Category Archives: Nurse practitioners
Have you signed up to receive Sharing Nursing’s Knowledge? The monthly Robert Wood Johnson Foundation (RWJF) e-newsletter will keep you up to date on the work of the Foundation’s nursing programs, and the latest news, research, and trends relating to academic progression, leadership, and other essential nursing issues. Following are some of the stories in the February issue.
Preparing Nurses for Leadership in Public Policy
Many nurse education programs, including those that confer doctoral degrees, fall short in educating nurses about public policy, leaving them unprepared to maximize their expertise in policy arenas. To help change that, the RWJF Nursing and Health Policy Collaborative at the University of New Mexico hosted a recent conference that brought together leading nurse educators, public policy experts, social scientists, and others. The goal was to identify and share effective ways to prepare students in doctoral (PhD and DNP) nursing programs to be health policy leaders. Talking to lawmakers is “high-stakes communication,” one speaker said, and nurses need to know how to do it.
Nurse Leader Urges Nurses to Study Political Science, Too
Nancy Ridenour, PhD, APRN, FAAN, has combined a lifelong passion for policy with a drive to improve public health. Throughout her career, she has fought state laws that prevented Nurse Practitioners from practicing to the top of their education and training, and spoken out on health policies affecting access to care for patients in rural communities. “Policy is a tool to foster social change. Leadership and expertise in health policy ensure that nursing expertise is used to improve the health of the nation,” Ridenour says.
Have you signed up to receive Sharing Nursing’s Knowledge? The monthly Robert Wood Johnson Foundation (RWJF) e-newsletter will keep you up to date on the work of the foundation’s nursing programs, and the latest news, research, and trends relating to academic progression, leadership, and other essential nursing issues. These are some of the stories in the January issue:
Patients Slowly Gaining Access to Care Provided by Advanced Practice Registered Nurses
In recent years, several states have taken steps to ease restrictions on advanced practice registered nurses (APRNs), indicating that efforts to empower them and improve patient access to care are picking up steam. However, many consumers still lack unfettered access to care provided by APRNs because two-thirds of states do not allow them to practice without physician supervision—and even in states that do, APRNs aren’t always able to practice independently.
Stronger Primary Care System Is Goal of RWJF Scholar
RWJF Executive Nurse Fellow Margaret Flinter, PhD, APRN, has been at the center of three movements: community-oriented primary care, the growth of the community health center movement, and the growth of nurse practitioners as primary care providers. She founded the country’s first formal post-graduate residency training program for new nurse practitioners, and co-directs The Primary Care Team: Learning from Effective Ambulatory Practices, a national project supported by RWJF that is working to help health care organizations develop and accelerate innovations.
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.
This is part of the January 2014 issue of Sharing Nursing’s Knowledge.
“Nurses are needed wherever people are, and we are positioned to deliver care. Since the nation is moving towards population care, health care will have to be delivered to those in the greatest amount of need. We can take care of individuals, families and the communities, and take all of these elements into consideration when we are conceptualizing this care. Nursing is the leader in orchestrating all of this.”
--Betty N. Adams, Dean, Prairie View A&M University College of Nursing, HBCUs Leading Next Generation of Minority Health Care Research, The Huffington Post, January 8, 2014
“Imagine being a working mother in rural Missouri with a sick child. He needs medical attention, but there are no doctors available within 50 miles. This situation is not a stretch: Many rural Missourians struggle to find nearby medical care. While nearly 40 percent of Missourians live in rural areas, less than 20 percent of the state’s primary care physicians practice in rural areas. There is a simple solution, one that Iowa employs: Give certified nurse practitioners more autonomy.... Whether it is a mother with a sick child or a 60-year-old man seeking care, nurse practitioners are competent providers.”
--Caitlin Hartsell, JD, MPH, former research assistant, The Show-Me Institute, Restrictions on Nurse Practitioners Hurt Missouri Health Care, The Columbia Missourian, January 7, 2014
Arthur Kellermann, MD, MPH, FACEP, an alumnus of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars and Health Policy Fellows programs, is dean of the F. Edward Hébert School of Medicine at the Uniformed Services University of the Health Sciences. He wrote an article in the November issue of Health Affairs calling for a new class of health care provider—the primary care technician—to improve accessibility to and affordability of primary care.
Human Capital Blog: What is the thrust of your idea?
Arthur Kellermann: We’ve had a decades-long shortage of primary care physicians in this country and, up until now, it has defied solution. One definition of insanity is to continue to do the same thing over and over again and expect a different result. My article suggests a rethinking, and literally a reengineering, of how we deliver primary care in this country. It makes the case for a new class of providers—primary care technicians (PCTs)—who would work remotely, under the online supervision of primary care physicians or nurse practitioners (NPs), to manage stable chronic disease patients, treat minor illnesses and injuries, and provide basic preventive services. These PCTs would make primary care more accessible, more convenient, and more affordable to Americans, wherever they live.
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.
This is part of the September 2013 issue of Sharing Nursing's Knowledge.
More New Nurse Practitioners Heading to Primary Care
Two recent analyses of workforce data offer new insights into the role nurse practitioners (NPs) are likely to play in combating the coming shortage of primary care providers in the U.S.
