Monday, May 31, 2010

The DNP for Me

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 nurse practitioner only practice, creating further confusion. For some great fact gathering, look at the AACN - Doctor of Nursing Practice section. One must throughly research the program and decide if it is congruent with their own practice philosophy, learning & lifestyle.

  • Third are the financials - it does indeed cost a significant amount of money for doctoral education. However, there are loans and grants available for those willing to search them out. In keeping in line with the financial aspect, no one really knows what the additional education will translate into when it comes to salaries. I'd say, if that is your main motivating factor, the DNP probably isn't for you. (As an aside, I've started reading the book, "Drive" by Dan Pink and he asserts that autonomy, mastery and purpose are the real long-term successful motivating factors rather than financial incentives when it comes to non-task oriented work). I don't think I know one NP who became one for the money (because the reality is, some RNs are making significantly more than NPs). Of course, one would want to know what their return on investment would be but it just isn't that simple. I believe that it is safe to assume that somewhere & sometime, a doctorally prepared clinician can make more than one who is not and will have a number of new opportunities at their door.

So, why did I decide to return to school for a DNP? Here is a little background: I have been an FNP for 10 years and have held a variety of positions in correctional health, college health, men's health, retail health and occupational health. I've seen many patients in many different settings and I've been able to build upon each experience. However, I was growing increasingly frustrated with conflicting published data, major dysfunction of the health care and system and at the end of the day, wanted to be able to provide the absolute best care for the patients I served. I vehemently refused any additional "residency" type of education. In fact, I had very mixed feelings when I first heard about the creation of the DNP. Not to be coy, but I already had the education and training to take traditional care of my patients in the family practice setting. I could manage my patients with asthma, diabetes, and hypertension just fine. But I felt that I wasn't using the latest proven evidence in my care. The research classes I took as a student were generally pretty dry and seemed to have little applicability to direct practice. For me, it was critical to take my practice to a new dimension. This is the essence of the DNP for me and I was fortunate to find a program that I believed would take me where I needed to go.

The last two years of doctoral education has been both grueling and exhilarating. I am viewing my patients, their health concerns and the health system through different lenses. Didactic coursework included health policy, informatics, economics, legal/ethical, and teaching/learning/mentoring. One may look at this sampling and say that it isn't very "practice" based. I'd say that is quite a naive view of health care today. It would be easy to "just" take care of patients' health issues and ignore the rest since patients are multi-dimensional and never just present as an illness or disease. In addition to subtle differences in pathophysiology, patients bring their own cultural, societal, and beliefs to each and every encounter with a provider. The key is being able to navigate these complex intertwined systems and team together to best care for the patient for that time and place.

I am now onto the practicum portion of the program and am excited to take all of this new knowledge and integrate it into a patient care initiative. For the summer, I am part of a group that will be conducting a systematic review of the current evidence (related to diabetes care) utilizing the Joanna Briggs Institute method of systematic review. We have met and will continue to meet with the practice locations' key stakeholders (including patients) to implement an evidence based, culturally congruent practice improvement plan that will be assessed and reassessed. We are hoping to uncover some great evidence and have it affect our patients in a positive way. I am also hoping for a few publications from this process as well!

I am going to try chronologize some of the general themes over the next year and post them here.

To sum, the DNP will make me a more adaptive clinician. I will still see the same patients that I've already been seeing and will still collaborate in a multidisciplinary environment. What has changed is a truly evidence-based, patient-centered approach. Pink's concepts of autonomy, mastery and purpose resonate with me and are in alignment with my philosophy. At the end of the day, I want to be able to care for patients in the way that they should be cared for. I believe I am on the right track.

Thursday, May 27, 2010

A Lesson

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.

Wednesday, May 26, 2010

Proceed with Caution

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 fill the void in primary care settings while maintaining the widespread dysfunction of the health system. It will only be a losing battle as we try to care for our patients. I do however, remain optimistic that we have taken an incremental step in the right direction. We realize that maintaining the status quo is no longer an option. NPs will hold increasingly significant roles in the system. To avoid ending up in the same situation, we need to ensure that all stakeholders are at the table as we write the next chapter in health care.

Monday, May 24, 2010

Guest Post: The Future is Bright for Careers in Nursing

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 will), and some of us more than others. The sizeable generation known as the baby boomers is currently hitting retirement age. As they continue to age, the number of senior citizens requiring medical care in this country is going to skyrocket, creating a need for more medical professionals. And since this time is nearly upon us, nurses will soon be in high demand.

