Nurse Practitioners Want More Independence

Some of David Jones’ patients call him Dr. David, but he’s not an M.D.

Jones is a nurse practitioner, one of many who practice in Alabama, meeting with patients, diagnosing their health problems, running tests and writing prescriptions. For some of his patients, he’s a lifesaver.

Take Ruby Lamar, a patient at the Capstone Rural Health Center in Walker County where Jones works. The unemployed, uninsured 61-year-old hadn’t sought medical care since her daughter was born in 1986, but this summer she got such bad bronchitis she couldn’t sleep at night. So she came in for treatment and recently returned for a checkup, during which Jones also checked a lump she recently found in her arm. 

“They’re real nice. You can’t get any better than here,” Lamar said. “They take the time to talk to you and ask you how you’re doing.” 

Some health experts say the nurse-run care Jones provides is the future of medicine in this country. Last month, the Institute of Medicine issued a 500-plus-page report saying that advanced practice nurses, including nurse practitioners, are a critical part of health reform and should be used to their full potential, especially in rural areas where there’s a shortage of primary care doctors. 

“The need is here, seriously,” said Jones, whose federally funded clinic sees about 2,000 patients a year, most of them poor, from Winston, Walker, Tuscaloosa and western Jefferson counties. 

But nursing advocates say Alabama’s restrictions on nurse practitioners, which are among the tightest in the country, are hindering residents’ access to care. Despite the national push to expand nurses’ role, efforts to loosen some of the regulations here have failed to get traction in the state Legislature. 

“The problem is that nurse practitioner law as it is now really limits the quality of care in Alabama,” said Leigh Ann Poole, who chairs the family nurse practitioner program at Samford University’s Ida V. Moffett School of Nursing. “We have a great need for increased numbers of providers who can provide primary care to patients in Alabama, both in the urban and rural areas, and nurse practitioners can be a solution to that problem. But because of the restrictive practice act, we are limited in how far we can go to help our patients.” 

They’re hoping that changes soon: A task force convened at the request of now Gov.elect Robert Bentley recommended in 2004 that more nurse practitioners should be trained in and recruited to Alabama and the state’s rules governing collaborative practices between doctors and nurse practitioners should be modified. 

Alabama’s restrictions 

Certified registered nurse practitioners, or CRNPs, are registered nurses who get a graduate degree in a nurse practitioner program and national certification. In Alabama, they are then required to work under a collaborative practice agreement with a physician. Many serve in hospitals, clinics and private offices, sharing patients with physicians. But others work on their own, in which case they have to have a doctor visit at least 10 percent of the time and review at least 10 percent of their patient charts. 

Other states have a broad range of requirements, from Arizona and Iowa, which allow nurse practitioners to work independently, to Oklahoma, which requires that every two full-time nurse practitioners have a physician overseeing them. 

Alabama is the only state besides Florida where CRNPs can’t prescribe controlled substances, which means that although they can write prescriptions for antibiotics and other medications, they can’t dole out pain drugs, many antidepressants and even some antidiarrheal or cough medicines. If their patients need those medications, the nurse practitioners must consult with their collaborating physician, who then writes a prescription. 

That can be frustrating when it comes to treating patients, as can other inconveniences, like needing a doctor to sign off on physical therapy orders and even handicapped hang tags, said Beth Whitworth, a CRNP who treats mostly elderly patients from Scottsboro, Albertville and Guntersville. When she worked previously in Kentucky and Tennessee, she didn’t face those roadblocks, she said. 

“Some things just don’t make a whole lot of sense,” she said. “We are completely competent to do them; it’s just the state of Alabama.” 

Nurse practitioner Lindsey Todd.jpgNurse practitioner Lindsey Todd enters information into the computer as she talks with patient Vivian Key of Parrish at the Capstone Rural Health Center. (The Birmingham News/Linda Stelter)

The nurses have gotten two bills sponsored in the state Legislature — one that would allow them to work independently and prescribe controlled substances and another, narrower measure that would just let nurse practitioners and nurse midwives in collaborative practice with doctors prescribe some controlled substances, but not all. 

