Archive for the ‘nurse practitioners’ Category

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Supporting Nurse Practitioners as ‘Priority Primary Care Practitioners’

July 29, 2010

By Susan McBride, PhD, RN, professor at Texas Tech University Health Science Center School of Nursing 

It’s important for nurses to understand the Medicare and Medicaid incentives to implement electronic health records (EMRs) and to move to their “meaningful use,” as well as the purpose of the Regional Extension Centers created to support nurse practitioners and other “priority primary care providers” in the implementation process.

Dr. Mari Tietze, John Delaney, and I are fortunate to be involved in two of the Regional Extension Centers in Texas. We believe that nursing professionals have many contributions to make in the evolving electronic highway in the U.S. We will blog later about our roles as nursing informaticists in the Regional Extension Center program.

What are ‘Regional Extension Centers’? Under the Office of the National Coordinator (ONC) Health Information Technology Initiative to support getting providers to meaningful use on electronic health records, the ONC has established Regional Extension Centers. There are 60 Regional Extension Centers that will furnish assistance to providers in specific geographic services areas covering virtually all of the U.S. A total of $643 million is devoted to these centers.

The purpose of the Regional Extension Centers is to support priority primary care practitioners in priority settings to implement and use EMRs according to the meaningful use requirements outlined in our previous post (below is a screenshot illustrating one example of how an EMR might align with meaningful use requirements; click image to enlarge). The goal of the program is to provide federally subsidized outreach and support services to over 100,000 priority primary care practitioners within the next two years. 

© 2010 e-MDs, Inc. All rights reserved. Product and company names are trademarks or trade names of their respective corporations.

Regional Extension Centers will provide the following support services to providers:

  • EHR implementation
  • education and training
  • project management
  • incentives
  • meaningful use

NPs as “priority primary care practitioners.” A priority primary care practitioner is defined by the ONC as a primary care provider  that is any doctor of medicine or osteopathy, any nurse practitioner, nurse midwife, or physician assistant with prescriptive privileges in the locality where she or he practices, who is actively practicing in one of the following specialties: family, internal, pediatric, or obstetrics and gynecology.

Priority settings. Many NPs work within priority settings identified by the ONC, including small group practices of 10 or fewer, public and critical access hospitals, federally qualified health care clinics, rural healthcare clinics, and other settings serving uninsured, underinsured, and medically underserved populations.

NPs are eligible for support services of the Regional Extension Centers. For more information on what services might be available to you, contact the Regional Extension Center within your geographic region. A table and map covering the 60 centers is available here.

Incentives program for EMR implementation. February 17, 2009, President Obama signed the American Recovery and Reinvestment Act (ARRA) and along with that Act $33 billion dedicated to Medicare and Medicaid incentives for providers and hospitals who adopt, implement, or upgrade an EMR system and meaningfully use that system. As we blogged previously, meaningful use of EMRs has many parameters that providers must meet—but with that comes financial incentives that eligible providers can receive.

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For Those Interested In Learning More, See Below….

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Nurses Under the Influence of Pharma—Not Just an NP Problem

July 1, 2010

By Shawn Kennedy, AJN editorial director/interim editor-in-chief

On his blog yesterday, health news watchdog Gary Schwitzer’s note about a conference he attended on whether pharmaceutical companies should fund medical education pointed out that “nurses are not immune from drug industry influence.” He focused, though, just on NPs who prescribe medications. ALL nurses are subject to influence.

When’s the last time you were at a large nursing conference? I go to many—at the major meetings, the exhibit halls are filled with vendors giving away everything from free ice cream and pens (I once collected 32 just to see how many I could get) to mugs and cash. If you filled out surveys, giveaways were worth more—you could be put in a drawing for a laptop or iPhone. 

The danger of an NP succumbing to influence is obvious—she or he may prescribe for reasons (which may be on an unconscious level) other than clinical ones. The issues for nurses who do not prescribe medications are subtle and different. AJN‘s ethics columnist Doug Olsen did a two-part series exploring this last year—in January and February 2009. And AJN‘s editor-in-chief emeritus Diana Mason wrote on this even earlier, in an editorial in December 2000, noting, among other concerns, that ”it’s not unusual to see drug company underwriting of speakers at nursing conferences; of course, the topic addressed is almost always related to one of the company’s top drugs.”

Nurses have been proud of our high ranking on Gallup polls as one of the most trusted professions. We need to make sure we continue to earn that ranking.

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Turf Wars Aside, How Do NPs and MDs Really Differ?

April 20, 2010

By Christine Moffa, MS, RN, AJN clinical editor

By Richard Danby/via Flickr

There’s been a lot of talk lately about turf wars between NP’s and physicians, especially when it comes to the much discussed U.S. shortage of primary care providers. Before going back to school and getting a master’s in nursing education, I batted around the idea of becoming a nurse practitioner. It seemed like the ideal next step for someone who was happy being a clinician but wanted to take on an advanced role.

