tag:blogger.com,1999:blog-40111449378080239812024-03-14T05:17:56.865-04:00A Nurse Practitioner's ViewThis is my blog that will highlight current issues, trends and policies affecting Nurse Practitioners and the health care system today.Stephen Ferrara, DNP, RN, NPhttp://www.blogger.com/profile/16673192365074420538noreply@blogger.comBlogger178125tag:blogger.com,1999:blog-4011144937808023981.post-3602705870582936012014-05-22T18:22:00.000-04:002014-05-22T18:22:31.355-04:00New York's Nurse Practitioners Modernization Act Here is a great infographic on NY's recently passed Nurse Practitioners Modernization Act that summarizes the new law which takes effect on January 1, 2015 (the written regulations are still however, pending).<br />
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<br />Stephen Ferrara, DNP, RN, NPhttp://www.blogger.com/profile/16673192365074420538noreply@blogger.com1tag:blogger.com,1999:blog-4011144937808023981.post-68623587879896963062014-05-12T08:24:00.001-04:002014-05-12T08:24:48.190-04:00Podcast InterviewCheck out my recent podcast interview by Barbara Phillips over at Sage Clinician. I am honored to have had the chance to discuss recent legislative developments in New York State with the passing of the <a href="http://www.healthleadersmedia.com/content/NRS-303686/NY-Abolishes-Written-Practice-Agreement-for-NPs">Nurse Practitioners Modernization Act </a>along with blogging, and more. <div>
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<a href="http://www.sageclinician.com/stephen">Feel free to check out it here! </a><div class="separator" style="clear: both; text-align: center;">
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Stephen Ferrara, DNP, RN, NPhttp://www.blogger.com/profile/16673192365074420538noreply@blogger.com0tag:blogger.com,1999:blog-4011144937808023981.post-19885901497174175972014-04-28T19:12:00.001-04:002014-04-28T19:12:41.053-04:00Milestone New York legislation eases practice restrictions on NPs | Nurse.com News<a href="http://news.nurse.com/article/20140428/NY02/140428001#.U17gXaxb9P0.blogger">Milestone New York legislation eases practice restrictions on NPs | Nurse.com News</a>Stephen Ferrara, DNP, RN, NPhttp://www.blogger.com/profile/16673192365074420538noreply@blogger.com0tag:blogger.com,1999:blog-4011144937808023981.post-88346947763628837152014-04-09T08:39:00.001-04:002014-04-09T08:39:23.218-04:00April 2014 Updates & Interview at Nursing411.comLots going on for nurse practitioners in New York these days! We are very excited to have the N<a href="https://thenpa.site-ym.com/?page=LegislativeAgenda" target="_blank">urse Practitiioners Modernization Act </a>pass as part of the 2014-15 NY State Budget! This is a major step forward that eliminates the written collaborative agreement between a an experienced nurse practitioner and physician. We have been at work on this for a long time and it is an acknowledgement by stakeholders that nurse practitioners are key to increasing health care access across NY state. <div>
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Also, check out my interview at <a href="http://www.nursingschool411.com/interviews/stephen-ferrara/">NursingSchool411.com</a>. They had asked me some thoughtful questions and I am glad to have the opportunity to answer them! </div>
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That's all for now.....Hope everyone is well! </div>
Stephen Ferrara, DNP, RN, NPhttp://www.blogger.com/profile/16673192365074420538noreply@blogger.com0tag:blogger.com,1999:blog-4011144937808023981.post-47536298369341302412014-01-08T22:31:00.002-05:002014-01-08T22:44:34.703-05:00Back in the SaddleWow - I randomly checked my blog and see that it's been THREE months since I last blogged! It's not from a lack of activity going on in the nurse practitioner world but more from having far too commitments than I have time for and unfortunately, my blogging has lagged behind a bit -- ok, a lot. While clinically, I am seeing tons of patients with nasty upper respiratory infections and good ole influenza (and the New York State <a href="http://www.syracuse.com/news/index.ssf/2013/12/ny_tells_unvaccinated_health_workers_to_don_face_masks_now_that_flu_activity_is.html" target="_blank">mandatory mask requirement </a>for health care workers if not vaccinated) is rearing it's ugly head.<br />
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Practically every day, we see more and more coverage of nurse practitioners in the mainstream media. These NPs are responding to health questions, giving advice on things from influenza vaccines to cervical cancer screening and opening up their own practices. That's not to say that the toxic and predictable vitriol against nurse practitioners has ceased though. If anything, it has been turned up even more. Yet, it's obvious that it is having less of an effect as stakeholders far and wide recognize the contributions of NPs and seek ways to reduce the arbitrary and outdated barriers facing nurse practitioners.<br />
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I believe (hope) we will see the discussions about nurse practitioners and other professions focus on patient outcomes rather than how many million hours of training one profession has over the other. Undoubtedly, 2014 will be filled with uncertainty and change with regard to health care. There is the obvious Affordable Care Act (ACA) that we all know about, there will also be the <a href="http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10FAQs2013.pdf" target="_blank">transition from ICD-9 to ICD-10</a> on October 1, 2014, and the <a href="http://www.healthit.gov/buzz-blog/meaningful-use/2014-meaningful-objectives-quick-reference-grids/" target="_blank">meaningful use objectives</a> of health information technology are still going strong. I also hope to have some regular blogging frequency with topics that are of interest. In the past, I've kept my topics focused on health policy, trends and, clinical content. I'm not sure what future direction I will take -- most likely it will be those topics and maybe some new. I am open to suggestions and would love to hear from you!<br />
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I've tried to update my blog roll with some newer NP blogs that I've come across. If you know of one that I don't have listed, let me know.<br />