Neither got traction, and advocates claim they’ve been stymied by resistance from the state’s physicians. They say the doctors carry more weight than nurses and fear losing control of the profession and their patients. 

“It seems to be an issue based on competition, and it shouldn’t be. 

The issue should be access to care,” said Lori Lioce, president of the Nurse Practitioner Alliance of Alabama. 

Larry Dixon, a retired state senator who heads the Alabama Board of Medical Examiners, which shares oversight of the collaborations between doctors and nurse practitioners with the state Board of Nursing, says it’s about safety, not competition, because doctors have more education and clinical training. The board says it supports more collaborative practices but doesn’t want nurses working without physician oversight. And ALAPAC, the lobbying arm of the Medical Association of Alabama, urged doctors to oppose loosening restrictions for nurses, writing on its website in response to a 2009 bill that it “would put patient safety and quality care in Alabama at risk.” 

There are few in-depth looks into whether that’s true; in fact, this fall, members of the American Academy of Family Physicians asked the group to fund a study even if the doctors represented didn’t like the outcome. 

A recent American Medical Association policy briefing says that even though nurse practitioners who act as primary caregivers instead of doctors receive high marks for patient satisfaction, there are few recent, statistically reliable studies comparing health outcomes between doctors and nurses. 

“There’s just a world of difference” between the two, Dixon said. “There’s lots of things that a nurse practitioner is capable of diagnosing and treating, but the Board of Medical Examiners will never 

agree to let someone, because they’re a nurse practitioner, put out a shingle and start practicing medicine because they’re not physicians.” 

More time with patients 

That riles the nurses, who bristle at the fact that, under the collaborative practice rules, they are inspected by the medical board as well as the Board of Nursing, and the medical board gets some of the fees. They also say many of the CRNPs who train and study in Alabama end up leaving for other states where they can practice more easily and make more money; in fact, Alabama’s largest insurer, Blue Cross Blue Shield, will not cover nurse practitioners’ services when performed independently of a physician. 

“We’re really not out there to expand our scope of practice,” said Lioce. “We’re just fighting to do what we’re nationally certified to do.” 

The nurses also argue that they offer a different approach to medicine, one that’s focused on relationships and holistic care. They charge less and their days aren’t as packed, so they can take more time with patients, said Jones, who has his doctorate in nursing. 

That’s why Kenneth Newsome likes visiting Jones’ clinic. The 58-year-old from Cordova, who was unemployed, was having trouble managing his diabetes until a friend brought him in. Now his nurse, Lindsey Todd, checks the dosage on his medications, goes over his blood sugar journal and makes sure he can afford needles for his insulin. 

“The doctors I went to loaded me down with all this medicine and said, ‘see you in three months,’ ” Newsome said. “It’s more personal down here. It’s more friendly.”

 

Written and Published by Hannah Wolfson — The Birmingham News

Nov 7th 2010


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The Utilization of Nurse Practitioners In The Hospital.

More and more hospitals are using in-house physicians and nurse practitioners to monitor patient care.

“Is this the wave of the future? Yes, because it is already the wave of the present,” said Robert Wachter, MD, president of the National Association of Inpatient Physicians and chief of medical services at UCSF, where 20 percent of last year’s internal medicine residents chose to follow the school’s hospitalist

“The forces promoting it are only accelerating it,” Wachter said.

You can read the entire article here:   Nurse Practitioner Jobs

For more information visit The American Academy of Nurse Practitioners:

Nurse Practitioner Careers


Nurse Practitioner Job Description

Have you ever needed a job description for a nurse practitioner? From time to time I get calls from clients that are in need of a good job description. In most cases they have not used nurse practitioners in the past and putting together a good job description is a great place to start. I found a good little web site that offers job descriptions, educational information and some good articles on the nurse practitioner profession. You can check it out HERE I hope you find this informative….check back later for more posts. Happy Holidays


