A Nurse Practitioner's View

Wow - 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 mandatory mask requirement for health care workers if not vaccinated) is rearing it's ugly head. 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 ...

The infographic below comes courtesy of Simmons School of Nursing & Health Sciences. Check the full link out at:  http://onlinenursing.simmons.edu/affordable-care-act-family-nurse-practitioners/

As 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  example  of the rhetoric and follows a formula that I am going to reveal to spare any future time wasting reading them. Refer to the physician shortage and mention "Obamacare"  State the obligatory, "nurse practitioners are valued as part of the health care team"  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)  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) Make sure NOT to mention anything about patient outcomes being the same or better when NPs are primary care providers If there is mention of outcome studies, be sure to highlight how they are "ol...

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 bill is known as the NP Modernization Act. 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 Senate and Assembly '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 pr...

I 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 Missouri  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.  The other article is about the first nurse practitioner to practice in Bermuda . 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.  It is great to see NP practice evolve and have regulations that reflect a scope of practice that is congruent with the train...

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 real...

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

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 a...

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.

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

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, ple...

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.....

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...

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...

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.

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...

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

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

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

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