A Nurse Practitioner's View

We find ourselves in the midst of a massive egg recall. Current estimates say that 500 million eggs have been recalled. The CDC is the place to go for the latest information on these recalled eggs and salmonella . Foodsafety .gov also is a great resource with updated information. Here is a link to the FDA site on how to identify if you are in possession of any of the recalled eggs. Food safety surveillance must be vigilant and people deserve to have access to reports, citations, and above all the ability to consume food that is safe from contamination. Who is to blame in all of this - governmental red tape, the food industry, the distributors, the FDA for lack of oversight? Politico has an article that suggests a slow moving Senate may be the culprit. Will this latest recall affect how/where you purchase food?

Here is an op-ed piece that I wrote some time ago that unfortunately didn't get published. However, this blog is a great place to put it! Patient-Centered Health Care Patient centered. To the average health care consumer, the notion that they themselves are the main focus of the care received is a no- brainer . However, the reality that exists in health care today is quite the opposite. More often, interacting with the current health care system is often a deeply dissatisfying and frightening experience, fraught with errors, miscommunication and waste. As a community-based nurse practitioner for 10 years, I practice within the fragmented confines of an inefficient and costly system and know how this current system is too often harming people. Fundamental reform is needed. According to the Institute of Medicine, care is often delivered in silos producing poorly coordinated and overly complex care. The current healthcare system is fraught with opacity and is unnavigable for most o...

The NY Times recently wrote about pharmacists expanding roles on the health care team. This is one example of a concept who's time has come that has the potential to make a significant positive impact on health care outcomes. Conceptually, this makes sense since as we all know, health care doesn't just take place in hospitals or in private offices. Patients are constantly making choices about their health in their everyday actions such as choosing what and when to eat. Pharmacies are located in the communities where people live and work and having access to a health care coach or guide in the form of a pharmacist (or other professional) gives people the opportunity to discuss their options and perhaps make better every day health decisions. Community health nurses have long known this as they visit patients in their homes and assess their living environment and offer recommendations that could eliminate safety hazards for partially paralyzed patients following a stroke for ex...

Here are some of my top read posts from the past. I hope you enjoy reading them. Collaboratus Provider Ratings Your Chart: Do you know what's in there?

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...

I recently wrote about my pursuit of the DNP and my rationale for it. As promised, here is the first brief installment of posts chronicling my final year of school (I actually have 10 months left now but who's counting!) Part of the final project is writing a systematic review. Since one of the principles of our program is evidence-based practice (EBP), our final project must be framed in the form of a PICO question. That is, Population, Intervention, Comparison, and Outcome. My group and I are still tweaking our question but it is centered on adults with type II diabetes. (Plus, I do need to maintain some level of suspense throughout these posts!) In order to gather the evidence, a comprehensive, systematic, and exhaustive search of the literature must be performed using key words and MeSH terms to narrow down the number of hits we get on our search. This is a critical part of any systematic review since the evidence gleaned will lay the groundwork for the review. We are searc...

I started to write this post and then said to myself, I'm not going there...its so passé. I saved it as a draft with little intention of completing it. Then I come across this " media kit " posted on the American Academy of Family Physician's (AAFP) website and just can't believe my eyes with their approach. They have set out to point out the obvious: NP education and training is different than that of physicians! Who knew?!?! I am so disappointed in the AAFP. Perhaps no other specialty works as closely together as NPs and family practice physicians. Up until now, I've generally come across very supportive family practice physicians of nurse practitioner practice. This is a slap in the face of sorts. And now the original post: Another day, another article about nurse practitioner's filling roles traditionally held by physicians, and another physician-centric theme by organized medicine. It's nice to read an article with some NP input and perspective....

How Hospitals Can Better Retain Their Nurses America is in the middle of a nursing shortage that is only expected to worsen as baby boomer nurses reach retirement age and a burgeoning population requires more healthcare. Here are just a few statistics that highlight the serious problems facing the healthcare industry: · More than 581,000 new nursing positions are expected to be created by 2018. This growth is much faster than any other industry, and there just aren’t enough nurses to fill the positions. · U.S. nursing shortage is projected to grow to between 260,000-500,000 by 2025. · Over the next 20 years, the average age of the RN will increase and the size of the workforce will plateau as large numbers of RNs retire. Because demand for RNs is expected to increase during this time, a large and prolonged shortage of nurses is expected to hit the US in the latter half of the next decade. · There are more than 100,000 vacant RN position...

No, this has nothing to do with breast feeding. This post is really a non-healthcare topic but I just needed to vent. Back in the Winter , I blogged about my passion for technology and looked forward to the new iPad coming out. To preface, I have always been a PC guy and never really understood the whole Apple fascination. I had many PCs and was very comfortable troubleshooting any issues I had. Though, I did have many different of the iPod models and had purchased the 3G iPhone back in October 2008. Well, I did decide to purchase the 32 GB Wi-Fi iPad and hopped on board the Apple gravy train. I woke up early that Saturday in April and headed on down to wait in line at my local Apple store. Overall, I am happy with my purchase as I knew it wasn't really a replacement for any device that I'm currently already using. This for me was really a "nice to have" rather than "need to have" purchase. I do have an issue with the device which is known by Apple and the...

With Father's Day just around the corner, now is a great time to remind all men about prostate health and screenings. Follow the link to a video from the Prostate Cancer Foundation. Happy Father's Day to all Dad's out there!

