Wednesday, December 29, 2010

2010 End of Year Reflections & A Look Ahead

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 apparent that many still have a poor understanding of the NP role. The IOM provided the current state of the profession and lays the framework to a road of barrier-free NP practice. I hope that we are finally able to move past the turf battles and patronization of the NP role to focus on the multidimensional aspects of patient care.

On a personal note, my DNP group and I saw our systematic review protocol accepted and published on the Joanna Briggs Institute's website. Looking ahead, I will graduate with my DNP in 2011 and will continue to incorporate those new layers of knowledge into my daily practice. Unfortunately, I still have a significant amount of work to complete before May but I look forward to soon finishing up our systematic review/meta-analysis and the implementation/evaluation of group medical visits in actual practice for patients with diabetes.

I am so happy that more and more people are finding and reading this blog. When I started the blog 3 years ago, I didn't know where I would go with it. Now 3 years later, I believe that I accomplished in part of what I set out to do: advocate for the NP role, correct many of the published inaccuracies and offer a NP voice on healthcare issues. I will continue doing this in 2011 and look forward to the successes and challenges that it brings.

Thank you for reading & Happy New Year!

Sunday, December 5, 2010

NP Residency

The healthcare system of today is so complex yet so dysfunctional that I believe the time has come to educate and train the NP providers of tomorrow in a way that is reflective of that complexity. We have done a good job up to this point but need to bring that to the next level.


I'm not necessarily referring to the typical residency training of physicians which takes place in hospitals but a residency-type of program in an out-patient setting (ironic that we use the term residency). We realize that healthcare is not exclusively delivered in hospitals. It takes place in independent providers offices, in community health centers, in mobile health vans, and in retail settings. It takes place in people's homes and places of employment. It takes place in many of the health decisions that we make on a daily basis. I found this NP residency program in Connecticut that claims to be the first NP residency in the US. The programs admits 4 NPs each year and trains them to handle scenarios encountered in Federally Qualified Health Centers (FQHCs). The residency lasts 1 year and appears to be a wonderfully structured program and setting.

So why are NP schools still relying on the preceptor model to train NP students? It comes down to money. The majority of medical residency's are funded by Medicare & Medicaid (I don't purport to know the full details of funding but do know that it is largely our tax money supporting physician residencies). For what I'm sure is a myriad of reasons, NP training just wasn't appropriated. Enter the Patient Protection and Affordable Care Act. Section 5316 authorizes a demonstration project to replicate the NP Residency Model. This at least is a start.

There is no doubt that the residency model in proven and tested to train professionals in the real world. In fact, a recent article in the Las Vegas Review Journal discussed residencies for new RNs working in Vegas-area hospitals.

Patient's haven't necessarily become more complex, its just that our understanding of the multidimensional aspect of them has. There are nuances in physiology, culture, health beliefs/disparities and socioeconomic standing. Taking care of disease processes is relatively easy - taking care of an individual is the real challenge. Not to mention the importance of collaborating, communicating and interacting with all the members of the multidisciplinary care team. All of our training needs to encompass and embrace these factors so that we may provide the best culturally competent and evidence based care possible to our patients. Perhaps residencies will provide us with guided real world training to take all of this complexity into account. It certainly will be interesting to follow.

Thursday, December 2, 2010

Guest Post: North Carolina Nurse Practitioner Fights for Change

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, a Republican from Lenoir County. He says, “If we can tackle the nutrition standards in the schools, it will benefit the entire community … the things [Sandy] showed me in her presentation were pretty powerful in terms of what our kids were eating at schools.”

Tripp has been a Kinston Pediatrics nurse practitioner for 14 years, and a nurse for 24 years. She is now working toward her doctorate in nursing at Duke University. You can follow Sandy on Twitter. I’m sure she would welcome your input and advice. We are all in this together.

Robin Merrill is a freelance writer who writes for Wisconsin Dells Hotels.