However, there was something that didn’t sit right with me about becoming an NP—namely, my fear of public perception. I’m not sure most people know exactly what the role of an NP is and how it differs from that of a physician, particularly in primary care. I’ve seen patients call their primary care NP “doctor [insert first name here],” which to me illustrates the confusion.

When people ask me the difference, I myself have a hard time articulating it. How do I respond when someone says something like this: “if entry to medical school and residency is typically more competitive than for advanced degree nursing programs, and if physicians spend a longer time attending tougher programs, how do you justify their doing the same work as NPs?” (For instance, when I was in school we, along with the NP candidates, were only required to take two semesters of pathophysiology!)

Now, I’ve been to an NP as a patient, and I was happy with the care I received. She certainly spent more time with me than any medical doctor ever did. And people often point out that NPs work in poor and/or rural areas that have a tough time recruiting physicians. But by promoting ourselves as a cheaper, less busy alternative, are we doing ourselves a favor or confirming the suspicions of those who—despite the available research to the contrary—say we’re less qualified than physicians to provide effective primary care? I’m still looking to go back to a post–master’s certificate program to become an NP because I’d like to work in that capacity one day. I’d like to hear from any NPs or DNPs about how they handle these kinds of questions. How are you like physicians, and how do you differ?

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Nurses Doing Primary Care, Hospital-Acquired Infections, Questionable Celebrity Advice, and Tort Reform

April 14, 2010

With a looming shortage of primary care doctors, 28 states are considering expanding the authority of nurse practitioners. These nurses with advanced degrees want the right to practice without a doctor’s watchful eye and to prescribe narcotics. And if they hold a doctorate, they want to be called “Doctor.”

That’s the start of an MSNBC story called “Doc Deficit? Nurses Role May Grow in 28 States.” Much of the article is about nurse practitioners (NPs)–and the different ways they are (or are not) allowed to practice in different states, as well as the ongoing efforts of physician groups to limit their practice (even as the health care overhaul increases the demand for primary care physicians and invests in nurse-managed clinics). We’ve posted on scope of practice issues here more than once—what’s your take as nurses, or patients?

HAIs persist. Also today, as described from a number of perspectives in a collection of articles on Kaiser Health News, the Department of Health and Human Services (HHS) released a report stating that the rate of hospital-acquired infections did not improve in 2009, despite ongoing attention to this issue in studies, IHI initiatives, nursing journals, and nearly everywhere else. What gives?

Does getting sick make you an expert? Elsewhere, at Covering Health (the blog of the Association of Health Care Journalists), Andrew Van Dam is critical of tennis star Martina Navratilova’s public advocacy for yearly mammograms for women over 40.

In February, Martina Navratilova was diagnosed with ductal carcinoma in situ, the most common form of breast cancer. She has since had a lumpectomy and says she’s doing well and doesn’t expect the cancer to return. But in an interview with Good Morning America during which she announced her diagnosis and surgery, the tennis star stepped beyond the world of sport and into the world of medicine. And there she made the sort of missteps she’s known for avoiding on the court.

Tort reform, redux. Lastly, today the Wall Street Journal Health Blog reported on a new study that takes a fresh look at the question of whether tort reform–making it harder to sue health care providers for mistakes or perceived mistakes in your care–is really that important or not. During the health care reform debate, Republicans often held it out as the single most important solution to our health care system’s ills, arguing that doctors ordered so many unnecessary tests because they were praciticing “defensive medicine.” Democrats, on the other hand, were less enthusiastic about tort reform, which was predicted to only save about .05% of total U.S. spending.

The new study found that nearly 24% of cardiologists surveyed said that fear of malpractice lawsuits influenced their decision to order catheterization. As health care reform is implemented, the cost issue is not about to go away; tort reform may not be as important as comparative effectiveness research, but many people think it deserves another look. Nurses, doctors, how many of your decisions are influenced by “non-clinical factors” such as fear of litigation?

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Advanced Practice Nurses: Pushed Forward by Health Reform Advocates, Pushed Back by Physicians over Turf – Enough Already!

March 12, 2010

By Shawn Kennedy, MA, RN, AJN editor-in-chief

As we’ve noted in past posts on this blog and in AJN editorials in August 2006 and August 2008, organized medicine does not want to acknowledge that nurses can practice independently.  And now the turf war between advanced practice nurses (APRNs, which include nurse practitioners, nurse anesthetists, nurse midwives and clinical nurse specialists) and physicians is heating up.

In California, physicians are suing the state for allowing nurse anesthetists to practice without supervision, using patient safety as a reason. In Kentucky, physicians are opposing legislation to expand the scope of practice for NPs—at issue is whether NPs should need a signed collaborative arrangement with a physician (even though the physician does not supervise the NP). According to an article by a Louisville, Kentucky, newspaper, the Courier-Journal, the physicians charge high fees for their signature or demand a percentage of the practice.  The bill, though, passed the state House committee on March 4, with several members questioning the ethics of physicians’ requiring fees.

