Category Archives: Scope of practice

Aug 26 2014
Comments

An Expanded Role for Nurses in Chronic-Condition Care

As health reform increases access to care for people with chronic conditions at a time when the supply of primary care physicians is decreasing, one viable alternative is nurse-managed protocols for outpatient treatment of adults with diabetes, high blood pressure and high cholesterol, according to a study published in the Annals of Internal Medicine.

The research team reviewed 18 studies on the effectiveness of registered nurses (RNs) in leading the management of those three chronic conditions. In all 18 studies, nurses could adjust medication dosage; and in 11 studies, they could independently start patients on new medications. The review showed that patients with nurse-managed care had improved A1C levels, lower blood pressure and steeper reductions in LDL cholesterol.

“The implementation of a patient-centered medical home model will play a critical role in reconfiguring team-based care and will expand the responsibilities of team members,” the researchers wrote. “As the largest health care workforce group, nurses are in an ideal position to collaborate with other team members in the delivery of more accessible and effective chronic disease care.”

Read the study, Effects of Nurse-Managed Protocols in the Outpatient Management of Adults With Chronic Conditions.

Jul 10 2014
Comments

Quotable Quotes About Nursing, July 2014

This is part of the July 2014 issue of Sharing Nursing’s Knowledge.

“We can’t just sit back and wait for things to get created, to be made for a bigger market, to be made just for a patient like that, so we have to make and create what we need ...”
--Roxana Reyna, BSN, RNC-NIC, WCC, skin and wound care prevention specialist, Driscoll Children’s Hospital, MacGyver Nurse and Maker Nurse Program, KRISTV (Corpus Christi, TX), June 30, 2014

“Nurses make up the single largest segment of the health care workforce and spend more time delivering patient care than any other health care profession. Nursing’s unique ability to meet patient needs at the bedside and beyond puts us in a critical position to transform health care.”
--Michelle Taylor-Smith, RN, BSN, MSN, chief nursing officer, Greenville Health System, GHS to Require B.S. Degrees for Nurses, Greenville Online, June 28, 2014

“This country won’t succeed in its implementation of health care reform without more of these types of [nurse-led] clinics in underserved communities.”
--Tine Hansen-Turton, MGA, JD, FAAN, CEO, National Nursing Centers Consortium, At Paul’s Place, Partnership with Nursing School Promotes Good Health, Baltimore Sun, June 22, 2014

Read more

Jul 10 2014
Comments

RWJF Scholars in the News: Healthcare.gov, depression and mortality, stress among nurses, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

Young adult users of Healthcare.gov, the health insurance marketplace established under the Affordable Care Act, recommend that the site offer better explanations of terminology, more clarity about the benefits various plans offer, and checkboxes and other features that make it easier to compare plans. Those are among the findings of a study conducted by RWJF Clinical Scholar Charlene Wong, MD, along with alumni David Asch, MD, MBA, and Raina Merchant, MD, that looked at the experiences of young adults who used the website. The scholars write about their findings in the Philadelphia Inquirer. Wong told the Leonard Davis Institute of Health Economics blog that these users “may not know what insurance terms mean but they have a lot of expertise and insights about maximizing the usability of the digital platforms that have always been such an integral part of their lives.”

Major depression (also known as “clinical depression”) is associated with an elevated risk of death from cardiovascular disease, according to research covered by Kansas City InfoZine. The study, co-authored by Patrick Krueger, PhD, an RWJF Health & Society Scholars program alumnus, also found that the relationship between depression and early non-suicide mortality is independent of such factors as smoking, exercise, body mass, education, income, and employment status. The authors say the findings indicate that the relationship between depression and mortality is not due solely to the interplay between depression and health-compromising risk factors.

Expanding scope of practice for advanced practice nurses and implementing better management practices could alleviate some stress factors for nurses and improve patient care, Matthew McHugh, PhD, JD, MPH, FAAN, tells Healthline News. For example, in some medical facilities, nurses are empowered to decide if a patient’s urinary catheter should be removed without consulting a doctor, thus preventing delays in care. “Lots of things that don’t require policy change” can have an important impact on patient outcomes and nurses’ job satisfaction, said McHugh, an RWJF Nurse Faculty Scholars alumnus.

Read more

Jun 10 2014
Comments

More Newly Licensed Nurse Practitioners Choosing to Work in Primary Care, Federal Study Finds

For more than a decade, the percentage of newly licensed nurse practitioners who chose to work in primary care was on the decline. But that trend is changing, according to a survey released last month by the Health Resources and Services Administration (HRSA).

