Posts Tagged ‘nurse practitioner’

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When Lawmakers and Physicians Hold Nurses Back

February 13, 2012

Editor’s Note: Toni Inglis, MSN, RN, CNS, FAAN, writes opinion for the Austin (TX) American-Statesman. She works at the Seton Healthcare Family in Austin as a neonatal ICU staff nurse and also writes a nursing blog for Seton and edits its monthly NursingNews. This article is a reprint of an April 22nd commentary in the Statesman. Toni was inspired to write the column after a particularly disappointing legislative session, in which Texas advanced practice nurses made fewer gains than in past sessions—despite Texas ranking last in access to health care and having the most restrictive laws in the country regarding APRN scope of practice and prescriptive authority. She believes the poor access and barriers to practice are related.

AJN finds the article particularly relevant as legislatures across the country deliberate on APRN barriers to practice. You can read her commentaries at ingliscommentary.com.

Here’s an idea that wouldn’t cost Texas a dime but would save millions of dollars every year: Remove all barriers restraining nurses from practicing to the full extent of their education and training.

by Brian Romig/via Flickr

No state needs primary care providers more than Texas, which has a severe shortage. Texas ranks last in access to health care and in the percentage of residents without health insurance. Of Texas’ 254 counties, 188 are designated by the federal government as having acute shortages of primary care physicians. Of that number, 16 counties have one and 23 have zero.

If every nurse practitioner and family doctor were deployed, we still couldn’t meet the need. Texans are desperate for health care.

Doing the math and to help meet the need, the Legislative Budget Board recommended autonomous practice of advanced practice nurses after a preceptorship.

In Texas, our legislature — session after session — keeps the most restrictive laws in the country. Nurse practitioners don’t want to perform brain surgery. They just want to provide primary care and are quick to refer cases to a doctor when necessary.

Most states with far less need do not legislate practice barriers to nurse practitioners. Given the severity of our problem, shouldn’t we at least bring ourselves in line with those other states? Read the rest of this entry ?

Posted in advocacy/political action, nurse practitioners, nursing perspective | Tagged , , , , , , | Leave a Comment »

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Nurse Practitioners Are Not ‘Physician Extenders’

November 11, 2011

By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

“Physician extender.” It’s way past time to kill that term.

A study published in the October issue of Surgery found that adding an NP to the surgical team decreased the number of unnecessary ED visits by 50% and increased the use of visiting nurse, physical therapy, and occupational therapy services. A Medscape article (registration required) on the study explained the importance of the findings in this way: “According to the researchers, physician ‘extenders,’ such as NPs, help maintain continuity of care while resident work hours are kept at a maximum of 80 per week. . . .”

Sure enough, the stated purpose of the study was to determine if “integrating this physician extender into the surgery team” would improve outcomes and resource allocation. Ouch.

Experts in our own right. Nurse practitioners are not physician extenders. We are highly skilled and educated nurses who provide evidence-based care grounded in the nursing model. We are not “extensions” of anyone. We are colleagues and collaborators, independent clinicians and experts in our own right. Our purpose is to provide comprehensive care, promote health, educate, and advocate. It is not to relieve interns, supplement physician education, or be the low-cost alternative when physicians have to “do more with less,” as Medscape quoted one of the study authors. Yes, we should be integrated into health care teams, surgical and otherwise—because nurses provide a distinctive aspect of care that research has repeatedly shown to be essential to good patient outcomes. Read the rest of this entry ?

Posted in media depictions of nursing, nursing perspective, nursing research, professional identity | Tagged , , , , | 7 Comments »

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Military Metaphors, Unnecessary Admissions, New Blogs, Keeping Secrets

September 29, 2011

It’s a common scenario: a 90-year-old resident of a U.S. nursing home — call her Ms. B. — has moderately advanced Alzheimer’s disease, congestive heart failure with severe left-ventricular dysfunction, and chronic pain from degenerative joint disease. She develops a nonproductive cough and a fever of 100.4°F. The night nurse calls an on-call physician who is unfamiliar with Ms. B. Told that she has a cough and fever, the physician says to send her to the emergency room, where she’s found to have normal vital signs except for the low-grade fever, a normal basic-chemistry panel and white-cell count, but a possible infiltrate on chest x-ray. She is admitted to the hospital and treated with intravenous fluids and antibiotics. During her second night in the hospital, Ms. B. becomes confused and agitated, climbs out of bed, and falls, fracturing her hip. One week after admission, she is discharged back to the nursing home with coverage under the Medicare Part A benefit. The episode results in about $10,000 in Medicare expenditures, as well as discomfort and disability for Ms. B.

