the initial start-up costs, finding a new collaborating physician and see solo physician colleagues joining large practices and think that is not what I want to do right now.

What are your thoughts? Will you be starting your own practice? If you are a patient, would you go to an NP practice? For those NPs interested in starting your own NP practice, I highly encourage you to check out fellow blogger and NP practice owner, Barbara Phillips' website at http://www.nursepractitionerbusinessowner.com/. She offers tips and networking opportunities to give you the best chances for success.