A Nurse Practitioner's View

Wow - I randomly checked my blog and see that it's been THREE months since I last blogged! It's not from a lack of activity going on in the nurse practitioner world but more from having far too commitments than I have time for and unfortunately, my blogging has lagged behind a bit -- ok, a lot. While clinically, I am seeing tons of patients with nasty upper respiratory infections and good ole influenza (and the New York State mandatory mask requirement for health care workers if not vaccinated) is rearing it's ugly head. Practically every day, we see more and more coverage of nurse practitioners in the mainstream media. These NPs are responding to health questions, giving advice on things from influenza vaccines to cervical cancer screening and opening up their own practices. That's not to say that the toxic and predictable vitriol against nurse practitioners has ceased though. If anything, it has been turned up even more. Yet, it's obvious that it is having less ...

The infographic below comes courtesy of Simmons School of Nursing & Health Sciences. Check the full link out at:  http://onlinenursing.simmons.edu/affordable-care-act-family-nurse-practitioners/

This post was written in response to the WSJs article, " Should Nurse Practitioners Be Able to Treat Patients Without Physician Oversight? " As much as some would like you to believe that this is not about turf protection, make no mistake, it is exactly about protectionism and nothing in the interest of the patient. The latest buzz words are now “team-based care” where nurse practitioners, physicians, and other members of the health care team, are working for the common goal of better health outcomes while the inefficiencies of today’s healthcare system vanish. The problem with this presumption is that there is no defined model of team-based care. So what then is team-based care? If you ask a physician what team-based care is, they would say it is where they are in charge of the team and tell what the other members to do. They hold the most hours of in-patient training and in doing so can care for every patient and every condition without anyone else telling them how...

As the case for nurse practitioners is becoming increasingly obvious across the spectrum, predictably, the turf battles are rearing their ugly heads. Here is a blatant  example  of the rhetoric and follows a formula that I am going to reveal to spare any future time wasting reading them. Refer to the physician shortage and mention "Obamacare"  State the obligatory, "nurse practitioners are valued as part of the health care team"  Point out the differences in education and training (for example, physicians have 1 billion hours of training where NPs have nothing even remotely close to that)  Make the inference that quality of care will somehow suffer because of the differences in education/training (though there is not one shred of evidence that proves this) Make sure NOT to mention anything about patient outcomes being the same or better when NPs are primary care providers If there is mention of outcome studies, be sure to highlight how they are "ol...

My apologies in advance for this post as I'm sure it is a bit all of the place. I wanted to just jot down some of my thoughts on the "nurse practitioner vs. physician debate." There has been many articles recently written about this, so here are my thoughts: (these of course are my own thoughts and not representative of my affiliations) Above all else, nurse practitioners want to practice at the "top of our licenses." That is, to our full education and training. Imagine having access to the most wonderful car in the world - that can not only take you to wherever you want to go, in great comfort and with with excellent gas mileage, but not having the keys to start it. That is the restriction of the collaborative agreement. NPs have the education and training to care for patients in their specialty. However, without a collaborative agreement with a physician, we can't use any of it. We are stuck in the proverbial parking lot without keys.  Nurse practiti...

Hello Everyone and thanks for reading my blog. It has been a while since my last post - not for a lack of topics to post about - but due to an insane schedule that I have been keeping. Here in New York, we have been through he effects of SuperStorm/Hurricane Sandy, another presidential election, and the tragedy of the unfathomable nearby Newtown Connecticut shootings. There is so much also going on in healthcare and the aforementioned happenings are also intertwined in the landscape - from emergency preparedness, state health insurance exchanges as part of the Affordable Care Act, and mental health respectively. Specific to nurse practitioners, there have been numerous articles written about us (and the interesting negative commentary that always follows and isn't worth commenting on anymore). We have also seen the merger of two national nurse practitioner organizations into one large one. CMS announced that there will be increased Medicaid reimbursement for certain physici...

I've been following plight of the Oregon Nurse Practitioners regarding reimbursement rates. It seems that back in 2009, NP reimbursement rates from insurance companies were arbitrarily cut by up to 55% for no apparent reason. An attempt to correct that was introduced in the form of legislation . While it appears that the bill itself contained some flaws, it is now destined to flounder in committee once again. The sad thing here is politics at play. Heavy lobbying from the insurance companies and from organized medicine guaranteed the bill's demise. The lobbyists relied on the "costs will go up" tagline to shoot down the bill. This is laughable. Did those who were insured costs go down when they saw a nurse practitioner? Nope. The NPs diagnosed and treated the patients as they were educated and trained to do - not from some alternative medicine crack pot cookbook. It came from recognized health care standards, procedures, and guidelines. Yet, the insurance companies...

