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On our radar: Nurse practitioners

Saturday May 17, 2014
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Nursing school dean urges Congress to fund residencies

To help alleviate a shortage of primary care providers, Congress should reauthorize and fully fund nurse practitioner residencies in primary care clinics, said David Vlahov, RN, PhD, FAAN, dean and professor at the UC San Francisco School of Nursing. A three-year pilot program that ends this year established NP residencies in federally qualified health centers and nurse-managed health clinics as part of the Affordable Care Act.

Vlahov, writing a recent opinion piece in the San Francisco Examiner, urged support for a bill proposed by U.S. Sen. Bernie Sanders (I-Vermont) that would reauthorize and fund NP residencies at $75 million for the next five years.

Vlahov in the opinion piece listed five reasons why the programs should be renewed:

~ A shortage of primary care physicians to meet the country’s healthcare needs, especially in underserved communities;

~ A greater demand for primary care providers, driven by an aging U.S. population and increased healthcare coverage under the ACA;

~ Substantial research showing nurse practitioners perform at least as well as physicians on clinical outcomes and patient satisfaction;

~ A need to train and support new graduates of nurse practitioner programs in complex clinical settings;

~ Opportunities for new nurse practitioners to work in teams with other providers, including physician colleagues, in a model that has proven successful for training physicians.

Nurse practitioners, physician assistants more likely to offer health education, study says

Nurse practitioners and physician assistants were more likely than physicians to provide health education to patients with chronic conditions, though none of the practitioners offered such education on a regular basis, according to a study by the Centers for Disease Control and Prevention, published in April.

The CDC study examined five years of data (2005-2009) from the outpatient department of the National Hospital Ambulatory Medical Care Survey, looking at adult patient visits for chronic conditions, including asthma, COPD, depression, diabetes, hypertension and obesity.

The percentage of visits in which providers counseled patients on their condition ranged from 13% for patients with COPD or asthma who received information on tobacco use and exposure from nurse practitioners to 42.2% for patients with diabetes or obesity who received counseling on exercise from physician assistants. Rates of health education were higher among nurse practitioners and physician assistants than among physicians for all conditions, though the reasons for this were unclear, according to the report.

Nurse practitioner group supports commission’s warning against practice restrictions

The American Association of Nurse Practitioners is urging state lawmakers to pay heed to a Federal Trade Commission warning that restricting the practice of advance practice nurses “may reduce competition that benefits consumers.”

The FTC policy paper, released in March, recommends state legislators be cautious about considering and enacting proposals that might limit APRN practice and direct access to nurse practitioner services.

“State legislation that prevents full and direct access for patients has the potential to further hamper our healthcare delivery system,” said Angela K. Golden, RN, DNP, FNP-C, FAANP, co-president of AANP.

“It is our hope that legislators pay close attention to the analysis of the FTC and honor the healthcare needs of their constituents.”

New York removes physician oversight for nurse practitioners; Connecticut follows suit

New York lawmakers recently gave nurse practitioners more independence by removing a requirement for a written agreement between a physician and an experienced nurse practitioner as a condition of practice.

The Nurse Practitioners Modernization Act, enacted as part of the New York state budget, will become effective Jan. 1, 2015. Nurse practitioners with fewer than 3,600 hours of experience still will need to have a written practice agreement with a physician, according to a news release.

“Today’s passage of the Nurse Practitioners Modernization Act is great news for patients and for nurses in New York,” said Bobbie Berkowitz, RN, PhD, FAAN, dean of Columbia University School of Nursing.

“As the federal Affordable Care Act extends insurance coverage to more New Yorkers, the (new law) will allow advanced practice nurses to better serve patients and provide high quality, cost-effective care. Nurse practitioners are educated to provide primary care, and we look forward to additional efforts that allow NPs in New York to extend their independent practice to the full extent of their education and training.”

The Connecticut State Senate passed a similar bill on April 9, allowing nurse practitioners to practice without physician oversight after three years of practicing under a collaborative agreement. That bill, which originated in the governor’s office, was approved by the state House of Representatives on April 28 and signed into law by the governor. Physicians groups in both states opposed the legislation.

Eighteen states and the District of Columbia do not require nurse practitioners to have a written practice agreement with a physician.

VA Medical Center in Durham, N.C., launches new nurse practitioner residency

Duke University School of Nursing and Durham (N.C.) Veterans Affairs Medical Center have launched a psychiatric nurse practitioner residency program to develop expertise in mental healthcare delivery for military veterans. The program at the Durham VA Medical Center is for psychiatric nurse practitioners with less than a year of experience since graduation.

“We call upon nurse practitioners who are committed to delivering the highest-quality mental healthcare for the heroes who served their country,” said Greg Eagerton, RN, DNP, NEA-BC, co-director of the residency program and associate director for patient care and chief nurse executive at the Durham VA.

Since 2001, 2.4 million active duty and reserve military personnel have been deployed to the wars in Iraq and Afghanistan. Of this group, 30%, nearly 730,000 men and women, will have a mental health condition requiring treatment.

