A Nurse Practitioner's View

Here is a post of a lighter nature. The new Schick Bikini razor is new on the market and with it comes "viral" advertising of sorts - Mow the Lawn. The ad is posted below: Now to make this a health-related post, I will add a few tips about grooming since I've seen patients with significant folliculitis (infected hair follicles "down there" that are red and painful) after their grooming regimen: Use a new razor with clean, sharp blades. Consider using a pre -shave to soften the hair and protect the skin Use plenty of cream/gel (I suggest a good hypoallergenic gel - at least for my face) Use plenty of clean warm/hot water and rinse razor frequently Use a good aftershave lotion/balm If you are into genital grooming/shaving, you probably want to avoid using a traditional men's shaving cream and aftershave lotion. There are many products out there made specifically for this sensitive area. This goes for men too. I've seen plenty of infections after guys have...

Here is a link to an article where Health and Human Services Secretary Kathleen Sebelius spoke to a nurses union today and stated, "If health care reform is to be a reality, we need you at the front line." Since health care is multi- disciplinary entity which no one profession "owns," it is encouraging to see an inclusive approach. I look foreword to health care reform and working with my other health care colleagues in making this a reality.

Here is a news-worthy article and clip about NP practice in New York. The piece is from East Syracuse, New York and highlights how NPs can be part of the solution to primary care shortages. Also, April is Nurse Practitioner month in New York State. This would be a fine time to recognize NP's contributions to the health care system and patient care.

Undoubtedly, most are aware of the swine flu by now and the potential impact it has on pandemic fears. While cause for concern, it isn't cause for panic...yet. Know the symptoms of the flu. That is, remember that influenza is a respiratory illness. Typically, if one doesn't have a cough (usually non-productive), fever and body aches, then it is unlikely that it is classic influenza. Common sense precautions are in order, stay home if you are sick with mild symptoms, seek care if they worsen wash your hands frequently, especially after touching your nose & mouth. (Most people don't wash their hands properly if you can believe it. You should wet your hands with water, use soap and scrub for at least 30 seconds {sing "Happy Birthday" twice to yourself}; be sure to get your wrists and under jewelry. Phone your health care provider if you have specific questions. Also visit credible sites such as the CDC. Anti-viral medications exist for pre or post exposure to ...

This is a wonderful post over at The New Life of e-Patient Dave's website about electronic health records. I strongly encourage patients and clinicians to read it. While there has been much debate about whether EHRs actually improve patient care and save money (I believe they will do both) the move to electronic records will enable transparency when it comes to viewing and reviewing your own chart. Have you ever tried to get a copy of your own record? It is not exactly the easiest process. Most providers offices require you to complete a records release form which is filled with legal jargon and makes you seriously question if you really want to get these records in the first place. Some providers charge you per page to photocopy your record and good luck in thinking that this will be processed promptly by the staff. Once you get your hands on a traditional paper chart copy, it is nearly impossible to decipher. Is this acceptable? Maybe accessing your health record should be like...

Hi All, It has been a full year since I started this blog. I wanted to thank everyone who stops by and reads it. I hope to continue posting with some semblance of regularity and share my view on topics not only specific to nurse practitioner practice, but to all relevant healthcare topics today. Thank you! Stephen

Feel free to check out some questions I answered over at The Nurse Practitioner's Place ! I thoroughly enjoyed it. Also check out the interviews with two other NP bloggers , NewFNP and Barbara Phillips, FNP . Thank you to The Nurse Practitioner's Place for my 15 minutes!

Nurse Practitioners in Florida currently cannot write prescriptions for controlled substances (47 states currently allow NPs to prescribe these). One can understand the fear that having more prescribers can potentially lead to more abuse. However, that is a very narrow view and really doesn't help the thousands of patients NPs are seeing every day in Florida. What I find most disturbing about this article is (R) Senator Thad Altman's comments. He is quoted as saying: "We need to protect the practice of medicine," Altman said. By sharing tasks that used to be solely the domain of doctors, who have the highest level of training among health care professionals, "it's discouraging people from going through the vigor of becoming a physician." Why must this be a MD vs. NP issue!?! After all, we now consider "pain" as the fifth vital sign. For us to not adequately address pain, severely inhibits practice and our patients are the one's suffering...