Nurses have been and continue to fight for the right to practice, and during this period where the government is seeking solutions to health reform, this is a battle that shouldn’t have to happen—a view shared by Stephen Ferrara, NP, at A Nurse Practitioner’s Place (“I have tried to refrain from taking the bait from some recent negative opinions regarding nurse practitioner delivered care”). Read the rest of this entry ?

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ANA Chart Compares Key Nursing Provisions in House and Senate Bills

December 4, 2009

By Judith Leavitt, MEd, RN, FAAN

There’s a tremendous amount of information available about the different congressional proposals on health reform. But it’s difficult to know how the proposed legislation might affect nurses and the profession. The American Nurses Association has just released an excellent chart offering side-by-side comparison of key provisions related to nursing in the two current bills, the House bill (H.R. 3962) and the Senate bill (H.R. 3590). These provisions include:

  • increased financial support for nursing recruitment and advanced education
  • increased funding for graduate education for nursing faculty
  • increased funding for education for students who will practice in underserved areas
  • establishment of a Public Health Workforce Corps
  • increased Medicare reimbursement rates for advanced practice nurses, including nurse–midwives
  • pilot programs to provide reimbursement under Medicare for nurse practitioners to create or lead “medical homes”
  • increased reimbursement to school-based health clinics under Medicaid

There’s much more to be gleaned here, and the chart format makes scanning for particular points of interest easy. Have a look!

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Blogging Nurses: Latest ‘Change of Shift’ Roundup Now Up at Emergiblog

August 21, 2009

ChangeofShiftScreenshotWant to keep up with the nursosphere? The most recent Change of Shift, a regular compendium of links to blog posts by nurses, nursing students, and sundry others is now up over at Emergiblog.
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Why Nurses Matter: NP’s Thorough Assessment Points to Cause of Infant’s HIV

July 24, 2009

Karen Roush, AJN’s former editorial director, alerted me to a great story. A careful assessment by a nurse practitioner (NP) at St. Jude Children’s Research Hospital in Memphis, Tennessee, uncovered a potential reason for an infant’s HIV diagnosis. The staff at the hospital had been stymied in trying to ascertain how a nine-month-old infant developed HIV after earlier tests had shown her to be HIV-negative. The mother, who was HIV-positive, had not breastfed the child, nor was there evidence of injury or sexual transmission, and the infant had not received blood transfusions.

Marion Donohoe, the NP, in taking a detailed history from the mother, asked her about feeding practices, including pre-mastication. Yes, said the mother, she had been pre-chewing food for her daughter. Read the rest of this entry ?

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Seeds of Change? Nurses Want Prescribing Power When It Comes to Health Care Reform

May 20, 2009
"Buck Up," by zenera / via Flickr.

"Buck Up," by zenera / via Flickr.

According to a useful overview by the Kaiser Daily Health Policy Report, nurses, insurers, and others are fighting to be included in the health care reform debate. We know the insurers can take care of themselves, so let’s focus on the nurses:

Hundreds of nurses last week rallied on Capitol Hill in an attempt to have their voices and opinions on health care reform heard and included as lawmakers begin to draft legislation, Roll Call reports. The rally included the California Nurses Association -  National Nurses Organizing Committee, the American Academy of Nursing, the American Nurses Association and the American Academy of Nurse Practitioners. According to Roll Call, some of the groups disagree on the details of reform, including whether reform should include a single-payer system, but are united in their effort to be included in discussions on overhaul legislation. Michelle Artz, a lobbyist for ANA, said, “We want to make sure this isn’t a physician-centric dialogue” (Ackley, Roll Call, 5/18).

As far as I know, the American Academy of Nursing (AAN) wasn’t actually present at that rally. But what matters is that there is growing recognition that effective health care reform will not happen without the involvement of nurses. The AAN has been educating policymakers about nurse-led models of care and the need to remove the barriers to this care, including opening up criteria for who can lead a medical home (right now, you have to be a physician to qualify under the criteria set by NCQU, the National Committee on Quality Assurance). Read the rest of this entry ?

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Nurse Practitioners and Health Care Reform: “A Solution in Plain Sight” say Former HHS Secretary Donna Shalala and PA Governor Ed Rendell

May 8, 2009
“Lion’s Gate Bridge Sunrise,” by thelastminute, via Flickr.

“Lion’s Gate Bridge Sunrise,” by thelastminute, via Flickr.

The American Academy of Nursing just held a news briefing on nurse-managed care and health centers as solutions for our ailing health care system. Former Health and Human Services (HHS) secretary and now president of University of Miami, Donna Shalala; Pennsylvania Governor Ed Rendell; Tine Hansen, CEO of the National Consortium of Nursing Centers and executive director of the Convenient Care Association; and Susan Sherman, president of the Independence Foundation, sent a coherent message: nurse practitioners (NPs) have developed an infrastructure of health centers and convenient care clinics (such as MinuteClinics) that can help our nation reform a health care delivery system that is currently unable to meet the primary health care needs of its people. Read the rest of this entry ?

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