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With that, I wish you a very Happy & Healthy 2014! Stephen Ferrara, DNP, RN, NPhttp://www.blogger.com/profile/16673192365074420538noreply@blogger.com3tag:blogger.com,1999:blog-4011144937808023981.post-83763356024124307792013-10-08T23:22:00.000-04:002013-10-08T23:22:56.218-04:00Infographic: Nurse Practitioners & the Affordable Care ActThe infographic below comes courtesy of Simmons School of Nursing & Health Sciences. Check the full link out at: <a href="http://onlinenursing.simmons.edu/affordable-care-act-family-nurse-practitioners/">http://onlinenursing.simmons.edu/affordable-care-act-family-nurse-practitioners/</a><br />
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<a href="http://4.bp.blogspot.com/-uyuB6q2zH9Q/UlTLEQIHhFI/AAAAAAAAAVs/rq4dVCF2nXE/s1600/Nurse-Practitioners_v4-02_Final_Final2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-uyuB6q2zH9Q/UlTLEQIHhFI/AAAAAAAAAVs/rq4dVCF2nXE/s1600/Nurse-Practitioners_v4-02_Final_Final2.jpg" /></a></div>
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Stephen Ferrara, DNP, RN, NPhttp://www.blogger.com/profile/16673192365074420538noreply@blogger.com2tag:blogger.com,1999:blog-4011144937808023981.post-17101571892137525322013-07-01T20:27:00.001-04:002013-07-01T20:27:41.070-04:00Encourage Members of Congress to co-sponsor the Home Health Care Planning Improvement Act of 2013<span style="background-color: white; font-family: 'arial narrow', arial, sans-serif; line-height: 17.5px;"><b><span style="font-size: x-small;">Encourage your Members of Congress to co-sponsor the Home Health Care Planning Improvement Act of 2013</span></b></span><br />
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</span> <span style="background-color: white; font-family: 'arial narrow', arial, sans-serif; font-size: x-small;">Enactment of the Home Health Care Planning Improvement Act of 2013 will make it possible for NPs to provide necessary services for their Medicare patients by allowing them to certify that patients under their care are eligible for home health care services. Passage of this legislation will reduce Medicare spending by eliminating duplicative services while also improving the quality and timeliness of care for the beneficiaries who require home health services.</span><br />
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</span> <span style="background-color: white; font-family: 'arial narrow', arial, sans-serif; font-size: x-small;">Here is the link to the Bill, <a href="http://beta.congress.gov/bill/113th-congress/house-bill/2504/actions" target="_blank">H.R. 2504</a> - </span><span style="font-size: x-small;">To amend title XVIII of the Social Security Act to ensure more timely access to home health services for Medicare beneficiaries under the Medicare program.</span><br />
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<a href="http://www.capwiz.com/aanp/issues/alert/?alertid=62755921#.UdIdhyhkfr4.blogger">Take Action Now</a>Stephen Ferrara, DNP, RN, NPhttp://www.blogger.com/profile/16673192365074420538noreply@blogger.com1tag:blogger.com,1999:blog-4011144937808023981.post-85467866171149333072013-06-17T20:38:00.003-04:002013-06-17T20:38:52.328-04:00Response to WSJ Article, "Should Nurse Practitioners Be Able to Treat Patients Without Physician Oversight?"<div class="MsoNormal">
This post was written in response to the WSJs article, "<a href="http://online.wsj.com/article/SB10001424127887324715704578480911396098592.html?mod=wsj_valettop_email#articleTabs%3Darticle" target="_blank">Should Nurse Practitioners Be Able to Treat Patients Without Physician Oversight?</a>"</div>
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As much as some would like you to believe that this is not
about turf protection, make no mistake, it is exactly about protectionism and
nothing in the interest of the patient. The latest buzz words are now
“team-based care” where nurse practitioners, physicians, and other members of
the health care team, are working for the common goal of better health outcomes
while the inefficiencies of today’s healthcare system vanish. The problem with
this presumption is that there is no defined model of team-based care. <o:p></o:p></div>
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So what then is team-based care? If you ask a physician what
team-based care is, they would say it is where they are in charge of the team and
tell what the other members to do. They hold the most hours of in-patient
training and in doing so can care for every patient and every condition without
anyone else telling them how to do it. Plain and simple. Captain of the ship. <o:p></o:p></div>
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If you ask a nurse practitioner about team-based care, they
will refer to a theoretical model where all members of the team are active
participants in the provision of care for that patient. True collaboration
takes place where providers seek solutions collectively and the right provider
is caring for the patient at the right time and place. Precious time is spent
developing the communication strategies of the team, the team composition and
conflict resolution. <o:p></o:p></div>
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To simply state that the “…University of Missouri Department
of Family and Community Medicine conducted a recent study of all comparative
research on the topic and concluded ‘substitution of physicians by independent
nurses providing comprehensive primary care is not an approach supported by the
literature’” is disingenuous at best. First, this purported study simply used
the data from an established systematic review published by the Cochrane
Library of Systematic Reviews – “Substitution of doctors by nurses in primary
care” by Laurant et al. (<a href="http://webcache.googleusercontent.com/search?q=cache:Ffm3TsFaMgQJ:www.aafp.org/online/etc/medialib/aafp_org/documents/about/congress/2010/res605background.Par.0001.File.tmp/SubstitutionofPhysiciansbyNursesinPrimaryCare2011.pdf+&cd=1&hl=en&ct=clnk&gl=us">http://webcache.googleusercontent.com/search?q=cache:Ffm3TsFaMgQJ:www.aafp.org/online/etc/medialib/aafp_org/documents/about/congress/2010/res605background.Par.0001.File.tmp/SubstitutionofPhysiciansbyNursesinPrimaryCare2011.pdf+&cd=1&hl=en&ct=clnk&gl=us</a>).