The NY Times reports on a significant health initiative that is part of the $787 billion dollar stimulus bill. It is specifically referred to as Comparative Effectiveness Research. A council will be formed that will study the effectiveness of current treatments including medications, procedures, medical devices and surgeries by examining the research. I imagine these will consist of systematic reviews of the research and will examine the validity of the studies conducted (including Confidence Intervals, p-values, etc.) This is a major step towards integrating evidenced based practice ( EBP ) and cultural competence into our practice. There is often a significant lag time before research actually impacts daily practice. I recall a wise professor of mine stating that it would take a clinician reading 3 primary research articles every day of the year to stay current. I am hopeful that we will ultimately see treatments and outcomes tailored to gender and ethnicity (it is a fact that certa...

The NY Times has a regular section that aims to debunk common health-related myths. This week, they take on the claim: Can Hot Liquids Can Ease Symptoms of a Cold or Flu ? Unfortunately, there isn't a lot of research examining these effects. However, the research that is out there supports hot liquids over room temperature or cold ones. (See the study referenced here and I searched for any meta-analysis studies and could only find this one study.) Of course, there are still lots of questions out there regarding how much liquid you should drink, does caffeine affect these results, is there an ideal beverage to drink over others, etc? So the next time you have a cold or the flu, consider consuming hot liquids over cold ones. Your nasal passages and respiratory tract will thank you for it. Also should you need to visit your health care provider, be sure to tell them all of the self-care steps you are taking to ease the symptoms. They will thank you for it too!

There are a few pharmacy chains currently running free antibiotic promotions . I really question if that is the right message to health consumers. I have blogged about the dangers of over prescribing antibiotics and resistance here and here . Most of the free antibiotics include penicillins and the like. It is worthy to note that these prescriptions normally cost no more than $10 for a standard course. I can imagine that this will make it harder for the prescribing clinician. While it is wonderful to practice in a cost-efficient way while being cognizant of the costs placed on patients, I wonder if this sends a message that it's OK to take antibiotics (because they are free) for conditions that clearly don't warrant them. What do you think? Do you have patients asking for antibiotics now because of these promotions?

I frequently peruse the local NP job offerings and am constantly amazed at the lack of knowledge regarding NP practice within these postings. Below are a few of may favorites: "NP or RN needed" - umm , do you know that there is huge scope of practice difference?!?! Not to put down any of our RN sisters & brothers (after all, we are all RNs first!) However, the scope of practice of each is very different. "Work under the supervision of..." - Get the terminology correct. If you are in NY State (as I am) NPs work in collaboration with our physician colleagues. I can't imagine that this would be a terribly supportive environment. "Competitive Salary" - $35 -40/hour or $60,000 - $70,000/year is not competitive at all, it's insulting. "Must be a team player..." - The word "team" is thrown an awful lot. In the true sense of the word, it would mean that you are an individual grouped with similar individuals for the purpose of a co...

There is a physician blogger that uses every opportunity that he can to minimize , patronize and belittle the NP role and he is at it again . I refuse to leave a comment on his blog since others who have induce a tirade of back and forth nonsense that gets no where. He can track back to my post and maybe read this blog and maybe gain some relevant insight into NP practice. I must now return to counting tongue blades since that is as complex as this nurse practitioner gets. One, two, seven....damn!

My informal salary survey had 6 respondents (thank you for responding!) You can see the actual results on the right hand side of my blog. Interestingly, 3 of the 6 respondents reported salaries in the $70 - $79,999 category. I know for certain in the NY metropolitan area that salaries are a bit higher than that. One may look at this and say "I can make more money as an R.N." and that would be true. In my experience with my colleagues, NPs don't mainly become NPs for the financial incentives. It is about taking on patient care from a unique perspective - a perspective that synthesizes nursing and medicine, that sets out to be culturally competent, that strives for evidence and that focuses on the whole person. There are still many out there who do not (nor care to) understand NP practice. I maintain that we are not "physician wannabes" and bring something inherently unique and valuable to patient care. Thanks again for responding!

