© 2009 fitzgerald health education associates, inc. hot topics in np practice margaret a....

© 2009 Fitzgerald Health Education Associates, Inc.

Hot Topics in NP Practice

Margaret A. Fitzgerald DNP, FNP-BC, NP-C, FAANP, CSP

President Fitzgerald Health Education Associates, Inc.

Family Nurse PractitionerAdjunct Faculty, Family Practice Residency

ProgramGreater Lawrence (MA) Family Health Center

Editorial Board MemberThe Nurse Practitioner Journal, Prescriber’s Letter,

American Nurse Today

May you live in interesting times.

© 2009 Fitzgerald Health Education Associates, Inc.

© 2009 Fitzgerald Health Education Associates, Inc.

Advances in Health Care

Lifestyle Pharmaceutical Surgery

© 2009 Fitzgerald Health Education Associates, Inc.

“Routine” angioplasty while Vice President, now LVAD

New diseases, new threatsH1N1 influenza A, Dengue

Fever

© 2009 Fitzgerald Health Education Associates, Inc.

© 2009 Fitzgerald Health Education Associates, Inc.

Helping to create

Chronically critically ill

New-form acutely ill

Groups who have not historically lived in the community

Opportunity: We can look at where we have

come as the NP and PA professions.

© 2009 Fitzgerald Health Education Associates, Inc.

© 2009 Fitzgerald Health Education Associates, Inc.

What else happened in 1965?

The Medical Board was persuaded to allow nurses to read ECGs, diagnose life-threatening arrhythmias, and administer emergency medications as well as defibrillation – a revolutionary step at the time. (www.cornell.edu)

© 2009 Fitzgerald Health Education Associates, Inc.

1965Feminine Forever

Dr. Robert Wilson

Menopause is a "living decay," he wrote, which often destroys a woman’s "character as well as her health." He added, "The unpalatable truth must be faced that all postmenopausal women are castrates. …

© 2009 Fitzgerald Health Education Associates, Inc.

1965Feminine Forever

Dr. Robert Wilson

A man remains a man until the very end. The situation with a woman is very different. Her ovaries become inadequate relatively early in life. She is the only mammal who cannot reproduce after middle age."

© 2009 Fitzgerald Health Education Associates, Inc.

1965 vs 2010

Type 2 DM therapy 1965–Chlorothiazide–Orinase

About $8/ month in 2009 dollars–Death within 5 years of diagnosis

© 2009 Fitzgerald Health Education Associates, Inc.

1965 vs 2010 Type 2 DM therapy 2010

– TZD (perhaps) – Biguanide– SU or DPP-4 inhibitor or some

combination of insulin secretagogues or insulin

– Statin– ACEI or ARB or direct renin inhibitor– ASA

Up to $400-500/ month in 2009 dollars, as little as $16/ month with 4, $4 per month Rxs

– Living decades post diagnosis

1965 vs. 2010

© 2009 Fitzgerald Health Education Associates, Inc.

Sound Familiar?

A time of..– Societal change– Social unrest– US involvement in military action

overseas– Desperate need for healthcare

providers, particularly in primary care– The institution of healthcare

insurance plan that was a source of great debate. © 2009 Fitzgerald Health Education Associates, Inc.

© 2009 Fitzgerald Health Education Associates, Inc.

In 1965…

Dr. Loretta Ford, the cofounder of the first NP

program, and Dr. Eugene Stead, attributed to be the

founder of the PA profession, were NOT

concerned about physician shortage but WAS

concerned about the lack of primary health care

services.

In 1965..

Both professions had their start.

© 2009 Fitzgerald Health Education Associates, Inc.

What did they all face?Is this 1965 or 2010?

Opposition for nursing and medicine

Public misunderstanding of role and intent

Consumer acceptance of the role

© 2009 Fitzgerald Health Education Associates, Inc.

NPs and PAs: Today, by the Numbers

Number of PA programs– 140

Number eligible to practice in USA– 72,433

Source- www.aapa.org

Number of NP programs– 325

Number reliable to practice in USA– 135,000

Source- www.aanp.org

© 2010 Fitzgerald Health Education Associates, Inc.

© 2010 Fitzgerald Health Education Associates, Inc.

NPs and PAs by the Numbers

PA– Average 2009 full

time salary= $93,486

www.aapa.org

NP– Average 2009 full

time salary= $94,142

http://nurse-practitioners.advanceweb.com

Opportunity: Our professions’ salaries are approximately

double that of the average US wage earner.

© 2010 Fitzgerald Health Education Associates, Inc.

Pitfall: We often do not take home a representative portion of the income

we generate.

© 2009 Fitzgerald Health Education Associates, Inc.