The new residency program will give nurse practitioners experience with a diverse group of patients needing treatment for mental health conditions, including depression and post-traumatic stress disorder.

Nurse practitioner residents will work with experienced providers, treating patients in a variety of settings, advancing their skills and learning about integrated healthcare for veterans.

Johns Hopkins School of Nursing to train NPs in mental health

To prepare primary care nurse practitioners to care for patients with mental health problems, the Johns Hopkins School of Nursing will offer an intensive one-year post-master’s online course in integrative mental health care.

The psychiatric mental health nurse practitioner certificate program will train students working in underserved areas to provide mental health services, including assessment, diagnosis and prescribing medications. It will include clinical training partnerships with facilities in underserved areas of Maryland. One of the program’s goals is to keep the nurse practitioners practicing in those areas while they earn the certificate. Students will complete core courses in the first semester and devote the remaining two semesters to practice.

“People are going to go where they’re comfortable, which usually means their primary care provider,” said Karan Kverno, RN, PhD, PMHCNS-BC, PMHNP-BC, who spearheaded the program along with Deborah Finnell, RN, DNS, PMHNP-BC, CARN-AP.

“Instead of having them shuttle between healthcare systems, we want to have nurse practitioners who can provide integrated care for physical, social and mental health across a range of settings and services. The focus on integrated care is new and relevant to the healthcare system today.”

Nurse practitioners add value to medical practices

Medical practices that employ nurse practitioners and physician assistants typically perform better financially than those that do not, according to an analysis published by the Medical Group Management Association in March.

Data collected by the association show that the use of non-physician providers in every specialty group, including cardiology, family medicine and orthopedic surgery, has increased in the last 15 years, and that physician compensation is higher for practices with NPs and physician assistants.

“Where NPPs (non-physician providers) are the only practitioners, facilities see significantly lower operating and staff costs, although revenue also drops,” the report states, perhaps because non-physician providers see less complicated patients who require fewer procedures and ancillary care than those seen by physicians.

Nurse practitioners and physicians assistants may help bring in revenue because they allow practices to accept more patients.

They can provide 80% or more of services in primary care practices with patient satisfaction equal to or better than a physician, and at lower cost, said David Gans, MSHA, FACMPE, senior fellow, at MGMA Industry Affairs. “NPPs allow practices to care for more patients and free physicians to perform work that only physicians can do,” the report states.

Nebraska governor vetoes nurse practitioner bill

The governor of Nebraska vetoed a bill that would have allowed experienced nurse practitioners to practice without physician oversight. The bill, passed unanimously by the unicameral state legislature days earlier on April 18, removed a state requirement that nurse practitioners with more than 2,000 hours of practice have an integrated practice agreement with a collaborating physician.

Nebraska State Sen. Sue Crawford, who introduced the measure, said she did not expect the veto from Gov. Dave Heineman. Legislators have adjourned, so they cannot override it. The bill was strongly opposed by the state medical association, and Heineman said in his veto letter he thought it went too far in granting independence to nurse practitioners and expressed concern for patients. He said he would not have vetoed it if it had required 4,000 hours of clinical experience.

The bill had been amended to include the 2,000-hour requirement to address concerns such as those cited by the governor, Crawford told reporters. There was no discussion or input from the governor’s office about whether it should have been 2,000 or 4,000 hours, she said. Crawford said she introduced the bill to help keep nurse practitioners in the state. She said 70% of newly graduated nurse practitioners trained in mental healthcare leave Nebraska to practice elsewhere.

Florida considers loosening restrictions on APRNs

Florida lawmakers are considering two bills this spring to loosen restrictions on practice for nurse practitioners and certified registered nurse anesthetists. Both are opposed by physicians’ groups.

The proposed laws would allow CRNAs to practice without physician supervision (HB 7071) and nurse practitioners to prescribe controlled substances with a license from the U.S. Drug Enforcement Administration (SB 1352).

Nursing groups argue an increasing demand for care is expected as more people become insured under the Affordable Care Act and a shortage of providers make it imperative to allow nurse practitioners to practice to the full extent of their training and education.

“Florida has the highest population of geriatric patients and it’s getting harder and harder for them to get care, especially in rural areas,” Susan Lynch, RN, NP, MSN, CEO of the Florida Association of Nurse Practitioners, told the Naples Daily News. “The fewer restrictions on nurse practitioners, the more costs go down.”

There are 19,000 advanced registered nurse practitioners in Florida with masters and doctoral degrees. Of those, 12,000 are nurse practitioners who provide primary and acute care services and 6,300 are nurse anesthetists. The remaining 700 are nurse midwives.

The Florida Medical Association, which opposes the laws, advocates increasing the number of primary care physicians by increasing residency slots, providing medical school loan forgiveness to new physicians who go into family practice, and increasing collaboration with nurse practitioners, with the physician in charge.

To see what else is trending, visit www.Nurse.com/Nurse-Practitioners.


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