Another Media Piece

Here is another positive view of NP guided care specifically in New York. Of course, it is not without the organized medicine tagline of playing the "quality of care" card under the guise of protecting patients. However, we know that retrospective chart reviews (the current requirement in NY and in many other states) is not about quality of care.

In fact, peer chart review should be a requirement for all clinicians. Every professional should engage in ongoing chart reviews (I actually prefer benchmarking and looking at actual data/outcomes against versus simply reviewing a chart).

I just don't understand the constant undertones that NPs are prone to making mistakes or will "miss something" and that having a collaborating physician review the chart 3 months later somehow will "ensure quality." NPs see thousands of patients every day and we have proved and will continue to do so that we provide quality evidence-based care.

And now to the video...

Susan Apold, PhD, ANP on Fox and Friends Debating NP Role

Wonderful job by Dr. Apold, Chairperson of the Board of Directors of the Nurse Practitioner Association, New York State (The NPA). Dr. Motta of the Massachusetts Medical Society also did a good job for making the case for fully utilizing NPs in the health care system and couldn't give any evidence-based reasons not to.

Great Read

Maggie Mahar writes a wonderful column, "The Battle over Letting Nurse Practitioners Provide Primary Care." I couldn't have summed it better myself.

Reflections

With the recent increased media attention regarding nurse practitioner practice, I've noticed many inconsistencies and misconceptions in the media. Here are some of my own clarifying points:

• Nurse Practitioner practice is not brand new. The profession has been around since the mid 1960's. Therefore, all of these intimations that we are doing something (or looking to do something) new is inaccurate. There is a 40-year history of NP practice.

• NPs are not individuals who one day arbitrarily started writing prescriptions. There is a standardized education, training, licensure, and certification process that allows us to perform in that capacity. There are differences in each State practice act that sets the standard for what we can (and can't) do in each state. Note that the majority of State acts have these regulations that haven't been updated to reflect current education and training.

• The Doctor of Nursing Practice (DNP) degree is often linked to these conversations but this is really a separate issue. Yes, this is a relatively new terminal clinical degree for the profession. There used to be to be the Doctor of Nursing Science (DNS) that has pretty much fallen out of favor to the DNP. Why in the world would this be a bad thing? (Oh right, because we are trying to confuse everyone into thinking we are really a "doctor" which I guess is some how synonymous only with a "physician" these days.) Now, this educational degree in and of itself does not change existing practice. There are many opinions about the DNP degree out there (of which I will share mine soon) but the bottom line is that the degree does not change the requirements of current state licensure/certification and to the already existing 140,000+ NPs.

• Our approach to patient care is not the allopathic model. We utilize a synthesis of both nursing and medical knowledge to care for patients. I as an NP, generally feel that lifestyle modifications, health education and communication, disease prevention/treatment, wellness preservation and a partnership approach are driving principles of my philosophy to practice. NP education has largely adopted the evidence-based practice (EBP) model of care. That is, using proven interventions in the provision of care rather than doing something the way it's been done forever. Does this allow us to spend more time with patients? Perhaps. But maybe the evidence suggests that spending more time with patients produces better outcomes.

• NPs face the same reimbursement issues that primary care physicians face (albeit at an even more reduced rate - Medicare reimburses NPs at 85%) yet the majority of NPs choose primary care or closely related field to work in. This, of course, assumes that every NP wants to own their own practice. I will go out on a limb and say that most want no part of this. The push for autonomous practice stems from out-dated and arbitrary barriers that negatively affect patient care. For example, the NP working for a physician in Florida with no intention of starting their own practice but with their own panel of established patients. The NP sees one of their patients determines that the patient needs some pharmacological pain medication intervention yet cannot prescribe this to their patient since there is no physician in the office that day (Florida NPs cannot prescribe controlled substances). The patient is ultimately out of luck here and suffers since they cannot have their pain managed. It also puts the NP at an unfair disadvantage since patients knowing this regulatory issue may choose another provider based on this.

• NPs are filling a void in primary, not "taking over." I've said time and time again in this blog, let the patients decide if they want care from an NP. If not, we would surely have little to argue against. However, if patients want to choose care from an NP, they should be able to without prejudice or barrier.

I continue to have tremendous respect for my physician colleagues. I appreciate their time commitment to the education/training process and vast knowledge base. I cannot perform surgery or many other procedures nor would ever want to. But I am confident in identifying when a patient does need surgery for example. I just don't necessarily think that physicians can be the only providers and captains of health care. I don't buy into the argument that we don't know what we don't know. We all collaborate and refer to colleagues when something falls outside of our comfort zone or specialty. The one who thinks they know it all and can cure all is the one I would be especially leery of.

Momentum

U.S. World News & Reports' Dr. Bernadine Healy gets it. She serves as their health editor and her latest column, The New Doctors in the House, is one of the most objectively and frankly written that I've seen that describes NPs filling the gaping holes in primary care.

Check it out and tell me what you think.

The Interwebs are Abuzz

The interwebs are abuzz with the latest AP article, Doc deficit? Nurses' role may may grow in 28 states. The article is pretty well balanced and has views from patients, nurse practitioners and our physician colleagues. There is a sense and some from the medical community imply that NPs are trying to expand scope of practice. I think that is a fairly short-sided and inaccurate view of what is going on at the state level. Most of the collaboration and supervisory regulations were written when the profession was brand new, is not based on any evidence, and does nothing to improve the quality of care as they are retrospective in nature. Removing statutory collaboration or supervision would not change how NPs are educated or trained. It would however, increase access to more providers.

Each day I see how breakdowns in communication and how ill-planned initiatives negatively impact patient care. This has little to do with the knowledge base of the providers rather than not knowing how to work together and ensure everyone is on the same page. It is so cliche but what we often have is a failure to communicate.

Nurse Practitioner Recognition in New York

Here in New York, the month of April is proclaimed by the governor as Nurse Practitioner Month. This is a noble attempt to recognize the work and care that the 13,000 or so Nurse Practitioners do every day in New York.

I'm curious if other states have such proclamations or if anything is done on the state level to recognize NPs. Please post any information relevant to your state and I'd be happy to list the data in a table.

And to my fellow New York Nurse Practitioners (and NPs all over), Happy Nurse Practitioner Month!

More Bloggers

There have been quite a few new NP student/NP blogs that have recently sprung up and I highly recommend that you check them out. Over the last few years, there has been a lack of NP representation in the blogosphere (other than a handful of NP authored blogs). There are plenty of well written physician and RN blogs in existence so it is nice to hear the stories, messages and advice from the NP perspective. I try to keep my blogroll on the right hand side of this page updated with new and timely blogs. Here are just a few to check out:

• Laura blogs over at Ask the Nurse Practitioner, http://askthenp.blogspot.com/, and gives patient-centric answers to some common questions and sets the record straight on some myths health myths.
• Jeff blogs at NP Health Care - Nurse Practitioner Owned and Operated Practice, http://nphealthcare.blogspot.com/, and shares his (seemingly frustrating) instances of owning his own NP practice in Texas.
• FNP Student blogs at Triumphs and Tribulations of a Student Nurse Practitioner,http://fnp2011.wordpress.com/, and shares her experiences on her road to becoming an NP.
• Michael is a Physician Assistant and blogs over at Are you a Doctor?, http://physasst.blogspot.com/and offers his views on timely health topics from the PA perspective.

I encourage anyone with a story to start a blog. There are many untold experiences out there and blogging helps to get the message out and can even be therapeutic in a way. Be sure that patients can not be identified and update often!

(I've also connected with some awesome people on Twitter and have found additional blogs and stories to share. Follow me on Twitter @StephenNP).