Because the American Academy of Family Physicians (AAFP) didn’t like the
outcome of the peer-review process, they decided to fund a second review and
essentially re-write the results so that it favored a fictitious outcome,
thereby minimizing the contribution of NPs. To date, their “new” study has yet
to be published in any peer-reviewed journal that I am aware of. <o:p></o:p></div>
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The next talking point is to highlight how NPs order more
tests. There was one small study that observed this (well over 10 years ago), however
the study did not focus on patient outcomes. Therefore, this has very little
applicability to draw any significant conclusions about healthcare costs or
anything else for that matter.<span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
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Finally, nurse practitioners do not want to be physicians
nor do we purport to be. NPs are not taking a “shortcut” to medicine or trying
to fool patients into thinking we are something we are not. It is our goal to
be recognized for the unique clinicians that we are – melding nursing and
medicine together to care for the whole patient. Nurse practitioners are among
the majority of providers caring for the health disparate and doing so in an evidence
based, culturally competent, and high quality manner that NPs bring to every
patient encounter. The pillars of health promotion, health education, wellness,
and disease management make nurse practitioners uniquely qualified for the aging
population. And when there is a patient with multiple health issues whose body and/or
mind are not responding to the latest recognized treatment, it’s good to know
that a physician is waiting for the handoff. Or are they?<span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
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Stephen Ferrara, DNP, RN, NPhttp://www.blogger.com/profile/16673192365074420538noreply@blogger.com1tag:blogger.com,1999:blog-4011144937808023981.post-84045551995150573902013-05-11T09:28:00.000-04:002013-05-11T10:08:08.427-04:00A Great Time SaverAs the case for nurse practitioners is becoming increasingly obvious across the spectrum, predictably, the turf battles are rearing their ugly heads. Here is a blatant <a href="http://www.buffalonews.com/apps/pbcs.dll/article?AID=/20130430/OPINION/130509983/1074" target="_blank">example</a> of the rhetoric and follows a formula that I am going to reveal to spare any future time wasting reading them.<br />
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<li>Refer to the physician shortage and mention "Obamacare" </li>
<li>State the obligatory, "nurse practitioners are valued as part of the health care team" </li>
<li>Point out the differences in education and training (for example, physicians have 1 billion hours of training where NPs have nothing even remotely close to that) </li>
<li>Make the inference that quality of care will somehow suffer because of the differences in education/training (though there is not one shred of evidence that proves this)</li>
<li>Make sure NOT to mention anything about patient outcomes being the same or better when NPs are primary care providers</li>
<li>If there is mention of outcome studies, be sure to highlight how they are "old" studies with small numbers of patients</li>
<li>Conclude by saying something with the phrase "physician-led team"</li>
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There you have it! I hope with this post, I was able to save the reader time wasted reading the same old argument. </div>
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As a bonus, for on-line stories that allow readers to comment, I am going to save you time from reading the barrage of denigrating comments by summarizing here:</div>
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<li>Blah blah blah...as a medical student blah blah blah....physicians should stop teaching NPs/PAs etc</li>
<li>Blah blah blah...(make statement about NP education yet have no clue about it)...blah blah</li>
<li>And finally, state that NPs won't see the poor and underserved and prefer to practice in the "better" practices with insured patients </li>
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Of course, this is not the sentiment of most and the one's who truly want to improve health care understand that. </div>
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Stephen Ferrara, DNP, RN, NPhttp://www.blogger.com/profile/16673192365074420538noreply@blogger.com3tag:blogger.com,1999:blog-4011144937808023981.post-78763988056191789662013-03-26T12:57:00.000-04:002013-03-26T13:39:43.650-04:00Health Policy ObservationsMy apologies in advance for this post as I'm sure it is a bit all of the place. I wanted to just jot down some of my thoughts on the "nurse practitioner vs. physician debate." There has been many articles recently written about this, so here are my thoughts: (these of course are my own thoughts and not representative of my affiliations)<br />
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<li>Above all else, nurse practitioners want to practice at the "top of our licenses." That is, to our full education and training. Imagine having access to the most wonderful car in the world - that can not only take you to wherever you want to go, in great comfort and with with excellent gas mileage, but not having the keys to start it. That is the restriction of the collaborative agreement. NPs have the education and training to care for patients in their specialty. However, without a collaborative agreement with a physician, we can't use any of it. We are stuck in the proverbial parking lot without keys. </li>
<li>Nurse practitioners DON'T want to replace or supplant any profession. Yet inherently, there is the insinuation of NPs "taking over" or "replacing" others. I guess I would be defensive if someone told me that I would be replaced by someone else too. </li>
<li>Yes, we all get that physicians have more hours of training.</li>
<li>I laugh at the pilot and flight attendant analogies. </li>
<li>We are not the enemy.</li>
<li>Collaboration is not a dirty word. I refer back to my post written nearly five years ago, <a href="http://npview.blogspot.com/2008/06/collaboratus.html" target="_blank">Collaboratus</a>. Working together in the interest of the patient. Novel concept? It shouldn't be. </li>
<li>I really laugh at the "if you want to be called doctor, then go to medical school." I haven't heard that one before. </li>
<li>When NPs practice, physicians aren't in the room watching over them waiting for them to make a mistake or miss something.</li>
<li>Who "owns" quality of care? Every single licensed provider has a vested interest in the quality of care they deliver. With more and more available data points, patients will judge and decide who provides their care. </li>
<li>Decreased costs. There is an assumption that since NPs are paid less than physicians, then costs should go down. My counter for pay parity: patients are receiving treatments (with similar or higher quality) and THAT will decrease costs.</li>
<li>NPs can only take care of "simple" things. Not true. No condition is simple. We treat patients, not conditions. Nothing is simple and we recognize and understand that as we partner with our patients. </li>
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Please no more "us vs them." Stakeholders far and wide agree, that the way we provide healthcare in this country must change. It will be much better for all involved if we go at it together. Ok, I feel a little bit better now.</div>
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Stephen Ferrara, DNP, RN, NPhttp://www.blogger.com/profile/16673192365074420538noreply@blogger.com3tag:blogger.com,1999:blog-4011144937808023981.post-16858953186827250472013-01-27T21:46:00.000-05:002013-01-27T21:51:38.090-05:00New Year, New PostHello Everyone and thanks for reading my blog. It has been a while since my last post - not for a lack of topics to post about - but due to an insane schedule that I have been keeping. Here in New York, we have been through he effects of SuperStorm/Hurricane Sandy, another presidential election, and the tragedy of the unfathomable nearby Newtown Connecticut shootings.<br />
