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!

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 prac...

NP Residency

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...

Precepting Students

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...

A Nurse Practitioner's View

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