Maritza C. Alencar, DNP, MBA, APRN-BC

Nursing Symposium and Multidisciplinary Team

2019 International Symposium of Onco-Hematology

The role of the advanced registered nurse practitioner in the United States

Disclosures

Kite Speakers’ Bureau

Where did we begin?

Late 1950’s and early 1960’s

Beginning of specialization in medicine

Resulted in shortage of primary care physicians

Rural areas impacted most

Physicians began to recruit registered nurses with clinical

expertise

Source: Kaiser Permanente History

First Nurse Practitioner Program

By 1965:

Social Security Amendments came Medicare and Medicaid

Programs

Increased access for low-income children, women, elderly and

people with disabilities

Created an increased need for primary care providers

Loretta Ford, a nurse and Henry Silver, MD at the University of

Colorado developed the first NP program

Source: Simmons University & University of Rochester Medical Center

Loretta Ford Henry Silver

Gaining independent practice

During 1970’s and 1980’s:

Lack of credentialing process and training led to:

Document patient satisfaction scores

Development of standards of practice

Monitored overall increase of primary care availability

11 NP organizations created in the US

Implemented certifications exams

Aligned practice with US regulations and reimbursement

policies

Source: Wikimedia Commons & Florida Nursing History Project

What does a Nurse Practitioner do?

Perform procedures:

Bone Marrow Biopsies

Lumbar Puncture

Intrathecal Chemotherapies, etc.

Record medical history, diagnoses and

manage symptoms

Write prescriptions

Diagnose and treat diseases

Conduct, order and interpret

diagnostic tests

Managing patients’ overall care

Provide education on:

Wellness and prevention

Medication side effects

Source: Nurse Journal: Social Community for Nurses Worldwide & American Academy of Nurse Practitioners

Specialty Areas

Nurse Practitioner

Acute Care

Adult

Gerontology

Family

NeonatalOncology

Pediatric/Child

Psychiatric/Mental

Women's

Source: American Academy of Nurse Practitioners

How to become a Nurse Practitioner?

Source: American Academy of Nurse Practitioners

BSN

• Bachelors preparation as a Registered Nurse (RN)

• 4 year degree

• Completed at a university or college

MSN

• Master’s preparation

• 2 year degree

• May be done in combination with BSN

• May require clinical RN experience

DNP/PhD

• Doctorate preparation

• 1-4 years to complete (DNP vs PhD)

• Clinical track vs research track

• Not currently required to practice as a nurse practitioner

Where are we today?

Practice Privileges

Source: Nurse.org, 2019

Current State of US NPs

>270, 000 Nurse Practitioners in

the US to date

87.1% certified in primary care,

with 72.6% delivering primary

care

95.7% prescribe medications

(~20 Rx/day)

NPs hold prescriptive privileges,

including controlled substances

in all 50 states

Mean full time base-salary

$105,903

Malpractice rates remain low;

only 1.1%

~400 academic NP programs in

the US

Source: American Academy of Nurse Practitioners, January 2019 and Clinical Advisor

Oncology Nurse Practitioners

~1.2% represent Oncology NPs of

270,000 in US

A shortage of 3,000 oncologists

or 9.5-15 million visits by 2020

Increased demands in oncology:

Rapid advancements in

cancer treatment (genetic

and immunotherapies)

Increase in survivors

Time allocated to EHR

requirements

Research responsibilities

Source: www.doximity.com/press_releases/major_us_cities_facing_shortages_of_cancer_specialists

Specialty Training Programs

Fellowship opportunities for NPs

~9 training programs in US

Provides mentorship for new NP

3 accredited fellowship in US by

ANCC

The James, Ohio State

University (Columbus, OH)

Sylvester Comprehensive

Cancer Center (Miami, FL)

MD Anderson (Houston, TX)

Certifications provided through

Oncology

Summary

Americans make more than 916 million visits to an NP annually

More nurse practitioner driven clinics

Primary care

Survivorship

Symptom Management

Ranked Best Job in America

Increases access to care for patients

Continue to work on full practice privileges in all 50 states

Can alleviate physician shortage (expected 130,000 by 2025)

Data shows NPs provide safe and quality care

More specialty training programs available:

Oncology

Emergency Medicine

Source: Medicalbillingstar.com

Thank You!