Here is President Obama's speech to the American Nurses Association from 6/17/2010. He specifically refers to NPs by stating: Now, there is more work to do. And that's why today my administration is announcing a number of investments to expand the primary care workforce. This includes funding to allow students training part-time to become nurse practitioners to start training full-time. (Applause.) We want to speed up the process where folks go from the classroom into the exam room. And we’re going to provide resources for clinics run by registered nurses and nurse practitioners. (Applause.) More work to do indeed.

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 ...

Nurse Walkout Highlights Conflict With Hospitals and Health Insurance Plans Ideally, all interests in the health care system should work together towards a common goal: the welfare of the patient. Unfortunately, nurses have been pitted against hospitals and the health insurance industry. The Obama administration's healthcare reform legislation will squeeze insurers and hospitals alike. Medicare payments to facilities are set to be cut over the next several years, and private health plans are set to follow suit. In order to prepare for these changes, many hospitals are looking for ways to maintain their margins. One of the most common methods is through staff cuts. Nurses, being on the front lines of providing health care services, are largely vulnerable. Nursing unions in Minnessota and other states are going on strike to protest staffing cuts. While they are certainly concerned about their own pay and benefits, some hospitals may take their cost cutting too far and put patients at...

Any “older” PhD students out there? This is my latest update in my quest for funding. Enjoy the humor of it all. As SNL host at the age of 88, Betty White proved she still has it; UConn Coach Calhoun, age 68, is going to get it (5 years and 13 million). So, it is with some cheek that I submit this treatise on aging in the world of academia. I mean, after all it is 2010; but a funny thing happened to me on the way to a fellowship. I am not a victim; I am an unabashed overachiever. I have no apologies for striving for more: more life, more liberty, and more happiness. The happiness for me comes in part from my family, a new “grand” coming in August, my work, my scholarship and my research. My work as a Nurse Practitioner is caring for the vulnerable aging, and the patients, families and communities suffering with dementia. My scholarship and research is from my new road to academia, specifically a Doctorate in Philosophy. My community knows I am striving to be a Doctor-Nurse...

It seems these days, anyone and everyone is willing to share their thoughts and opinions about the Doctor of Nursing Practice (DNP) degree. These include non-nurses and nurses alike. Well, I thought I'd take a stab at it as well since I am now 2/3 through my pursuit of the DNP. If you were to strictly listen to some of those opinions, you would have a very poor view of just what exactly this academic degree is and what it can (and can't) do. Perhaps I can dispel or at least clarify some of these points, at least from my view. First, no one is "forcing" anyone to go back to school to get this degree. The 140,000+ already practicing NPs will continue to practice without the need to return for formal academic education. However, starting in 2015 , it is presumed that MS programs will transition to the DNP. Second, there is some variation in the DNP program types. This is incredibly frustrating to me since not all programs are created equal. The DNP is not synonymous with...

Here is an article that refers to the NP led clinics that are flourishing in Canada. Canada established NP run clinics in 2007 and is continuing to add more as they are filling an important void in primary care. The article wonderfully points out that this initiative is collaborative an is not looking to supplant anyone else (for those worried about that). Great read. I'm hopeful that people are paying attention.

One can find a myriad of commentaries written on the future of primary care now that health insurance reform has passed. Many of these refer to nurse practitioner led clinics and how this can be one possible solution to care for the millions of Americans that will now have health insurance. Of course, I am a proponent of NP guided care and believe that patients form long lasting partnerships with NPs to help make choices about their health and wellness. As I've stated before, NPs are not brand new to the health system and have a 30+ year history of providing high quality care. A number of NPs right now own their own practices while others can be found in school-based clinics, hospitals and physician's offices. Unfortunately, NPs face many of the same types of issues that has driven physicians out of primary care. Dr. Karen Li wrote a wonderful column, " Why I Left Pediatrics ," that describes the reality of the barriers in health care. We simply cannot expect NPs to ...

The Future is Bright for Careers in Nursing If you listen to the media pundits, you probably think that now is the worst time in recent history to be entering the job market. With our country experiencing a definite financial downturn and the global economy in serious jeopardy, this is true for most career options. But some occupations are holding steady and even seem poised to expand in the coming years. Nursing is one such line of employment. From becoming a registered nurse in an ER or private practice to offering assistance and education to children as a school nurse to entering a caregiver situation in a private home, opportunities in nursing do not seem likely to subside over the next decade and here’s why. For starters, everyone needs health care. Maybe not today, maybe not tomorrow, but we’re all going to contract an illness, have an accident, or simply experience failing health at some point in our lives. We’ll need a nurse (or at the very least, our doctor wil...

Just wanted to say Thanks to anyone who voted for my blog at Lydia's Uniforms site. My blog won the Top Nurse Blog ! Again, thank you for reading and voting. Stephen

I was saddened to see an advertisement in the local paper for a new clinic which will be opening up. I'm very happy about the clinic and the fact that a good friend of mine will be the Nurse Practitioner (NP) there. She starts in a couple of weeks. Until then, another NP friend of mine is filling in. They had a ribbon cutting ceremony and pictures were taken outside the building for the local paper. This photo included staff members from the clinic, including a very professional-looking NP, the clinic manager, a "supervising physician," and some local "important people." All this looks great on the surface to the casual observer. Then I read the article. The only mention of the NP was to say that she is "a good listener." Well so what?? Plants are good listeners. Don't get me wrong, listening is a skill that all medical providers need to master, because most of our work is accomplished and proper diagnoses are made because we listen; but one must h...