Fifty-nine percent of nurse practitioners (NPs) who graduated in 1992 or earlier went into primary care, and 42 percent of those who graduated between 2003 and 2007 did so, according to the survey. But 47 percent of the very newest NPs—those graduating between 2008 and 2012—opted to work in primary care, reversing the downward trend.

“We are encouraged by the national growth of primary care nurse practitioners, and HRSA is committed to continuing this trend to ensure an adequate supply and distribution of nurses for years to come,” HRSA Administrator Mary K. Wakefield, PhD, RN, said in a statement.

Susan Schrand, MSN, CRNP, a family nurse practitioner and executive director of the Pennsylvania Coalition for Nurse Practitioners, agreed. “We’re excited,” she said. “It’s good to hear that nurses, and especially new graduates, are staying in primary care.”

Read more

May 2 2014
Comments

FTC Report on APRN Practice Demands Our Attention

Margo Brooks Carthon, PhD, APRN, is an assistant professor in the School of Nursing at the University of Pennsylvania and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar.

file

The Federal Trade Commission (FTC) created quite a stir when it released a recent report in support of expanded scope-of-practice (SOP) regulations for advanced practice registered nurses (APRNs)1. Why after all, would the FTC—an agency charged with protecting consumers—take an interest in the regulatory woes of nurses?

Because unnecessary restrictions on APRN practice have the potential to undermine competition in the health care market and impede consumer access to care. That, at least, is the conclusion of the FTC, which released a policy paper making that argument in March entitled Competition and the Regulation of Advanced Practice Nurses.

The FTC aims to prevent unfair methods of competition and unfair, deceptive acts or practices in (or affecting) commerce. Overly restrictive SOP regulations on APRNs may be an example of anti-competitive conduct, the FTC argues, because they may prevent nurse practitioners (NPs) and other APRNs from entering the health care market as providers of care that patients need.

The report also argues that while SOP policies may be intended as a form of consumer protection, they may have the opposite effect. Decades of research link APRNs to safe, high-quality, and cost-effective care. That extensive body of evidence makes it difficult to support the many restrictive SOP regulations that are in place in many states.

Read more

Apr 3 2014
Comments

RWJF Scholars in the News: Medical debt disparities, nurses providing primary care, technologies that maximize time with patients, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

In a study of women diagnosed with breast cancer, RWJF Physician Faculty Scholars alumna Reshma Jagsi, MD, PhD, found that Black and Latina patients were more than twice as likely as White patients to have medical debt and to skip treatments due to concerns about costs. Jagsi tells Reuters that “our findings suggest that racial and ethnic minority patients appear to be more vulnerable, as are those who are too young to qualify for Medicare, those who lack prescription drug coverage, those who reduce their work hours after diagnosis, and those with lower household income at the time of diagnosis.”

Expanding nurse practitioners’ role in primary care could help meet new demands on California’s health care system, as millions of previously uninsured residents gain coverage under the Affordable Care Act, according to Susan Reinhard, RN, PhD, senior vice president of the AARP Public Policy Institute. “We should make sure that the nurse practitioners can use every ounce of their talent for what is needed,” she tells the AARP Bulletin. “Consumers should have a choice of different clinicians who will suit their preferences and their needs.” Reinhard is chief strategist for the Center to Champion Nursing in America, a partnership of AARP, AARP Foundation, and RWJF and co-director of the Future of Nursing: Campaign for Action.

At a recent information technology summit, Ann O’Brien, MSN, RN, an RWJF Executive Nurse Fellow, discussed her work with Kaiser Permanente to leverage new health care technology to maximize nurses’ valuable time providing patient care. O’Brien explains that “you have to look at what can enable small amounts of change,” because saving seconds with each repeated use of rapid sign-on technology, for example, can mean gaining extra minutes in a day for a nurse to provide direct care, FierceHealthIT reports.

Read more

Feb 20 2014
Comments

Kentucky Removes APRN Practice Barrier

Kentucky Gov. Steve Beshear signed legislation last week that lifts a key limitation on advanced practice registered nurses (APRNs) and increases consumer access to health care.

The new law “allows more flexibility for nurse practitioners to provide accessible health care to Kentuckians,” Beshear said. “Nurse practitioners are a critical part of helping more Kentuckians get the medical care they need quickly and efficiently, and I am proud of the bipartisan effort to serve Kentucky’s health needs.”