© 2009 Fitzgerald Health Education Associates, Inc.

Nice to hear that a new high school grad is thinking about

becoming a nurse practitioner……

Opportunity

© 2009 Fitzgerald Health Education Associates, Inc.

A recent high school graduate, as quoted in local Louisville, KY

newspaper

I dream of: becoming a nurse  practitioner….

and living a life without worry. Married, with children

and stable for the rest of my life.

Pitfall and Opportunity: Our profession is

dynamic.

NP by 2016– NCSBN Vision

Statement= NPs as autonomous providers

NP by 2016 AACN= DNP as

entry degree to the profession

© 2009 Fitzgerald Health Education Associates, Inc.

© 2009 Fitzgerald Health Education Associates, Inc.

Pitfall:But we still have a long way to

go…

© 2009 Fitzgerald Health Education Associates, Inc.

© 2009 Fitzgerald Health Education Associates, Inc.

What is our collective responsibility?

Opportunity: Much legislative work has been done.

Pitfall: Much needs yet to be done.

© 2009 Fitzgerald Health Education Associates, Inc.

Arkansas State Medical Board Proposal

Regulation 30 outlines protocols and responsibilities of physicians and nurse practitioners who have a collaborative practice agreement. In the proposed rule, doctors and nurse practitioners must provide its method of management and protocols of authorizing prescriptions to the Arkansas State Medical Board.

© 2009 Fitzgerald Health Education Associates, Inc.

Kaplan and Brown (2006) in NPJ

Barriers range from receiving a lower rate of reimbursement than physicians to seemingly small acts of exclusion, such as not being able to authorize disability parking permits.

Pitfall and opportunity

Not enough of us belong to our professional organizations.

© 2009 Fitzgerald Health Education Associates, Inc.

© 2009 Fitzgerald Health Education Associates, Inc.

Opportunity:Caring for people in need

The US Uninsured

No health insurance– 46.3 million Americans– 15.4% of the population

Gaps in insurance during 2009– 60 million Americans– 1 in 5 of the population

Source- Cohen RA, et al "Health insurance coverage: Early release of estimates from the National Health Interview Survey 2009" NCHS Brief 2010.

© 2009 Fitzgerald Health Education Associates, Inc.

USA Estimated Consequences of No

Health Insurance Estimated 45,000 people die

annually in part because they lack health insurance and healthcare

© 2009 Fitzgerald Health Education Associates, Inc.

NP and PAs (APCs)= Growth industry

Pitfall:Have we “flooded the market”

with NPs and PAs?

© 2009 Fitzgerald Health Education Associates, Inc.

© 2009 Fitzgerald Health Education Associates, Inc.

Strength in numbers

Do the math!!!

NP and PAs educated as PCP, anticipated yield per annum–~3500 + 2500= 6000

Potentially 6000 new primary care providers per annum

Opportunity: We have caught

the eye of people in power.

© 2009 Fitzgerald Health Education Associates, Inc.

Patient Protection and Affordable Care Act

$15 million for the operation of 10 nurse-managed health clinics that help educate nurse practitioners

$5 million for states to expand their primary care workforce by between 10 and 25 percent over a decade

$168 million for more than 500 new primary care physicians by 2015

© 2009 Fitzgerald Health Education Associates, Inc.

Donna Shalala, former Secretary of Health and

Human Services “NPs are going to be key to health

care reform and must be at the health care reform tables.

“If you look at where our big costs are—chronic care management—that’s where you’re going to see nurses and physician assistants.”

“It’s a solution in plain sight.”© 2009 Fitzgerald Health Education Associates, Inc.

PitfallWhose pie is it, anyway?

© 2009 Fitzgerald Health Education Associates, Inc.

© 2009 Fitzgerald Health Education Associates, Inc.

Opportunity: Plenty of pie!

Old thought–We are taking work (therefore

income) from other healthcare providers, especially physicians.

New thought–We are creating opportunities to

provide healthcare for populations that had no care or have not previously existed.

© 2009 Fitzgerald Health Education Associates, Inc.

So we need to…

Restate our argument. We are not replacing physicians. We are caring for people in need. This is an opportunity that will take

many forms and be influenced by a number of factors.

We are operating from a state of strength, caring for people of great need. We are not simply

“filling in”.

For many people, in many places, we ARE

healthcare!

© 2009 Fitzgerald Health Education Associates, Inc.

© 2009 Fitzgerald Health Education Associates, Inc.

May you live in interesting times.

May you come to the attention of those in

authority.

© 2009 Fitzgerald Health Education Associates, Inc.

May you find what you seek.

© 2009 Fitzgerald Health Education Associates, Inc.

End Presentation

Thank you! peg@fhea.com www.fhea.com