There is an alternative scenario, however . . .

That’s from an article in NEJM called “Reducing Unnecessary Hospitalizations of Nursing Home Residents.” In any health care system of as much complexity as ours, there’s bound to be a huge amount of waste. The article gives a good example of how the skills of NPs might be put to excellent use both saving a lot of money for Medicare and making the lives of nursing home residents a whole lot nicer. It may be cheaper, but it’s not “rationing”—it’s rational.

Now a matter of language rather than money: the Viewpoint essay by Kathleen Thies in the October issue of AJN is about the use of military language to refer to nursing staff. Here’s how it begins, and you can click the link to read the whole article, including the author’s suggestion for an alternative terminology. We’d love to know whether the author’s perspective resonates with you:

How often have you heard the term frontline staff used to refer to direct care nurses and others working at a patient’s bedside? It conjures images of the great world wars, of soldiers marching across battlefields to fight the enemy. The infantry are invariably young, dispensable, interchangeable. Commands are issued by generals and passed down through the ranks. No questions are asked.

Blog roll update: We’ve added some interesting new blogs to our blogroll (they’re not new blogs, actually, just new to our blogroll). A few of them are by MDs, such as The Carlat Psychiatry Blog and Movin’ Meat, and a couple of are by nurses, such as madness: tales of an emergency room nurse, which has a good short post about why it doesn’t always help to be a nurse when your family member is in the hospital (there have been a few posts on this topic lately in different venues, I think?). Also added: The Nursing Ethics Blog, which is run by two people, a nursing professor/ethicist and a philosopher. It should be interesting to explore.

As the editor of the Reflections column (and this blog), I read hundreds of submissions each year about dying patients, with a subgenre of submissions devoted to dying infants or miscarriages. Read the rest of this entry ?

Posted in ethical issues, HIV/AIDS, nurse practitioners, nursing perspective, patient perspective, writing and nursing | Tagged , , , , , | 3 Comments »

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Memorial Day Weekend Notes from the Nursosphere Blog Roundup

May 27, 2011

As I walked into the exam room and introduced myself as a nurse practitioner, the patient announced she was “forced” to come to our clinic and “wasn’t allowed to see a real doctor” downtown. I was slightly taken aback. Here I was, running on time, in a pretty good mood and ready to assess and treat to the best of my abilities, and then WHAM. I took a deep breath and realized she wasn’t slamming NPs; she had a grudge against military providers, regardless of education background.

That’s from a recent post by a U.S. Air Force family nurse practitioner (NP) who’s been blogging from Afghanistan. She’s home now, and the post, about being discriminated against by a patient—not because she’s an NP, but because she’s a military provider—is worth noting as we prepare for another Memorial Day Weekend.

Memorial Day Flags/Eddie Coyote, via Flickr

Are you a nursing student, or just ready for a change in your nursing career? Curious about various nursing specialties and what they really involve? Codeblog has been running a helpful series of posts, each of which focuses on an interview with a particular type of nurse. The latest is with a cardiac catheterization lab nurse.

Nothing like a medication error to ruin everyone’s day. Lisa at In the Round has a useful post that lists the eight “rights” of medication administration.

“So there is very little, in the end, I won’t share. There are some things, however, that are beyond the pale. Here’s my short list of ten things I will never, ever tell you, my patient.” That’s from a recent post at Those Emergency Blues: “Don’t Tell Your Patient This. Or That.” Have a look and see if you agree.

Lastly, an article today on the NY Times “Well” blog summarizes the findings of a new report on the activity levels of Americans in the workplace. The basic idea is that we’re less active at work, and since we spend much of our time and energy at work, we’re also increasingly obese. Many nurses might dispute this finding if they spend their days on their feet. But it’s worth considering, as many of us prepare for a long holiday weekend full of opportunities to eat, relax, and also, yes, to get a bit of exercise—even if it’s only a matter of taking a daily walk after dinner in the lingering late May light. Or, as Sean at My Strong Medicine puts it, a little bluntly: “What Was Your Excuse for Not Exercising?” 