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There is so much also going on in healthcare and the aforementioned happenings are also intertwined in the landscape - from emergency preparedness, state health insurance exchanges as part of the Affordable Care Act, and mental health respectively.</div>
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Specific to nurse practitioners, there have been numerous articles written about us (and the interesting negative commentary that always follows and isn't worth commenting on anymore). We have also seen the <a href="http://www.aanp.org/about-aanp/aanp-acnp-merger" target="_blank">merger </a>of two national nurse practitioner organizations into one large one. CMS announced that there will be increased Medicaid reimbursement for certain physician providers but <a href="http://www.medicaid.gov/State-Resource-Center/Frequently-Asked-Questions/Downloads/Q-and-A-on-Increased-Medicaid-Payments-for-PCPs.pdf" target="_blank">seemingly omitted</a> nurse practitioners from the higher rates. </div>
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I will try my best to offer my commentary on the latest news, issues, and trends as I have been doing since 2008, the inception of A Nurse Practitioner's View. There has been many changes since then (I am so glad to see more NP Bloggers out there) and some things have stayed the same (i.e. an article published about NP guided care, then cue the demeaning and disparaging remarks). NPs are among those front and center and I look forward to sharing my view and perspective in this new age of healthcare. As always, there will be no advertisements on this blog and I am no longer accepting any guest posts (thanks to everyone who submitted over the last few months). </div>
Stephen Ferrara, DNP, RN, NPhttp://www.blogger.com/profile/16673192365074420538noreply@blogger.com2tag:blogger.com,1999:blog-4011144937808023981.post-34385869930684960922012-09-21T17:25:00.003-04:002012-09-21T17:25:29.115-04:00Repost: Different States, Different RulesOne of the biggest areas of frustration for students, stakeholders, and nurse practitioners are the seemingly lack of consistency among state regulations regarding NP practice. The rules in one state may not necessarily apply in the next (and even neighboring state). I have known NPs that lived near state borders, licensed in both states, yet had completely different sets of rules regarding what they can/can't do, requirements for collaboration versus autonomy and prescribing ability.<br />
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Barton Associates created this <a href="http://www.bartonassociates.com/nurse-practitioners/nurse-practitioner-scope-of-practice-laws/" target="_blank">free interactive tool</a> that lets you visually compare all 50 states' (plus DC) NP scope of practice. It is ultra handy and can help one decide whether to practice in one state that is very prohibitive compared to one that offers autonomy.<br />
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There is also a push for the <a href="http://onlinenursepractitionerprograms.com/2011/are-you-familiar-with-lace/" target="_blank">APRN Consensus Model</a> whose aim is to have consistency among the states when it comes to regulations.<strong> </strong><br />
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If moving out of the state isn't feasible, well, the alternative is to become involved, active, and supportive of a national and local nurse practitioner organization (it is helpful to be supportive whether your state is autonomous or not since there are constant threats to your practice!)<br />
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An example of the advocacy that membership affords was evidenced this past week. The American Academy of Family Physicians (AAFP) put out their white paper, "<a href="http://www.aafp.org/online/etc/medialib/aafp_org/documents/membership/nps/primary-care-21st-century/whitepaper.Par.0001.File.dat/AAFP-PCMHWhitePaper.pdf" target="_blank">Primary Care for the 21st Century</a>." I looked forward to reading this report based on the title and hoped that I would find innovation and new ways of enhancing care for our patients based on the primary care model. To my surprise (and dismay), I found myself reading the executive summary and seeing terms like "nurse practitioners are not doctors" and "the ideal practice ratio of nurse practitioners to physicians is 4:1" and on. Huh? "How is this a report about primary care?" I thought.<br />
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Then I realized that it wasn't, it was an attack on a profession by another wrapped in a pretty looking monograph with old data. It might as well have been called "Lets Denigrate the NPs Under the Auspices of Solving the Ills of the Health Care System Report." At least I would have known what to expect.<br />
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To be completely honest, I really couldn't read it beyond the executive summary (I looked at the Table of Comments and further became ill).
Luckily, one of our national NP organizations (the <a href="http://www.aanp.org/" target="_blank">AANP</a>) did read the whole thing (I am unsure if they became ill or not) and <a href="http://www.aanp.org/component/content/article/28-press-room/2012-press-releases/1082-aanp-responds-to-aafp-report" target="_blank">responded</a>. Here is one of the benefits of advocacy for nurse practitioners that benefits all nurse practitioners.<br />
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All areas of the health care sector must better work together to achieve outcomes that are truly patient-centric. Do reports like the one referenced above help? I am highly doubtful. We have real issues to deal with and turf wars will continue to distract from them.
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<i>This post was first published at<a href="http://onlinenursepractitionerprograms.com/" target="_blank"> Online Nurse Practitioner Programs</a>. </i>Stephen Ferrara, DNP, RN, NPhttp://www.blogger.com/profile/16673192365074420538noreply@blogger.com4tag:blogger.com,1999:blog-4011144937808023981.post-50761607241414151362012-07-30T19:34:00.003-04:002012-07-30T19:34:52.121-04:00Repost: Let Us Be Heard<br />
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I started this blog, A Nurse Practitioner’s View, 3 years ago because there were very few health stories that even mentioned nurse practitioners as part of the health care landscape. Right before I started the blog, I would respond to other health policy articles published on the Web by writing comments to the websites – only to be subjected to baseless and factually incorrect statements. It was soon thereafter that I decided I would write my own perspective on health policy, trends, and news. I also felt it important from a credibility aspect to not blog anonymously but to put my name on it.</div>
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I recall those few early blog posts that I proudly wrote and would feverishly check my blog visitor stats to see if people were reading. Well, it was a bit slow going in the beginning with about 10 – 15 readers but as they say, “if you build it, they will come.” Today, the blog enjoys hundreds of visits a day, has a Facebook following, has enabled me to be “discovered” to blog at <a href="http://onlinenursepractitionerprograms.com/" style="border: 0px; color: #464646; margin: 0px; padding: 0px; vertical-align: baseline;" target="_blank">Online Nurse Practitioner Program</a>s, and I have communicated with people across the country.</div>
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I hold a sense of satisfaction that today, nurse practitioners are readily referred to in articles as one of the possible solutions to the healthcare system (not that I attribute it solely to my blog of course) through the body of evidence and hard work that each nurse practitioner performs every day. We have also seen great advocacy efforts at the Federal and State level by our nurse practitioner organizations, and let us not forget the IOM landmark report,<a href="http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx" style="border: 0px; color: #464646; margin: 0px; padding: 0px; vertical-align: baseline;" target="_blank">The Future of Nursing</a> published in 2010.</div>