I saw 2 notable articles in the news last week about nurse practitioner practice that I wanted to share. The first one is about two new bills introduced in Missouri  that would eliminate the collaborative practice requirement between a nurse practitioner and physician and would allow NPs to prescribe controlled substances as indicated. Missouri is one of the most restrictive states when it comes to NP practice and if this legislation passes, they will move to the forefront of of autonomy. They will have substantial opposition but the bills would allow these NPs to practice to the full extent of their training and education.  The other article is about the first nurse practitioner to practice in Bermuda . She will begin this summer and work in King Edward VII Memorial Hospital. She is scheduled to be the first student to complete their NP program.  It is great to see NP practice evolve and have regulations that reflect a scope of practice that is congruent with the train...

I'm aware that many people roll their eyes at another "year in review" blog post but it's been some time since my last post here and I think it is a good way to end the year. 2011 was an important year for me professionally as I completed my DNP back in May. It was a grueling 3 years (that I mostly chronicled here on this blog) and in my mind was the right choice for me at this point in my life. I approach clinical problems and scenarios through an alternative perspective and I have really embraced this philosophy. I hope to apply some of this new wisdom to the health care system and patients alike. Because I'm a glutton for punishment, following the completion of the DNP, in the Fall, I enrolled full-time in one of the University Based Training programs that was part of the American Recovery and Reinvestment Act's HITECH Act. Technology has always been my passion and I am so interested in the integration of information technology and health - it is real...

I am posting this for a colleague who plans on writing a book about nurse practitioners.   Seeking nurse practitioners of all specialties to submit stories about the experience of being a nurse practitioner. The NP may live in any geographic area. This may include stories about the role of NPs, patients, circumstances or the health care system. Selected NPs will be confidentially interviewed and audiotaped if agree to be part of the project. Please contact mga11@caa.columbia.edu

The latest nurse practitioner study conducted at Loyola found that "...the nurse practitioner reduced ED visits by improving the continuity of care and troubleshooting problems for patients." These are the type of studies that need to be done. I am sick of the studies pitting nurse practitioners against physicians. The "us" versus "them" mentality is old, tired, and doesn't even belong in today's argument. The time has come to move past this and figure out a way to make the most out of available resources while ensuring that each profession practices to the extent of their education, training, and scope. Do we really need another study to show that NP practice is just as good or better than physicians or do NPs make more referrals or would NPs order more tests to arrive at a diagnosis? Please, this rhetoric is insulting to the entire US health care system. In my opinion, nurse practitioners are not interchangeable with physician practice. We a...

Hello, I just wanted to provide a brief update as to what I've been up to for the last few weeks. After completing my DNP this past May , I was actually feeling a bit melancholy thinking that my days of a "student" were officially over. Well, not so much! Since my passion is technology, I happened to be researching Health Information Technology (HIT) and found these University-based training programs set-up by the Office of the National Coordinator (ONC) under the HITECH Act . These programs train either health professionals on the IT side or IT professionals on the health side. Even better, there is grant that helps to pay for the majority of tuition fees! I've always had a passion for technology yet, have been all self-taught with no formal training. The program that I applied to and was accepted offers a clinician leader track. It's been about 3 weeks and the hybrid program is intense! (I thought I was done writing papers, etc!) Thus far, it really is a wo...

Hi All, Please check out my new blog at  Online Nurse Practitioner Programs ! Also, like this new page on Facebook to automatically get new updates. I am very excited to further expand my blogging and audience in this new forum! Not to worry, I will still continue to regularly update this blog with all things related to nurse practitioner practice. As always, thanks for reading. Stephen

A lot of nurse practitioners are finding my blog through searches regarding opening up a private practice from this January blog post . (I refuse to use the word independent since no clinician practices within a vacuum and requires multidisciplinary support to care for the whole patient). I happen to have a dear friend and colleague,  Dr. Joy Elwell, FNP, DNP , who has her own private practice. I asked her a few questions regarding her experience and she was gracious enough to sit down and answer them for me and my readers.  1. Why did you decide to open your own practice?  Well, first, my experience was a bit unique, since I had my own practice within an institution, i.e. I worked for an institution and was able to see my own patients at that site. I decided to leave and open a free-standing practice in the community because at this point in my career, I believed I could serve the community better by being self-employed. I also believed that I would have...