Job Challenges For Nurse Practitioners

The role of the Nurse Practitioner has been changing slowly over time due to the increasing demand for the NP in the medical work setting. This increase in demand now has nurse practitioners facing many new challenges. The need for a more flexible and progressive approach to a nurse practitioner’s delivery of care is a fundamental challenge. Much of the work traditionally carried out by general practitioners will need to be delegated to properly trained personnel such as nurse practitioners. This means that the ability to work with the medical profession and with other healthcare professionals is most important to the leadership challenges facing nurse practitioners. This is particularly important in poorer communities where access to a general physician is limited. Nurse practitioners in these settings will be relied on in such areas as providing medical advice, assessing illnesses and injuries, screening and categorizing patients, monitoring and care for patients with chronic illnesses, prescribing and interpreting diagnostic tests, health promotion and education, nutritional advice, breast and cervical screening…etc. There are also challenges with prescriptive authority and the barriers that are created when a practitioner does not have that ability. Nurse practitioners need to be given broad prescriptive authority to really address the cost of health care in the United States. As nurse practitioner programs spread across the country and more nurse practitioners become involved in all areas of the medical profession, there is growing demand to modify nurse practitioner programs to quell physician concerns and allow nurse practitioners to take on more responsibilities. There are many resources that can be used to help the practitioner deal with these challenges.

As the demand continues to increase for Nurse Practitioners they will have many job options to consider as they seek the best practice opportunity for them. Nurse practitioners are committed to excellence in meeting and exceeding a quality standard of care. Throughout the world, nurse practitioners are being accepted and respected as essential healthcare providers. The issue is the lack of acceptance and recognition by medical professional associations and legislative bodies. Since health promotion and disease prevention have become a concern throughout the world, in the coming years, nurse practitioners are going to be recognized as a valuable and essential asset for the entire medical community.


Check Out This Great Resource for Psychiatric Nurse Practitioners

I was doing some internet research for a private practice group that is in need of several Psychiatric Nurse Practitioners to join their group. In doing my research I ran across a very good resource. Check it out as I think you will find it helpful and informative. Here is the link Psych Resource Let me know what you think. Thanks


Jobs! Jobs! Jobs! NP and PA Jobs

Litton Resource Group – Houston County, TX
Our client is a well established busy Ob/Gyn practice in Houston Texas. There are 4 physicians and 1 PA on staff. This job involves working with one etc…
from physicianscentral.com – 30+ days ago – email – more…

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Litton Resource Group – Houston County, TX
Our client is a very busy weight loss surgeon that is in need of a PA with surgical experience. Candidate will be first assist with surgeon at the etc…
from physicianscentral.com – 30+ days ago – email – more…

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Litton Resource Group – TX
client is a prestigous orthopedic group that is in need of a PA with at least etc…
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Litton Resource Group – IL
hospitals as well as many physician groups in all specialties. This is currently … … hospitals as well as many physician groups in all specialties. This is currently etc…
from physicianscentral.com – 1 week 2 days ago – email – more…

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Litton Resource Group – IL
Our client is a prestigious General and Bariatric Surgeon that practices in southern IL. The practice is part of a large healthcare network. This is etc…
from physicianscentral.com – 1 week 1 day ago – email – more…

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Litton Resource Group – Charlotte, NC
You will be an employee of the medical group but work out of the hospital. They … … You will be an employee of the medical group but work out of the hospital. They etc…
from nursejobslink.com – 3 weeks 2 days ago – email – more…

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Litton Resource Group – Melbourne, FL
Our client is a solo Urology practice located in the Melbourne FL area that is in need of a PA to join the practice. The hours are Mon-Fri etc…
from physicianscentral.com – 5 days 17 hours ago – email – more…

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Litton Resource Group – Las Vegas, NV
Our Client  is an established and busy Neurology Practice in Nevada. Board certified physicians work with physician assistants daily in state of the etc…
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Using Social Media to find Nurse Practitioner and Physician Assistant Jobs

Social Media has really taken off in the last five years and is now a mainstream tool that can be used very effectively to locate nurse practitioner jobs and physician assistant jobs. Blogs and Forums are great places to gather information on PA and NP Schools, medical supplies, Jobs and career advice in general. The Forums are nice because you can interact with other Physician Assistants and talk about the issues you face on the job each day. People share stories and advice that you may find beneficial in your career. One of my favorite forums is Physician Assistant Forum And Jobs Check it out and let me know what you think.