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While there is still opposition out there about the role nurse practitioners should perform (and I imagine this will always be the case in some way), we are part of that conversation. You can imagine my utter disappointment when I read yesterday’s New York Times front page article, “<a href="http://www.nytimes.com/2012/07/29/health/policy/too-few-doctors-in-many-us-communities.html?_r=1&adxnnl=1&src=un&feedurl=http://json8.nytimes.com/pages/national/index.jsonp&adxnnlx=1343653284-LfJeRuxjq73vQc7koY6X6Q" style="border: 0px; color: #464646; margin: 0px; padding: 0px; vertical-align: baseline;" target="_blank">Doctor Shortage Likely To Worsen With Health Law</a>” and the only mention of NPs was towards the end of the article:</div>
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<em style="border: 0px; margin: 0px; padding: 0px; vertical-align: baseline;">“Dr. Smith said building more walk-in clinics, allowing nurses to provide more care and encouraging doctors to work in teams would all be part of the answer. “</em></div>
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<em style="border: 0px; margin: 0px; padding: 0px; vertical-align: baseline;"></em>Did you catch that? “Allowing nurses to provide more care.” I assume that’s the part referring to nurse practitioners. Today, in 2012, I would think that when there is talk about the current and future state of health care, the conversation about <em style="border: 0px; margin: 0px; padding: 0px; vertical-align: baseline;">health care </em>would be more inclusive of the actual professions comprising the health care system.</div>
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Our health system simply cannot continue with the status quo and present the primary solution being “graduate more doctors.” New care models, health information technology enabling more efficient and cost-effective care, increased patient engagement, enhanced payment structure and yes, even the use of nurse practitioners must be the embedded in that conversation.</div>
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Now is the time for nurse practitioners to be heard. I invite every nurse practitioner, nurse practitioner student and patient partnered with a nurse practitioner to write to the NY Times to present a viable alternative to “graduate more doctors.” With over 160,000 nurse practitioners across the United States, now is not the time for silence, but is the time for all stakeholders to understand the solution that NPs offer (and will be even more so when out-dated and unnecessary practice barriers are removed).</div>
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I am writing and <a href="http://www.nytimes.com/content/help/site/editorial/letters/letters.html" style="border: 0px; color: #464646; margin: 0px; padding: 0px; vertical-align: baseline;" target="_blank">e-mailing</a> (letters@nytimes.com) my letter today to the NY Times to shine some nurse practitioner light on the gloom and doom scenario presented in the article on the future of health care providers. Please consider joining me in writing one too. Let us be heard.</div>
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<i>This post was first published at <a href="http://onlinenursepractitionerprograms.com/" target="_blank">Online Nurse Practitioner Programs</a>. </i></div>Stephen Ferrara, DNP, RN, NPhttp://www.blogger.com/profile/16673192365074420538noreply@blogger.com11tag:blogger.com,1999:blog-4011144937808023981.post-20935271584870303062012-06-18T22:14:00.001-04:002012-06-18T22:14:08.823-04:00Modernizing Nurse Practitioner Regulations<div class="separator" style="clear: both; text-align: center;">
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It's been a busy last few months as the legislative agenda has heated up of the NP organization where I am the Chair-Elect. I have been to some fundraisers and legislative visits to try and garner support from lawmakers to sponsor and support the bill that will eliminate statutory collaboration between a physician and nurse practitioner in New York State. The <a href="http://open.nysenate.gov/legislation/bill/S3289A-2011" target="_blank">bill</a> is known as the NP Modernization Act.<br />
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We have been at this for about the last 5 years and up until now, there has not been much forward movement. While we had a sponsor for the bill and many co-sponsors, it was stuck in both the <a href="http://www.nysenate.gov/" target="_blank">Senate</a> and <a href="http://assembly.state.ny.us/" target="_blank">Assembly</a>'s Higher Education Committee (where all of the professions in NY state are regulated). The bill basically sat idle in these respective committees. We finally experienced a breakthrough after countless visits and grassroots efforts. The IOM Future of Nursing report absolutely helped make the case for increasing access to care as did the positive press that nurse practitioner partnered continues to receive. Some of the lawmakers were willing to act upon the bill albeit with some amended language.<br />
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Since then, the bill has been reported out of the Assembly's Higher Education Committee and should soon be on the floor for full Assembly vote. The same must also happen in the Senate and if it passes the Committee, will go to the Senate floor for a vote. We are staying positive that we will see movement in the Senate but this is one of the significant challenges right now. Oh, and the legislative session ends in 3 days. The bill must then be signed by the governor for to take effect. If it doesn't pass in this legislative session, the process starts all over next year since bills have a 2 year life cycle and this is the second year of the current bill. All is not lost however, since any legislative victories carry some momentum the next go-around.<br />
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Of course, there is opposition to the bill. Organized medicine largely does not support the bill and I'm sure that even some nurse practitioners aren't thrilled with it. But in the end, the NP Modernization Act in New York will allow enhanced access to care (while the Patient Protection and Affordability Care Act hangs in the balance of the <a href="http://health.msn.com/health-topics/articlepage.aspx?cp-documentid=250012408" target="_blank">Supreme Court</a>). And at the end of the day, this is what it is all about - giving patients the opportunity and allowing them to choose care that is delivered in partnership with a nurse practitioner.<br />
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On another note, I will be in Orlando Florida this week attending the <a href="http://www.aanp.org/" target="_blank">American Academy of Nurse Practitioners</a> Annual Conference. You can follow updates from the conference on Twitter at #AANP12 plus I will be tweeting from @StephenNP.<br />