Point taken.—JM, senior editor

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Posted in nurse practitioners, nursing perspective, patient safety, writing and nursing | Tagged , , , , | 3 Comments »

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An NP Prepares: Calling All Nurse Mentors

January 7, 2011

Jen Busse, RN, MPH, is an intern at the Center for Health, Media and Policy at Hunter College in New York City and is currently pursuing her MSN as a family nurse practitioner at Columbia University. This is her second post about studying to be an NP. Her first was “An NP Prepares: When Normal is Better Than Fine.”

While we watch schools of nursing significantly increasing class sizes in a stalled economy, students are still being told that new nurses should “have no trouble” securing jobs upon graduating. Advancing our careers won’t be an issue either, we’re told.

We new nurses, in masses, are then sent out to fend for ourselves. Many schools of nursing lack career services help for students—possibly due to the myth of the “nursing shortage.”

Well, I’m here to tell you, from the evidence gathered in my own laborious, and mostly fruitless, job search, that archaic ideas about the ease of finding a position as a nurse are dead wrong. What we really want to do is to take care of patients, not spend years of our lives searching for an opportunity to do so. 

So in steps the nurse mentor—if you’re lucky.

Unfortunately, career mentorship for many new and experienced nurses is rare, creating difficulties in securing a job or advancing one’s career. Without role models, it’s difficult to feel motivated or to gain confidence in your abilities. A seasoned professional or trusted peer is crucial in providing helpful advice, guidance, and inspiration. Nurse mentors offer protégés their knowledge and wisdom, in the process creating a legacy for future generations through the creation of new nurse leaders.

I was incredibly fortunate to find two women, both important nurse leaders, Barbara Glickstein and Diana Mason (bios here). They helped to pull me out of my despair of joblessness, when I had all but abandoned my hopes of working in nursing, and have helped to guide me to what I now see as a promising future in this field. They’ve helped me build my confidence, especially through writing about health-related issues, and shown me that I do have something special to offer to the field of nursing. Read the rest of this entry ?

Posted in nurse practitioners, nursing students, professional identity, writing and nursing | Tagged , , , , , , , , , , | 5 Comments »

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Today’s Notes from the Nursosphere

December 7, 2010
Image of Japanese Attack - Pearl Harbor, Hawai...

Image via Wikipedia

As noted today by Joni Watson at Nursetopia, it’s Pearl Harbor Day, and nurses were (surprise) key players in that day’s awful events. Here’s how the post begins:

My heart was racing, the telephone was ringing, the chief nurse, Gertrude Arnest, was saying, “Girls, get into your uniforms at once, This is the real thing!”

Speaking of safety, “Top 10 Health Technology Hazards for 2011″ (pdf), from the ECRI Institute, gives us a list of hospital patient safety risks that, according to the authors, ”reflects our judgment about which risks should receive priority now, a judgment that is based on our review of recent recalls and other actions . . . , our analysis of information found in the literature and in the medical device reporting databases of ECRI Institute and other organizations, and our experience in investigating and consulting on device-related incidents.” These include “radiation overdose and other dose errors during radiation therapy,” “alarm hazards,” and eight others.

And now to electronic charting vs. doing it the old-fashioned way: we have a comment thread going on at AJN‘s Facebook page about whether or not EHRs save nurses time or not. Go there to comment, or leave a comment here.

Also noted: Stephen Ferrara at A Nurse Practitioner’s View wonders whether the preceptorship model is still adequate for training NPs. Or is it time for a residency model instead?

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.

Just a few items of interest. As always, we welcome your comments.—JM, senior editor/blog editor 

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Posted in combat nursing, electronic medical records, health information technology (HIT), nurse practitioners, nursing perspective | Tagged , , , , , , , | Leave a Comment »

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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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Posted in electronic medical records, health information technology (HIT), nurse practitioners | Tagged , , , , , , , | 1 Comment »

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