But there’s more to it than that. The recent passage of health care reform has guaranteed that previously uninsured Americans will now have access to medical care through the implementation of a public program. This means that millions of people who avoided hospitals and doctor’s offices in the past will soon be seeking preventive care and other medical services. This bodes well for nursing, which will surely become one of the few occupations to offer employment in unparalleled numbers over the next several years. In fact, there is a good chance that our country will experience a deficit of qualified individuals as college recruiters scramble to fill the gap.

So if you’re still trying to figure out your college curriculum and you’re considering nursing, or even if you set to embark upon a career, getting into the job market should soon be even easier. A few years ago, people going into web design were taking their pick of jobs and demanding higher salaries due to a small supply of qualified workers facing an overwhelming demand. Nursing is set to experience a similar situation in the coming years. Those who are qualified will certainly experience the benefits of coming into the profession at just the right moment to capitalize on what looks to be a wide open field.

Guest Post by: Sarah Leonard of the Nursing Degree Website.

Submit a guest post: anpview at gmail dot com.

Monday, May 17, 2010

Thank You!

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.


Friday, May 14, 2010

Guest Post: Nurse Practitioners

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 have an education and some experience with diagnosing and treating illness to go along with those listening skills. I happen to know this particular NP has excellent diagnostic skills, which is what a patient needs to be assured of when seeking out a healthcare professional. Why do you think patients seek out the most qualified person for the job when looking for a healthcare provider? I can listen to her all day, but if I don't know how to diagnose or fix the problem, I'm not of much use to the patient.

The second issue I have with this article is the fact that a medical doctor was interviewed for the article and will have very little to do with the operations of this clinic. You see, in Tennessee, nurse practitioners are required to have a doctor come in and sign off on 20 percent of our charts (100 percent of any charts where a narcotic is written). This does not mean we are working "under the doctor," as so many imply. We are working under our own license and our own DEA prescribing number. They are simply paid to review some charts and put a signature on them. You see how ludicrous this is. Don't get me wrong, the doctor they interviewed is a wonderful guy, and a great doctor. I simply find it so sad that we feel we must give patients the illusion that a "real doctor" is somehow involved in operations of the clinic.

For those of you who don't know, NPs have at least at Master's Degree, which is 6 years minimum. For many of us, it also includes several years as an RN before completing those years of school for the NP degree, which was a priceless part of my educational process. I want to spread the word that we are here to stay, we don't need to hide behind a doctor's name, we have one of our own. Patients have a choice to see us or not, we are not pulling the wool over their eyes and trying to be deceitful just to get patients.
Most NPs, like most MDs do a good job. I urge you to see the difference for yourself. You may not notice any. You may have a bad experience. You may find the provider you want to stick with as long as you live. I just ask that you know who you are seeing and that you give the credit to that person alone for the care they provide.

Kim is a Nurse Practitioner and writes her own blog at KIMblogery. (This post originally appeared on KIMblogery on 12/15/2009 and was reposted with permission).

Submit a guest post: anpview at gmail dot com.

Tuesday, May 11, 2010

Submit a Guest Post

Have you ever wanted to write a blog but didn't have the time to keep up with it? Do you already blog and would like to get some additional exposure and cross-readership? If the answer is yes, I invite you to submit a guest blog post! E-mail me at anpview at gmail dot com and submit your post. Here are some guidelines:

  • Have your writing be related to something you are passionate about (in the health care field)
  • A minimum of 250 words
That's it! So, put on your writing caps and send me your post. Please include your contact information too (it won't be published unless you request it).

Hope to hear from you soon!

Monday, May 3, 2010

Bring It

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 providers is instantaneous and efficient.

They seem to suggest that only physicians are "those best suited to render care to patients." How about that? I wonder how that one will work out. If you think there is a shortage of physicians now, its going to be real tough to find one when they will be staffing hospitals in place of nurses, respiratory therapists, physical therapists, dietitians, etc since supposedly they are the only ones best suited to "care" for patients.

The facts are that nurse practitioners have been and will continue providing high-quality, efficient and evidence-based care and this largely doesn't have anything to do with mandatory collaboration but with our experience, education and training. If that wasn't the case, we would not be granted licenses or certifications from the state that allow us to care for our patients albeit with an arbitrary restrictive barrier. (If my collaborating physician moves out of the state, retires, or one day simply decides to stop collaborating with me, my patients are left without a health care provider and I am left with patients whom I treated yesterday, but can't today).

To them, it's all about maintaining the status quo in a dysfunctional system fraught with disparities, inequalities, and waste. For anyone who can't blatantly see past that, I know a good primary doctor that I can get you to see on the same day who even accepts your health insurance.