<br />Stephen Ferrara, DNP, RN, NPhttp://www.blogger.com/profile/16673192365074420538noreply@blogger.com3tag:blogger.com,1999:blog-4011144937808023981.post-34076562179913484862012-03-30T15:36:00.000-04:002012-03-30T15:36:47.418-04:00Repost: What Nurse Practitioners MUST Know About ACOs<div style="color: #444444; font-family: Georgia, 'Bitstream Charter', serif; font-size: 16px; line-height: 1.5; margin-bottom: 24px;">With all the <a data-mce-href="http://www.bostonherald.com/jobfind/news/healthcare/view/20120330supreme_courts_decision_on_health-care_law_is_likely_this_week-_in_secret/srvc=home&position=also" href="http://www.bostonherald.com/jobfind/news/healthcare/view/20120330supreme_courts_decision_on_health-care_law_is_likely_this_week-_in_secret/srvc=home&position=also" style="color: #743399; line-height: 1.5;" target="_blank">recent</a> discussion on the Affordable Care Act (ACA) being heard before the Supreme Court, I wanted to discuss one of the programs that was borne from the ACA. The <a data-mce-href="https://www.cms.gov/ACO/" href="https://www.cms.gov/ACO/" style="color: #743399; line-height: 1.5;" target="_blank">Centers for Medicare & Medicaid</a> (CMS) define Accountable Care Organizations (ACOs) as "... groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients. The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors."</div><div style="color: #444444; font-family: Georgia, 'Bitstream Charter', serif; font-size: 16px; line-height: 1.5; margin-bottom: 24px;">Wow, this sounds great so far, and seems to be congruent with nurse practitioner-partnered care, what could be wrong with this model? Read on.</div><div style="color: #444444; font-family: Georgia, 'Bitstream Charter', serif; font-size: 16px; line-height: 1.5; margin-bottom: 24px;">The "ACO Professional" is <a data-mce-href="http://www.regulations.gov/#!documentDetail;D=CMS-2010-0259-0425" href="http://www.regulations.gov/#!documentDetail;D=CMS-2010-0259-0425" style="color: #743399; line-height: 1.5;" target="_blank">defined</a>, "...as a physician (as defined in section 1861(r)(1) of the Act) or a practitioner described in section 1842(b)(18)(C)(i) the Act (that is, a physician assistant, nurse practitioner or clinical nurse specialist (as defined in section 1861(aa)(5) of the Act))."</div><div style="color: #444444; font-family: Georgia, 'Bitstream Charter', serif; font-size: 16px; line-height: 1.5; margin-bottom: 24px;">Wow, a win-win all around - a new model of care that is coordinated to reduce waste and duplication, utilizes nurse practitioners and is part of federal legislation. What's the catch?</div><div style="color: #444444; font-family: Georgia, 'Bitstream Charter', serif; font-size: 16px; line-height: 1.5; margin-bottom: 24px;">It is embedded here in the <a data-mce-href="http://www.regulations.gov/#!documentDetail;D=CMS-2010-0259-0425" href="http://www.regulations.gov/#!documentDetail;D=CMS-2010-0259-0425" style="color: #743399; line-height: 1.5;" target="_blank">Federal Register</a>:</div><div style="color: #444444; font-family: Georgia, 'Bitstream Charter', serif; font-size: 16px; line-height: 1.5; margin-bottom: 24px;"><em style="border-bottom-style: none; border-color: initial; border-image: initial; border-left-style: none; border-right-style: none; border-top-style: none; border-width: initial; line-height: 1.5;">Thus, although the statute defines the term ‘‘ACO professional’’ to include both physicians and non-physician practitioners, such as advance practice nurses, physician assistants, and nurse practitioners, for purposes of beneficiary assignment to an ACO, the statute requires that we consider only beneficiaries’ utilization of primary care services provided by ACO professionals who are physicians. The method of assigning beneficiaries therefore must take into account the beneficiaries’ utilization of primary care services rendered by physicians. Therefore, for purposes of the Shared Savings Program, the inclusion of practitioners described in section 1842(b)(18)(C)(i) of the Act, such as PAs and NPs in the statutory definition of the term ‘‘ACO professional’’ is a factor in determining the entities that are eligible for participation in the program (for example, ‘‘ACO professionals in group practice arrangements’’ in section 1899(b)(1)(A) of the Act). However, assignment of beneficiaries to ACOs is to be determined only on the basis of primary care services provided by ACO professionals who are physicians.</em></div><div style="color: #444444; font-family: Georgia, 'Bitstream Charter', serif; font-size: 16px; line-height: 1.5; margin-bottom: 24px;">Did you catch that? Yes, that's right, while NPs are included as "ACO Professionals," if a Medicare patient utilizes a nurse practitioner as their provider, they are not eligible to participate in the ACO unless the beneficiary is assigned to a physician. If that seems non-sensical to you, that's because it is.</div><div style="color: #444444; font-family: Georgia, 'Bitstream Charter', serif; font-size: 16px; line-height: 1.5; margin-bottom: 24px;">So what can NP practices do who want to participate in this money saving model of care (where half of the savings are reaped by the practice)? Unfortunately, the public comment period has closed on this issue. Right now, if an NP-owned practice wanted to participate in a similar type of shared savings model, they would have had to apply for a grant under the<a data-mce-href="http://innovations.cms.gov/initiatives/Innovation-Challenge/faq.html" href="http://innovations.cms.gov/initiatives/Innovation-Challenge/faq.html" style="color: #743399; line-height: 1.5;" target="_blank"> CMS Innovation Program</a> and hope to get a similar award for what an ACO would bring. That deadline was due in January and the actual awards should be announced any day.</div><div style="color: #444444; font-family: Georgia, 'Bitstream Charter', serif; font-size: 16px; line-height: 1.5; margin-bottom: 24px;">This is where NPs get shut out of the system. Yes, NPs may participate in an ACO, will improve care, reduce costs and duplication, but the only party benefitting is the physician or hospital-owned ACO. We must let our representatives know how backwards this is. <span style="line-height: 1.5;">The national nurse practitioner organizations have </span><a href="http://www.acnpweb.org/files/public/NP%20Roundtable%20comments%20on%20ACO.pdf" style="line-height: 1.5;" target="_blank">weighed in</a><span style="line-height: 1.5;"> on this issue via the NP Roundtable but nothing has really changed. </span>Doesn't seem fair, does it?</div><div style="color: #444444; font-family: Georgia, 'Bitstream Charter', serif; font-size: 16px; line-height: 1.5; margin-bottom: 24px;"> <i><a href="http://onlinenursepractitionerprograms.com/blog/" target="_blank">The above blog post was originally published on onlinenursepractitionerprograms.com/blog</a></i></div>Stephen Ferrara, DNP, RN, NPhttp://www.blogger.com/profile/16673192365074420538noreply@blogger.com5tag:blogger.com,1999:blog-4011144937808023981.post-36586982377392480432012-02-22T13:49:00.000-05:002012-02-22T13:49:08.686-05:00Oregon: Health Care Politics at PlayI've been following plight of the Oregon Nurse Practitioners regarding reimbursement rates. It seems that back in 2009, NP reimbursement rates from insurance companies were arbitrarily cut by up to 55% for no apparent reason. An attempt to correct that was introduced in the form of<a href="http://www.thelundreport.org/resource/legislation_giving_nurse_practitioners_equal_pay_appears_dead" target="_blank"> legislation</a>. While it appears that the bill itself contained some flaws, it is now destined to flounder in committee once again.<br />
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The sad thing here is politics at play. Heavy lobbying from the insurance companies and from organized medicine guaranteed the bill's demise. The lobbyists relied on the "costs will go up" tagline to shoot down the bill. This is laughable. Did those who were insured costs go down when they saw a nurse practitioner? Nope. The NPs diagnosed and treated the patients as they were educated and trained to do - not from some alternative medicine crack pot cookbook. It came from recognized health care standards, procedures, and guidelines. Yet, the insurance companies want to reimburse NPs less for the same work done and reap the rewards. Not fair.<br />
