A Nurse Practitioner's View

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...

A little bit on technology and how it is impacting health and patients. As an admitted techno-geek, I am passionately following mobile technology and where it is popping up in health. A cool app that I recently downloaded is Instant Heart Rate for my iPhone 4. This is a free app and requires no external hardware. According to their website, it works by placing your finger over the iPhone's camera and it "tracks color changes in the light that passes through your finger." I used it and found the readings to be fairly accurate. It is also available for Android as well. The basic app is free and for a $0.99 upgrade it adds features allowing you to document what you were doing at the time of recording, viewing graphed results over time, and auto-posting the results to Twitter. As a clinician, apps such as this can help patients keep accurate data to review with their providers at their visit. It is exciting to watch this technology develop. Today it is heart rate monitorin...

My physician's group utilizes an on-line patient portal to schedule appointments, view lab results, and to communicate with my provider. Fortunately, it is very rare that I need to actually schedule an appointment. I've only been a patient of the practice for just about 2 years and I thought I'd schedule my second annual physical. (In fact, I've been there once, a year ago, for a physical on a Saturday). Now, I do question the real value of the annual physical examination but as we all get a year older, there are certain screenings that are recommended . Nonetheless, I fired up the handy patient portal web address and requested a physical examination for any early Saturday appointment in June or July. Since I do work Monday through Friday with my own patient load and responsibilities, I don't think I should need to take a day off to have a physical. The practice has Saturday hours and I thought this would be ideal for me and my schedule. This is the response that...

The systematic review that my colleagues and I have been working on (for what seems like forever!) was finally published in the Joanna Briggs Library of Systematic Reviews! It is very gratifying to have an official peer-reviewed publication under my belt. The title of our Review is, "The effectiveness of group medical visits on diabetes mellitus type 2 (dm2) specific outcomes in adults: A systematic review." The work that we studied on group medical visits (GMV) is truly interesting and can serve as a viable model to aide in type 2 diabetes management. Graduation is just over a week away and we just have one more presentation standing in our way. I will be posting some of my reflections on the program and on the DNP in the weeks to come. For now, I will enjoy this moment!

Here are the poll results from the show New York NOW on the the NP Modernization Act Bill that has been introduced in the New York Legislator. I particularly like the comment from "Stephen" - for obvious reasons ;-)

I was recently contacted by a member of the National Health Services Corps (NHSC) and asked to highlight their program here on my blog. It certainly sounds like a wonderful opportunity for NPs regarding loan repayment. So here it goes: The NHSC is a federal program that offers primary care providers financial support in the form of loan repayment or scholarships so they can practice in underserved areas of the country without the burden of educational debt. The NHSC is currently expanding to help meet the need for primary care professionals. The current application cycle for loan repayment closes on May 26th and applications are now being accepted for the NHSC scholarship program . As the country faces a shortage of primary care providers, the NHSC plays a critical role in bringing primary care medical, dental and mental health professionals to communities in which people would otherwise have to travel miles for health care, or go without help. In return, the NHSC offers hel...

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...

It's been a while since I last posted and it's because I've been somewhat bogged down with the last few projects for school. To briefly update: We completed our systematic review and meta-analysis on the effectiveness of group medical visits for patients with type 2 diabetes (specifically the ABCs: Hemoglobin A1c, Blood Pressure and Cholesterol[LDL]). We have received peer-review feedback and have edited and resubmitted and are anxiously awaiting their response. We implemented an actual group medical visit model in our clinical agency site and are gathering data and tweaking accordingly via the PDSA cycle. Plus, I am trying to get motivated to work on the last individual paper which must be submitted for publication to a peer-reviewed journal (rough draft is due this Friday and I don't have much thus far - which completely explains why I am blogging right now!) Finally, we are working on our final presentation for the group medical visit project. Whew! We are also get...

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...

Congratulations to NP JoAnne Lutz of the Oregon Medical Group for being named in the Top 5 rankings of providers at DrScore.com. According to this press release , DrScore.com is " ... an interactive online survey site where patients can rate their physicians, as well as find a physician based on their service level preference. " Steve Feldman, MD, founder of DrScore, states, " This year marks the first time a nurse practitioner has been in the top five runners up,” Dr. Feldman said. “This may reflect an important trend for medical practices as health care continues to evolve —everyone on the frontlines is vitally important in improving patient satisfaction. ” Important trend indeed and some additional proof that NPs are highly regarding by their patients. It's also time to expand these rankings to other providers beyond physicians to include nurse practitioners and physician assistants to name a few.