The first analysis, commissioned by the Agency for Healthcare Research and Quality (AHRQ) and released in August, finds that slightly more than half the nation’s nurse practitioners are practicing primary care. In all, 55,625 of the nation’s 106,073 nurse practitioners are in primary care, according to data drawn from the Centers for Medicare and Medicaid Services’ National Provider Identifier database.
At the same time, an analysis of graduation trends conducted by Robert Wood Johnson Foundation Executive Nurse Fellow alumna Debra Barksdale, PhD, RN, FAAN, and colleagues, finds that graduation rates for NPs suggest more help is on the way. According to Barksdale’s reading of data from the American Association of Colleges of Nursing and the National Organization of Nurse Practitioner Faculties, 84 percent of NP graduates in 2012 were prepared in primary care. That represents an eye-catching 18.6 percent increase from 2011 to 2012.
Lori Melichar Gadkari, PhD, MA, is a senior program officer at the Robert Wood Johnson Foundation (RWJF), in the Research and Evaluation Unit.
Yesterday the New England Journal of Medicine published the results of a study co-funded by the Robert Wood Johnson Foundation, Johnson & Johnson, and the Gordon and Betty Moore Foundation. “Perspectives of Physicians and Nurse Practitioners on Primary Care Practice” finds that 96 percent of nurse practitioners and 76 percent of physicians agreed with the Institute of Medicine report recommendation that “nurse practitioners should be able to practice to the full extent of their education and training.” The new study is authored by Karen Donelan, ScD, EdM, Catherine M. DesRoches, DrPH, Robert S. Dittus, MD, MPH, and Peter Buerhaus, PhD, RN.
When asked how increasing the supply of nurse practitioners would potentially affect the United States health care system, the authors found that the majority of physicians (73%) said increasing the supply of primary care nurse practitioners (PCNPs) would lead to improvements in the timeliness of care. A much smaller majority of physicians (52%) said increasing the supply of PCNPs would lead to improvements in access to care for people in the country.
However, the new survey found significant disagreement between primary care physicians and PCNPs about whether increasing the supply of PCNPs would improve patient safety and the effectiveness of care, and whether it would reduce costs. There was also a large professional divide about proposed changes to PCNPs’ scope of practice, putting PCNPs in leadership roles, and the quality of care that PCNPs provide.
This is part of the April 2013 issue of Sharing Nursing's Knowledge.
“A nurse practitioner may be in your future — if he or she is not already in your present. This is a kind of super-nurse, who’s gone through four years of nursing school plus at least two more years of training in diagnosing and treating disease. Nurse practitioners may specialize in women’s health, pediatrics or cardiac care … I went to a superb nurse practitioner for years... When I had a complaint she considered beyond her expertise, out came her pad and the name of a specialist to call. Her accessibility was a big plus… Cutting health-care costs—and making health-care services more convenient for consumers—demands moving basic medical services away from hospitals and, in many cases, doctors’ offices. Sometimes we need a doctor; sometimes we don’t. A well-trained nurse practitioner can help point us in the right direction.”
-- Froma Harrop, Nurse Practitioners Can Help Save Big Health-Care Dollars, Columbus Dispatch, March 30, 2013
“I have watched my daughter, Sam, in action several times. She has volunteered for several years during the flu shot clinics at the health department. But her finest moments were the ones taking care of her dad while he was dying. The tenderness and careful attention she gave him was indescribable … I imagine she gives that kind of care to all her patients. She has sat with families while they waited on their loved one to pass. She has encouraged dying people to go with confidence and poise. Going through it with her dad has given her a special love for helping the dying to die peacefully. Going the extra mile is important in any professional field. In the nursing field, it is the difference between being a nurse and being a great nurse. It just doesn’t hurt to do everything you can for a patient. And it could be the difference between life and death. Appreciate those hard working nurses. They have tough jobs.”
-- Anita Goza, Those Hardworking Nurses, Waurika News-Democrat, March 27, 2013
In light of concerns about the nation’s shortage of primary care providers—which is likely to be exacerbated as health reform takes effect—many have argued that nurse practitioners (NPs) can help increase capacity. But because state laws about NPs’ scope of practice vary widely, in some places NPs may not be able to help fill the gap and satisfy demand for primary care services.
A new report from the National Institute for Health Care Reform examines the scope-of-practice laws and payment policies that affect how and to what extent NPs can provide primary care. The report examines laws across six states (Arkansas, Arizona, Indiana, Maryland, Massachusetts and Michigan) that represent a range of restrictiveness. The National Institute for Health Care Reform is a nonprofit, nonpartisan organization that conducts health policy research and analysis.
Rather than spelling out specific tasks NPs can perform, scope-of-practice laws generally determine whether NPs must have physician supervision. Requirements for documented supervision—collaborative agreements—are seen “as a formality that does not stimulate meaningful interaction between NPs and physicians,” according to the report. Collaborative agreements can limit how NPs are used in care settings or prohibit them from acting as the sole care provider, and can limit NPs’ range or number of practice settings, which can have serious consequences for underserved rural communities, the report says.