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I am not debating the whole physician versus nurse practitioner compensation argument here - we can save that for another time. This reaks of greed and is putting patient lives at risk - especially those in rural areas where these NPs are practicing and are often the sole provider in that area. Unfortunately, it seems as if this practice will continue unabated and those having the power to do something about it will sit idle and hope that maybe someone else will pick up the slack.Stephen Ferrara, DNP, RN, NPhttp://www.blogger.com/profile/16673192365074420538noreply@blogger.com1tag:blogger.com,1999:blog-4011144937808023981.post-91437069928842254512012-02-07T21:56:00.000-05:002012-02-07T21:56:28.017-05:00Advancing Nurse Practitioner PracticeI saw 2 notable articles in the news last week about nurse practitioner practice that I wanted to share. The first one is about two new bills introduced in <a href="http://www.semissourian.com/story/1810732.html" target="_blank">Missouri</a> that would eliminate the collaborative practice requirement between a nurse practitioner and physician and would allow NPs to prescribe controlled substances as indicated. Missouri is one of the most restrictive states when it comes to NP practice and if this legislation passes, they will move to the forefront of of autonomy. They will have substantial opposition but the bills would allow these NPs to practice to the full extent of their training and education. <div><br />
</div><div>The other article is about the first nurse practitioner to practice in <a href="http://bermudasun.bm/main.asp?SectionID=24&SubSectionID=270&ArticleID=56527" target="_blank">Bermuda</a>. She will begin this summer and work in King Edward VII Memorial Hospital. She is scheduled to be the first student to complete their NP program. </div><div><br />
</div><div>It is great to see NP practice evolve and have regulations that reflect a scope of practice that is congruent with the training and education of NPs. While there is much work to do (just look at some of the comments from the 1st article), it is becoming clear that NPs can make a meaningful difference in the health care landscape caring for patients. </div><div><br />
</div>Stephen Ferrara, DNP, RN, NPhttp://www.blogger.com/profile/16673192365074420538noreply@blogger.com3tag:blogger.com,1999:blog-4011144937808023981.post-80813857104446454352011-12-31T13:41:00.002-05:002011-12-31T13:48:11.642-05:002011 ReflectionsI'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.<br />
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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.<br />
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Because I'm a glutton for punishment, following the completion of the DNP, in the Fall, I enrolled full-time in one of the <a href="http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__university-based_training_program/1808" target="_blank">University Based Training</a> programs that was part of the American Recovery and Reinvestment Act's <a href="http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__home/1204" target="_blank">HITECH</a> 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.<br />
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In August, I also starting blogging over at <a href="http://onlinenursepractitionerprograms.com/blog/" target="_blank">Online Nurse Practitioner Programs</a>. 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. <a href="http://www.linkedin.com/pub/stephen-ferrara-dnp-np/6/b0/812" target="_blank">Linked In</a> & <a href="https://twitter.com/#!/StephenNP" target="_blank">Twitter</a> - feel free to connect with me there too.)<br />
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In November, I ran for and won the Chair-elect position for the <a href="http://thenpa.org/" target="_blank">Nurse Practitioner Association</a> 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.<br />
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I was recently notified that I won the American Academy of Nurse Practitioners <a href="http://mcnpweb.org/files/AANP2012StateAwardsCallforNom.pdf" target="_blank">2012 State Award for Excellence</a> in New York State. I am so surprised and honored to receive this distinction! <br />
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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!<br />
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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!Stephen Ferrara, DNP, RN, NPhttp://www.blogger.com/profile/16673192365074420538noreply@blogger.com5tag:blogger.com,1999:blog-4011144937808023981.post-89654307576799352272011-11-28T21:21:00.000-05:002011-11-28T21:21:54.011-05:00Seeking NP Stories<span class="Apple-style-span" style="background-color: white;"><span class="Apple-style-span" style="font-family: 'lucida grande', tahoma, verdana, arial, sans-serif;"><span class="Apple-style-span" style="font-size: 11px; line-height: 12px;">I am posting this for a colleague who plans on writing a book about nurse practitioners. </span></span></span><br />
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<span class="Apple-style-span" style="background-color: white; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 12px;">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.</span><br style="background-color: white; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 12px; text-align: left;" /><br style="background-color: white; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 12px; text-align: left;" /><span class="Apple-style-span" style="background-color: white; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 12px; text-align: left;">This may include stories about the role of NPs, patients, circumstances or the health care system.</span><br style="background-color: white; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 12px; text-align: left;" /><br style="background-color: white; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 12px; text-align: left;" /><span class="Apple-style-span" style="background-color: white; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 12px; text-align: left;">Selected NPs will be confidentially interviewed and audiotaped if agree to be part of the project.</span><br style="background-color: white; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 12px; text-align: left;" /><br style="background-color: white; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 12px; text-align: left;" /><span class="Apple-style-span" style="background-color: white; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 11px; line-height: 12px; text-align: left;">Please contact mga11@caa.columbia.edu</span>Stephen Ferrara, DNP, RN, NPhttp://www.blogger.com/profile/16673192365074420538noreply@blogger.com2tag:blogger.com,1999:blog-4011144937808023981.post-8719464535522346222011-11-10T20:43:00.000-05:002011-11-10T20:43:46.067-05:00Nurse Practitioner EvidenceThe latest nurse practitioner <a href="http://www.loyolamedicine.org/News/News_Releases/news_release_detail.cfm?var_news_release_id=973441614" target="_blank">study</a> conducted at Loyola found that "...the nurse practitioner reduced ED visits by improving the continuity of care and troubleshooting problems for patients."<br />
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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.<br />
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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. <br />
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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.Stephen Ferrara, DNP, RN, NPhttp://www.blogger.com/profile/16673192365074420538noreply@blogger.com4tag:blogger.com,1999:blog-4011144937808023981.post-40569047003577575122011-11-07T19:12:00.000-05:002011-11-07T19:12:06.485-05:00Guest Post: Keeping Your Brain Fit After 65: 5 Important Memory-Boosting Ingredients Found in Common Foods<span class="Apple-style-span" style="background-color: white; font-family: arial, sans-serif; font-size: 13px;">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. </span><br />
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<span class="Apple-style-span" style="background-color: white; font-family: arial, sans-serif; font-size: 13px;"><b>1. Vitamin B12</b></span><br />
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<span class="Apple-style-span" style="background-color: white; font-family: arial, sans-serif; font-size: 13px;">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. </span><br />
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<span class="Apple-style-span" style="background-color: white; font-family: arial, sans-serif; font-size: 13px;">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!</span><br />