In the past, APRNs were only allowed to prescribe medication with a physician’s written consent. The new law removes that requirement for APRNs who have four or more years of experience prescribing medication under a collaborative agreement with a physician or as an independent practitioner in another state, according to the Future of Nursing: Campaign for Action.

Read more

Jan 16 2014
Comments

Full Utilization of Nurse Practitioners: Helped by Laws, Hindered by Health Care Culture

Efforts to expand the role of nurse practitioners (NPs) to help address the country’s shortage of primary care providers have been bolstered by legislation in several states. But laws expanding scope of practice may not do all they could to relieve the nation’s primary care crisis, according to a new study by researchers at the Columbia University School of Nursing, which suggests that the culture in health care settings can impede full utilization of NPs.

The study, published in the Journal of Professional Nursing, was conducted in Massachusetts, where state health reform increased demand for primary care and legislation recognized NPs as primary care providers. Researchers found that gains made by government can be neutralized by formal and informal practices at health care organizations. For example, the study cited instances where NPs were not allowed to conduct physical assessments or see new patients.

“Organizational policies can often trump governmental policies, keeping the contribution of the nurse practitioner unrecognized and preventing them from making the fullest contribution possible to effective patient care,” lead researcher Lusine Poghosyan, PhD, RN, an assistant professor of nursing at Columbia and a Robert Wood Johnson Foundation Nurse Faculty Scholar, said in a news release.

Read more

Dec 11 2013
Comments

Recent Research About Nursing, December 2013

This is part of the December 2013 issue of Sharing Nursing’s Knowledge.

Americans Favor Increased Access to Nurse Practitioners

A new telephone survey commissioned by the American Association of Nurse Practitioners (AANP) shows strong support for increased access to care provided by nurse practitioners (NPs).

Among the survey's findings:

  • A large majority favors removal of requirements that NPs work only under the supervision of physicians. Sixty-two percent of respondents support allowing NPs to prescribe medications and order diagnostic tests without such supervision. Just 17 states and the District of Columbia currently grant NPs full-practice authority, according to AANP.
  • An overwhelming majority of Americans back legislation making it easier to choose NPs as their health care providers. Seventy percent of respondents favor legislation to eliminate barriers preventing patients from choosing NPs.
  • There is widespread familiarity with NPs. Eighty percent of respondents have either seen an NP or know someone who has. More than half (53 percent) say a family member has seen one.

"These results clearly confirm what we have known anecdotally for years: American health care consumers trust NPs and want greater access to the safe, effective services they provide," AANP Co-President Ken Miller said in a news release.

The telephone survey was conducted by The Mellman Group, a Washington, D.C.-based polling firm. Its margin of error is +/-3.1 percent at the 95-percent level of confidence.

Read the AANP news release on the survey.
Read a FierceHealthcare story on it.

Read more

Dec 10 2013
Comments

Quotable Quotes About Nursing, December 2013

This is part of the December 2013 issue of Sharing Nursing's Knowledge.

“Nurse practitioners, health aides, pharmacists, dietitians, psychologists and others already care for patients in numerous ways, and their roles should expand in the future. The rise of nonphysician providers will enable more team care. Skilled health aides will monitor patients at home and alert a doctor if certain medical parameters decline. Nurses will provide wound care to diabetic patients, adjust medications like blood thinners and provide the initial management of chemotherapy side effects for cancer patients. ... Policy changes will be necessary to reach the full potential of team care. That means expanding the scope of practice laws for nurse practitioners and pharmacists to allow them to provide comprehensive primary care ... Most important, we need to change medical school curriculum to provide training in team care to take full advantage of the capabilities of nonphysicians in caring for patients.”
-- Scott Gottlieb, MD, American Enterprise Institute, and Ezekiel J. Emanuel, MD, PhD, University of Pennsylvania, No, There Won’t Be a Doctor Shortage, New York Times, December 4, 2013.

“Let me put it this way, we have over 1,200 pre-nursing students. I can only take about 108 a year. In the fall, we had over 600 applicants for 44 positions. Realistically, we are turning away people with 3.6 and 3.7 GPAs. And I think that story is playing out on CSU campuses everywhere.”
-- Dwight Sweeney, PhD, California State University, San Bernardino, Nursing Students Being Turned Away Amid Faculty Shortage in Cal State System, Los Angeles Daily News, December 1, 2013

Read more