Lately, there has been increased emphasis on "preventative" care in the US now that there are some  mandates  under the Affordable Care Act. There is even the U.S. Preventative Services Task Force ( USPSTF ) which is a panel of private sector experts who recommend evidence based preventative screenings for certain conditions based on factors such as age and gender. As a family nurse practitioner, I base a large part of my practice on wellness and prevention in addition to episodic (or "sick") care. I believe in "wholistic" care - that is, care of the whole person including mental and physical states. Though lately, I question whether if "preventative" is really the best moniker for this type of care. Prevention assumes that one can completely avoid health conditions by subscribing to certain recommendations, screenings and/or tests. Is it naive or even obnoxious to think that we can prevent disease and illness? I have seen many patients follow a...

I am a huge baseball fan and my favorite team is the NY Yankees. Star third baseman Alex Rodriguez was recently diagnosed with a slight meniscus tear of his right knee. He has played through some pain over the last few weeks and was given conservative treatment by the Yankee training staff up until the point that it didn't really improve. Check out this timeline of events: Friday 7/8/2011 - MRI reveals meniscal tear. I presume the team physician recommends surgery. Sunday 7/10/2011 - A Rod gets a second opinion on SUNDAY with Dr. Lee Kaplan of Miami. Monday 7/11/2011 - A Rod has successful surgery and is expecting 4 - 6 weeks of rehabilitation. That is what I call access to care! From MRI to second opinion to surgery was a cool 72 hours (I surmise that he also needed a pre-op clearance thrown in there as well). Yes, he is arguably one of the greatest players to ever play the game and is also the highest paid player but it is amazing how anyone can get a second opinion ...

I had no sooner finished blogging about the announcement regarding the governmental plan to utilize mystery callers to assess access to primary care offices to find out that the survey has been put on an indefinite hold . Being a conceptual proponent of this research, I am disappointed that the administration backed down from the seemingly large physician backlash. Then again, as I stated in my last post, will this really tell us anything that we didn't already know? If you have any doubts, just try calling any office on a Friday afternoon, stating that you are a new patient and would like to come in on the same day for an appointment because you suspect pneumonia - oh, and that you have no insurance. Maybe the proper thing to survey is how long it will take to be hung up on or laughed at.....

One of the recent stories that spurred a lot of discussion was in the NY Times, U.S. Plans Stealth Survey on Access to Doctors . It is an interesting concept that will help to try and quantify how difficult (or easy) it is for one to get into to see a primary care physician. They will also evaluate if the office staff will give preferential priority based on the "patients" stated insurance. I applaud this move and believe it will produce some evidence as to how hard it is for new patient to seek care. Many physicians aren't too pleased with this survey as I would imagine it will tie up their resources. I blogged about this concept a few years ago when the AMA came out against the notion of "mystery shoppers." Health care needs to be patient-centric as the retail industry is consumer-centric. Why should health care be any different conceptually? I hope that this experiment isn't more of an exercise on provider's offices (i.e. poorly trained or rude staff...

10 Free Online Tools for Nurse Practitioners There are several online sites that offer a wealth of tools and resources for nurse practitioners- -and many of them are free. Here is a list of 10 sites that advanced practice nurses might find useful. NursingCenter.com - Created by nurses for nurses, this site is an excellent place to find professional resources, clinical information, and continuing education activities. Other features include free peer-reviewed journal articles, free eNewsletters, job listings, daily news, and a search engine that searched more 100 nursing-specific websites vetted by other nurses. NP Central - This site is operated by a non-profit organization that supports the development and advancement of nurse practitioners. NP Central offers job listings, education information, a list of nurse practitioner organizations by state, and other helpful resources. eMedicine - A branch of WebMD, eMedicine is a highly respected online medical resource. You can browse many...

Lately, it seems there is ratcheted up rhetoric on nurse practitioner practice making us prime targets for all things anti-NP. The WSJ reports on a study that examined the prescribing habits of NPs and whether there is Pharma influence on those habits. The study found that of the 263 surveyed NP respondents, 93% reported that free gifts had no effect on their likelihood to prescribe the medication that was being detailed by the representative. The study concludes that since many NPs had regular contacts with these reps in the form of face to face and industry backed lunches/conferences, there could be a degree of subconscious influence on prescribing habits - findings that are similar to prescribing habits of our physician colleagues. As you can see in the comments section that follows the story on the WSJ, some are using this study to once again attack NP practice. The comments are laughable as the insinuation is that NPs aren't really educated on pharmacotherapy and therefo...