On my snowy commute into work this morning for what seemed like 100th snow-laden car ride of this winter, I chuckled when the radio newscaster urged people to stay home. As a healthcare professional, we rarely see a "snow day." Hospitals and clinics don't close. So to all of my healthcare, EMS, police and fire (and anyone else needing to get to work) colleagues: Please stay safe out there when Mother Nature throws this nasty weather our way. Some people must get to work whatever the circumstances are.

There is an interesting trend that I'm observing and don't necessarily see how this is going to turn out. I'm seeing more and more nurse practitioner's opening their own autonomous practices. Many of these offices set out to offer care that is personalized, covered under insurance, and of course high-quality. I'm also seeing more NP specialty/sub-specialty practices such as house calls, incontinence, and women's health. This is in a time when more physician practices are joining together in these conglomerations that aren't necessarily tied to hospitals. You'd be hard pressed to find a solo primary care physician these days yet nurse practitioner solo practices are popping up. The talk about the formation of accountable care organizations can be attributed to health care reform and the spurring of large multi-physician practices. What to make of this? I honestly don't know. Many people and patients have said to me "you should start your own prac...

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 ap...

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. Residency. 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 ha...

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, ...

Why You Should Consider Becoming a Certified Registered Nurse Anesthetist Many registered nurses can tell you about the stress that comes with a profession where being overworked and under appreciated comes with the job. However, there is one nursing specialty where nurses report high levels of satisfaction with their jobs, their patients, and their salaries- Nurse Anesthesia. A Certified Registered Nurse Anesthetist is a registered nurse who has completed his or her Masters of Science in Nursing degree specializing in anesthesia. Today, between sixty and seventy percent of anesthetics are given by Certified Registered Nurse Anesthetists, according to the American Association of Nurse Anesthetists. Thanks to the high skill level required by the position, Certified Registered Nurse Anesthetists are highly independent, very well paid, and in demand all over the country. Certified Registered Nurse Anesthetists say that the field requires a lot of upfront commitment to receive the training...

On this unofficial Facebook " Unfriend Day " I thought I'd take brief stock of the different social networking platforms geared to nurse practitioners. There are a plethora of sites out there with varying degrees of engagement & activity. This list below is by no means meant to be exhaustive, it is just a sample of what I have come across: Clinician 1 NPs 2 NPs FaceBook (the many pages dedicated to different advanced practice nursing groups) LinkedIn (NP groups) Advance for NPs & PAs The American Academy of Nurse Practitioners (has a networking site that is difficult to find) The ENP Network Many NPs on Twitter Allnurses NP Central Listserv NP blogs These sites are primarily geared to the NP with the hopes of networking with fellow NPs . I have personally been a part of every one of these sites - more so as a lurker - to see what my NP colleagues are talking about and discussing. It's rare that I feel compelled enough to comment about an issue (well, I...

The Pros and Cons of Legal Nurse Consulting I’ve spent years pursuing different avenues in the health care industry. I spent my high school years studying to become a CAN, I was at one point a EMT, and I eventually turned to alternative practices like massage therapy, herbs and general fitness and nutrition. Not long ago, though, I heard a term that was relatively new to me – legal nurse consulting. My aunt told me about her pursuit of a legal nurse consulting certification. Her goal was to pass the certification exam and open her own business, partnering with lawyers around the country to help them understand medical charts and the medical profession as a whole. Sounds great, right? I’m wondering if it really is. I urge anyone who is considering legal nurse consulting to consider the pros and cons. While it is certainly an admiral and profitable career path, it may limit your future choices. First of all, legal nurse consulting is not a get-rich-quick solution to your problems. If you...

CareFirst Insurer Expands Role of Nurse Practitioners, IOM Recommends Same Last week, CareFirst BlueCross BlueShield, an insurer in Baltimore, Maryland, announced that it would enable nurse practitioners to serve as primary-care providers in Maryland, Northern Virginia, and the D.C. area. In response to both the physician shortage, which is expected to take a turn for the worse in the coming years, and to the health care reform law, which will produce an huge spike in insured patients by 2014, CareFirst made the decision to grant more authority to nurse practitioners. As quoted in a recent FierceHealthCare article , CareFirst Senior Vice President for Networks Management Bruce Edwards noted: "With these developments ahead and an existing need to expand access to these services, allowing nurse practitioners to practice independently as primary-care providers is a logical move to serve our members better." The CareFirst decision to rec...