A Nurse Practitioner's View

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).

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...

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

Nope, not a post on the dysfunction of the health care system, just on the wonderful New York State politics at play. Today, accidental governor Patterson vetoed a bill that had passed both NYS Senate and Assembly that would have allowed NPs to sign DNR orders. There were apparently some language/technical issues with the Bill. However, the most disturbing piece here is the Governors complete and total lack of understanding what NPs do (no real surprise there). He was quoted, "Finally, I am not convinced that this is an appropriate function to be carried out by nurse practitioners. Decisions of life and death should be made by physicians, not nurse practitioners.” Not convinced?!? Didn't you just sign a bill that eliminated collaborative agreements between physicians and nurse midwives? (That would be life). Ever hear of hospice care? (That would be death). I wonder if he understands exactly who is spending time with hospice patients in their final days of life. It is the tea...

Here is an article from NY's Newsday about NP practice and the goal towards the elimination of statutory collaboration in New York. It's a fairly predictable piece with the typical opposition from the organized medicine playbook (How many times do we have to see "If they want to play doctor, they should go t o medical school" in print? Seriously). Nonetheless, thriving NP practices are mentioned and show the significant impact that NPs are making in the lives of patients and in the health care system. I will mention it again as I've done countless times in my blog: NPs do not want to replace physicians and are NOT looking to change scope of practice (The presence of a collaborative agreement or not will have no impact on the quality of care I deliver but not having one in place simply renders me unemployed). I do hope that the vocal opposition eventually understand this so that we may begin to deliver care that is truly patient centered. UPDATE: I did something ...

An op-ed piece was recently written by the president of the Nurse Practitioner Association of New York, entitled, Take Advantage, New York, of our nurse practitioners . As if on cue, the medical society in New York played the same old card under the guise of "patient safety" and responded with their take on the issue, Rules exist to protect patients . Any regular reader of this blog knows the countless times I have pointed out the bogus claims that organized medicine uses as scare tactics that ultimately translate into turf protection. In this article, the author claims a "maldistribution" of the physician and nurse practitioner workforce. See, we don't really have a problem, its just that patients are in the wrong areas of the state! Perhaps we can find some grant money to redistribute patients to where there are so many providers in the vast utopia where most of us in NY live. This of course is where no one needs to wait for an appointment and access to provid...

Here is another positive view of NP guided care specifically in New York. Of course, it is not without the organized medicine tagline of playing the "quality of care" card under the guise of protecting patients. However, we know that retrospective chart reviews (the current requirement in NY and in many other states) is not about quality of care. In fact, peer chart review should be a requirement for all clinicians. Every professional should engage in ongoing chart reviews (I actually prefer benchmarking and looking at actual data/outcomes against versus simply reviewing a chart). I just don't understand the constant undertones that NPs are prone to making mistakes or will "miss something" and that having a collaborating physician review the chart 3 months later somehow will "ensure quality." NPs see thousands of patients every day and we have proved and will continue to do so that we provide quality evidence-based care. And now to the video...

Here in New York, the month of April is proclaimed by the governor as Nurse Practitioner Month . This is a noble attempt to recognize the work and care that the 13,000 or so Nurse Practitioners do every day in New York. I'm curious if other states have such proclamations or if anything is done on the state level to recognize NPs . Please post any information relevant to your state and I'd be happy to list the data in a table. And to my fellow New York Nurse Practitioners (and NPs all over), Happy Nurse Practitioner Month!

Thank you to New York Senator Montgomery of Kings County for introducing legislation that will allow nurse practitioners to sign death certificates ( S.2969 ). The bill passed the NY State Senate with strong bi-partisan support, 58-3. It must next pass the Assembly and then on to the Governor's desk for approval to become law. Here is some additional information on the bill and its rationale.