A Nurse Practitioner's View

One of the biggest areas of frustration for students, stakeholders, and nurse practitioners are the seemingly lack of consistency among state regulations regarding NP practice. The rules in one state may not necessarily apply in the next (and even neighboring state). I have known NPs that lived near state borders, licensed in both states, yet had completely different sets of rules regarding what they can/can't do, requirements for collaboration versus autonomy and prescribing ability. Barton Associates created this free interactive tool that lets you visually compare all 50 states' (plus DC) NP scope of practice. It is ultra handy and can help one decide whether to practice in one state that is very prohibitive compared to one that offers autonomy.  There is also a push for the  APRN Consensus Model  whose aim is to have consistency among the states when it comes to regulations.    If moving out of the state isn't feasible, well, the ...

I started this blog, A Nurse Practitioner’s View, 3 years ago because there were very few health stories that even mentioned nurse practitioners as part of the health care landscape. Right before I started the blog, I would respond to other health policy articles published on the Web by writing comments to the websites – only to be subjected to baseless and factually incorrect statements. It was soon thereafter that I decided I would write my own perspective on health policy, trends, and news. I also felt it important from a credibility aspect to not blog anonymously but to put my name on it. I recall those few early blog posts that I proudly wrote and would feverishly check my blog visitor stats to see if people were reading. Well, it was a bit slow going in the beginning with about 10 – 15 readers but as they say, “if you build it, they will come.” Today, the blog enjoys hundreds of visits a day, has a Facebook following, has enabled me to be “discovered” to blog at  Onl...

It's been a busy last few months as the legislative agenda has heated up of the NP organization where I am the Chair-Elect. I have been to some fundraisers and legislative visits to try and garner support from lawmakers to sponsor and support the bill that will eliminate statutory collaboration between a physician and nurse practitioner in New York State. The bill is known as the NP Modernization Act. We have been at this for about the last 5 years and up until now, there has not been much forward movement. While we had a sponsor for the bill and many co-sponsors, it was stuck in both the Senate and Assembly 's Higher Education Committee (where all of the professions in NY state are regulated). The bill basically sat idle in these respective committees. We finally experienced a breakthrough after countless visits and grassroots efforts. The IOM Future of Nursing report absolutely helped make the case for increasing access to care as did the positive press that nurse pr...

With all the  recent  discussion on the Affordable Care Act (ACA) being heard before the Supreme Court, I wanted to discuss one of the programs that was borne from the ACA. The  Centers for Medicare & Medicaid  (CMS) define Accountable Care Organizations (ACOs) as "... groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients. The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors." Wow, this sounds great so far, and seems to be congruent with nurse practitioner-partnered care, what could be wrong with this model? Read on. The "ACO Professional" is  defined , "...as a physician (as defined in section 1861(r)(1) of the Act) or a practitioner described in section 1842(b)(18)(C)(i) the Act (that is, a p...

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...

Eat your fish, it’s good for your brain.” This is what every mother said to get the kids to finish their meal. As we age, there are many physiologic mechanisms that occur making memory a thing of the past. While remembering something your wife said thirty years ago is still there, what the heck did you do with your car keys? Here are five tasty ways to encourage memory after age 65, or before.  1. Vitamin B12 Cyanocobalamin (B12) is an essential coenzyme required in many bodily activities. It is necessary to make the heme part of hemoglobin and it is also an integral part of nerve repair. A deficiency leads to pernicious anemia. Subclinical vitamin B12 deficiency can cause pain, electric shock feelings, sleep disturbance, depression, fatigue and memory loss.  Your body needs a chemical called intrinsic factor to absorb B12 in the gut. Production of B12 declines with age, so foods containing B12 are essential to provide optimal absorption. B12 is found in meat, fish and...

I have certainly been keeping myself busy these days! First, I have been immensely busy at my clinical site. Hundreds of flu shots have been given in the last few weeks and I have been inundated with the change of season upper respiratory infections and allergies in what seems like everyone has (really, the care is largely supportive and conservative. I am a big fan of saline nasal irrigation!)  Second, school work continues in the Office of the National Coordinator for Health Information Technology post graduate certificate program as Clinician Leader that I am enrolled in. I am considered full-time and plan on finishing up in May 2012. The amount of work has been intense (an intensity that I thought I was done with following completion of the DNP this past May!) The course work isn't as demanding as the DNP, but there is just so much of it that is condensed into a relatively short time frame.  Third, I am running for Chair-Elect in the Nurse Practitioner Associa...

I recently blogged about the prospect of patients getting access to their laboratory results before the ordering clinician signs off on it. This certainly is a patient-centric approach but is it a wise one? I am mostly in favor of this however, many details still need to be worked out. In our forthcoming electronic health records world, this may be the tip of the iceberg related to patient-centricity and access to their record. I'd love to hear your thoughts and concerns.

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...

I receive countless spam e-mail messages to my many e-mail addresses. The screenshot of the one that I received below is definitely one of the most bizarre and struck a nerve. Really, this is not a way to advertise a career in nursing. It's unclear to me how or why doctors specifically, are in need of people like me. Perhaps the inference is that doctors tell nurses what to do and nurses are there to serve at their beck and call. We all know that the profession of nursing has a whole science unto itself and that nurses are front line care givers, influencers and advocates in the world of patient care. Sandy Summers is a nurse who runs the The Truth About Nursing website and she dedicates the whole site to correcting the vast negative portrayals of nurses in the media and in entertainment. I can envision her targeting this type of inaccurate portrayal due to the poor choice of wording. I did not click on any of the links for fear of it taking me to some weird phishing site or t...

I check out many health-related websites on a daily basis. I click on links from Twitter and Linked In and see the entrepreneurial ventures of fellow health care professionals. One of the things that irks me of late is the random stock image of health care "professionals" posted throughout websites (for example see below). This woman has been featured on more websites that I can count. It's not that I doubt her professional credentials - she seems to at least have a legitimate Littman-type stethoscope and upgraded smoke finished clipboard. But is it that hard to post a picture of actual clinicians today? When we talk about patient-centered care, I believe patients deserve to see an actual image of their provider rather than the random clip-board touting, lab-coat wearing stock image that graces so many websites. I hope this woman is at least getting royalties from gracing so many sites!  So please, if you have a website and are a healthcare professional or entity, ple...

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.....