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<span class="Apple-style-span" style="background-color: white; font-family: arial, sans-serif; font-size: 13px;"><b>2. Phytofoods</b></span><br />
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<span class="Apple-style-span" style="background-color: white; font-family: arial, sans-serif; font-size: 13px;">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.</span><br />
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<span class="Apple-style-span" style="background-color: white; font-family: arial, sans-serif; font-size: 13px;"><b>3. Phenol and Phytoalixin</b></span><br />
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<span class="Apple-style-span" style="background-color: white; font-family: arial, sans-serif; font-size: 13px;">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. </span><br />
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<span class="Apple-style-span" style="background-color: white; font-family: arial, sans-serif; font-size: 13px;"><b>4. Quercetin</b></span><br />
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<span class="Apple-style-span" style="background-color: white; font-family: arial, sans-serif; font-size: 13px;">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. </span><br />
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<span class="Apple-style-span" style="background-color: white; font-family: arial, sans-serif; font-size: 13px;"><b>5. Omega Three Fatty Acids</b></span><br />
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<span class="Apple-style-span" style="background-color: white; font-family: arial, sans-serif; font-size: 13px;">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.</span><br />
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<span class="Apple-style-span" style="background-color: white; font-family: arial, sans-serif; font-size: 13px;">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!</span><br />
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<i><span class="Apple-style-span" style="color: blue;"><span class="Apple-style-span" style="background-color: white; font-family: arial, sans-serif; font-size: 13px;">Author Bio: </span><br style="background-color: white; font-family: arial, sans-serif; font-size: 13px;" /><span class="Apple-style-span" style="background-color: white; font-family: arial, sans-serif; font-size: 13px;">John writes for </span><span class="Apple-style-span" style="background-color: white; font-family: arial, sans-serif; font-size: 13px;"><a href="http://assistedlivingtoday.com/p/memory-care/">Assisted Living Today</a>, a leading source of information on a range of topics related to elderly living and retirement care and facilities, such as memory care.</span></span></i>Stephen Ferrara, DNP, RN, NPhttp://www.blogger.com/profile/16673192365074420538noreply@blogger.com0tag:blogger.com,1999:blog-4011144937808023981.post-36020998613743476132011-10-26T16:13:00.000-04:002011-10-26T16:13:46.298-04:00Potpourri & an ElectionI 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!) <div><br />
Second, school work continues in the <a href="http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=3007&PageID=20409">Office of the National Coordinator for Health Information Technology</a> 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. </div><div><br />
</div><div>Third, I am running for Chair-Elect in the Nurse Practitioner Association of New York's (<a href="http://thenpa.org/">The NPA</a>) 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:</div><div><br />
</div><div><i><span class="Apple-style-span" style="color: #0b5394;">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.</span></i></div><div><i><span class="Apple-style-span" style="color: #0b5394;"><br />
</span></i></div><div><i><span class="Apple-style-span" style="color: #0b5394;">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. </span></i></div><div><i><span class="Apple-style-span" style="color: #0b5394;"><br />
</span></i></div><div><i><span class="Apple-style-span" style="color: #0b5394;">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.</span></i></div><div><i><span class="Apple-style-span" style="color: #0b5394;"><br />
</span></i></div><div><i><span class="Apple-style-span" style="color: #0b5394;">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. </span></i></div><div><i><span class="Apple-style-span" style="color: #0b5394;"><br />
</span></i></div><div>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 <a href="http://www.thenpa.org/displaycommon.cfm?an=1&subarticlenbr=285">join</a>.</div><div><br />
</div><div>I will also be traveling to the NPA's Annual <a href="http://www.thenpa.org/displaycommon.cfm?an=1&subarticlenbr=241">Conference</a> this week and am looking forward to a great program. </div><div><br />
</div><div>Lastly, I've been regularly blogging (about 2 posts a week) at <a href="http://onlinenursepractitionerprograms.com/blog/">Online Nurse Practitioner Programs.com</a> since August. Feel free to check that site out as well (if you haven't gotten enough of me already :)</div><div><br />
</div><div>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. </div><div><br />
</div><div>Wish me luck and I will be sure to post updates! </div>Stephen Ferrara, DNP, RN, NPhttp://www.blogger.com/profile/16673192365074420538noreply@blogger.com0tag:blogger.com,1999:blog-4011144937808023981.post-66778440329807760362011-09-27T20:13:00.001-04:002011-09-27T20:15:01.616-04:00Instant Lab ResultsI recently <a href="http://onlinenursepractitionerprograms.com/2011/access-to-patients-lab-results/">blogged</a> 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?<br />
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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.<br />
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I'd love to hear your thoughts and concerns.Stephen Ferrara, DNP, RN, NPhttp://www.blogger.com/profile/16673192365074420538noreply@blogger.com5tag:blogger.com,1999:blog-4011144937808023981.post-14966521123876268912011-09-14T20:57:00.001-04:002011-09-14T21:00:43.042-04:00Brief UpdateHello,<br />
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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 <a href="http://npview.blogspot.com/2011/05/dnp-series-published.html">May</a>, 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 <a href="http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__university-based_training_program/1808">University-based training</a> programs set-up by the Office of the National Coordinator (ONC) under the <a href="http://healthit.hhs.gov/portal/server.pt?open=512&objID=1487&mode=2">HITECH Act</a>. 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!<br />
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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?!?)<br />
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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.<br />
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Also be sure to check out this <a href="http://onlinenursepractitionerprograms.com/blog/">site</a> (onlinenursepractitionerprograms.com/blog), where I am also blogging.Stephen Ferrara, DNP, RN, NPhttp://www.blogger.com/profile/16673192365074420538noreply@blogger.com1tag:blogger.com,1999:blog-4011144937808023981.post-32306711170783647042011-08-22T19:08:00.000-04:002011-08-22T19:08:47.448-04:00Additional Nurse Practitioner BlogHi All,<br />
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Please check out my new blog at <a href="http://onlinenursepractitionerprograms.com/blog/">Online Nurse Practitioner Programs</a>! Also, <a href="https://www.facebook.com/pages/Online-Nurse-Practitioner-Programs/120701841309419">like</a> 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!<br />
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Not to worry, I will still continue to regularly update this blog with all things related to nurse practitioner practice.<br />
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As always, thanks for reading.<br />
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StephenStephen Ferrara, DNP, RN, NPhttp://www.blogger.com/profile/16673192365074420538noreply@blogger.com3