Hi, I see a lot of inquires for NP wages. Please take my informal salary survey on the right of the page. Of course, there are many variables to consider such as benefits, bonuses, hourly vs. salaried, etc. I'd just like to get an idea of what others are making and will report on the results. The survey will be up for a week. Thanks, Stephen

A NY Times article refers to a new study from the BMJ involving the prescribing of placebos to patients. Many ethical dilemmas are raised with this practice. The "placebos" referred to in this study weren't placebos at all, they were either vitamins or different classes of pain management medications. Wiki defines Placebo as: ... a substance or procedure a patient accepts as medicine or therapy, but which has no specific therapeutic activity. Any therapeutic effect is thought to be based on the power of suggestion . The word placebo is Latin for I will please. Prescribing placebos is only part of the game. There is also the ordering of expensive lab work and diagnostic tests that go hand in hand with the powers of suggestion. I try to be mindful of the tests that I order and explain the risks and benefits of such tests/treatments. Sure, there have been times when I've contemplated creating my own "S- Pak " in the hopes of creating a magic treatment. But ...

On October 24, NOW on PBS will explore a projected nursing shortage that could impact quality of and access to care for millions of patients. Be sure to tune in! Below is the press release: Show will highlight Innovative solutions in New York City and elsewhere NEW YORK, September 26 – A U.S. government study projects that by the year 2020, there will be a nationwide shortage of up to one million professional nurses . The nursing shortage is already placing strains on the entire medical system. On October 24, 2008, the Emmy Award-winning newsmagazine NOW on PBS will examine the root causes of this crisis, and innovative efforts to reverse the trend. Even though qualified nurses are in high demand and hospitals are offering attractive incentives, many are leaving the profession. Even more alarming: few are choosing to teach the next generation of professionals. As a result, tens of thousands of applicants are being turned away from the nation's nursing schools. The production is sup...

A New Jersey jury recently awarded $400,000 to a deaf patient because her physician refused to provide a sign language interpreter throughout their visits. The patient ultimately switched physicians since the steroids she was receiving caused facial edema. The new rheumatologist subsequently took her off steroids and was able to explain that the edema was a side effect of the steroids and not from her illness. This case presents many ethical dilemmas for the practicing clinician. I have seen other blog posts related to this case. The knee-jerk reaction talks about moral obligations and financial implications for the physician to hire an interpreter that would result in a net loss for the visits (the visits were reimbursed at $49 and the interpreter would cost about $150-200/hr). Those angles miss the point. Where is the culturally competent care? Cultural Competence is defined as: (via wiki) ... an ability to interact effectively with people of different cultures. Cultural competenc...

Here is an article about a drive through flu shot clinic in Pennsylvania. The service is targeted at Seniors and health officials devised a system regarding which lane you drive up to and other logistics regarding the vaccination. At first, I thought it was another gimmick. However the more that I thought about it, it does make sense. I've had a few requests over the years to vaccinate seniors in the drive-by fashion. This always put me in a difficult situation -- not because of the actual injection -- but what happens if there is a reaction and how can I ensure that they wait the recommended 20 minutes post vaccination without driving off into the sunset? From a public health perspective, it makes complete sense. High-risk patients should get the immunizations and we must examine new ways to make this happen. We certainly can't visit them all in their homes. As long as there is a well-thought out system with policies and procedures in place, ideas such as this will prompt us ...

Here is a great post from a medical student about retail clinics. Here is someone who clearly understands the need the clinics are filling and more importantly (in my opinion), how nurse practitioners are part of that solution. It's good to see such an un -jaded perspective and how we can all work together in today's complex health system.