Fund Cancer Detection, Not a “Cure”

Your best weapon to defeat the beast known as cancer is early detection. So, why is funding so focused on finding a “cure,” instead of screening?

by Jason Blackson

There is an inherent misnomer about cancer prevalent in the world that needs to be corrected. Cancer is a disease of the body’s own cells developing a molecular flaw and then replicating out of control. For this, there is no cure. Not in the preventative sense that has led numerous foundations, organizations, and charities to generate billions of dollars over the years under the guise of finding ‘the cure’. An individual’s cancer can be cured, yes, but there will never be a drug or vaccine that could be administered to prevent cancer. Diseases, like the chicken pox or the flu, are foreign entities that enter the body and can be fought off, either by vaccine or the use and aid of medications. Other diseases can be fought off by the immune system, such as bacterial infections. Cancer is not an invasive substance. Cancer is our own cells gone rogue and then convincing our bodies that it belongs there. Because the immune system does not recognize cancerous cells as anything foreign, it will do little, if anything, to fight back. There is no cure to prevent this from happening. That isn’t to say there is no hope. Rather there needs to be a shift in focus, taken away from ‘finding the cure’ and placed on developing more efficient diagnostic testing. Pouring money into research to hit the bullseye at an ever-changing target isn’t the answer. The answer lies in finding these rogue cells, before the race against time begins.

The development of better treatment options has grown, evolved, and advanced in the most remarkable and unforeseeable ways, over the last several decades. While some routes of treatment are still borderline-barbaric, for lack of a better option, new developments, especially immunotherapy, have provided hope for patients with even the most egregious forms of cancer. Their diagnosis isn’t necessarily a death sentence. The problem here being that funding for this type of research is inconsistent. Studies have shown that over the last decade, while public support and research progress remain strong, funding has not increased to compensate for the demands of a pricier financial landscape. The federal government has provided tremendous monetary support for research, but has yet to meet the same level of funding it provided before the last recession. Grants have helped to offset expenditures for many organizations, but the overall tight financial constraints have created challenges in sustaining clinical trials and retaining talented researchers. Additionally, the horrifying and fascinating reality is cancer cells have routinely found ways to evolve and survive many of the implemented therapies. This is because each type of cancer has a unique combination of genetic changes. As the cancer grows, these genetic changes will continue, making each subsequent cell different from its parent cell. Cells within the same tumor have even shown to have different genetic changes. This is one reason why cancers become more difficult to treat over time and also why one therapy regime that works for one patient may not necessarily work for another patient with the same diagnosis. This, of course, is spoken in broad stroke generalizations. There are numerous studies proving the success and survival rates of any combination of therapies, and new research is showing new treatment options to be even more promising. But why is the focus of defeating cancer on the backend, after it has already wreaked havoc on the life of the patient and the lives of the people around the patient? Why is research less focused on the frontend of the disease process and preventing it from developing beyond a few cells?

CBCs, biopsies, colonoscopies, pap tests, and other tests are routinely used in conjunction with known statistics and demographics in screening patients for cancer. Current screening tests are predominantly accurate in the detection of tumors or blood- or bone marrow-based cancers but typically those cells number in the millions before being detected. The human body has trillions of cells and, of those cells, cancer starts in just one. Understanding the nature of that one cancer cell, how it operates, and how it operates differently from normal cells, could help doctors not only detect the cancer earlier, but also help them refine their treatment to be the most efficient. For example, cells from tumors are known to release minute amounts of mutated DNA and abnormal proteins into the blood stream, not unlike normal cells. Researchers in Australia have used this information to develop a test that can detect one mutated fragment of DNA among 10,000 normal DNA fragments. Research from Johns Hopkins Kimmel Cancer Center, in conjunction with the National Cancer Institute, has supported these findings by developing a technique that detects specific mutated DNA sequences. Additionally, a study out of China has identified cancer cells carry sugar molecules on their surfaces that are not found on the surfaces of normal cells. These are characteristics of all tumor cells that, with additional research and test development, can be used to create a screening tool that will detect cancer even before symptoms arise. Not only will this be crucial in increasing the overall survival rate of many types of cancer, a blood analysis test in far less invasive and inherently less expensive than many of the currently used screening tests.

The next step, as with any research study, is proven accuracy with redundancy and time. Much of this early detection research has been reported in the last twelve to eighteen months. Even with the promising accuracy of these tests on subjects within the study, the incidence of cancer developing in the test subjects, in comparison to the control groups, will have to be monitored over the next several years. Meaning, the research and the researchers will need to be funded to conclude their current studies, in addition to refining and improving their work. While no detection test for any malady can guarantee 100% accuracy, there is no reason to believe a cancer screening test could not be close to it. Ideally, equal amounts of money, time and effort could be used for treatment development and early detection test development, but it is realistically implausible. Cancer cells are known to replicate out of control without stopping and will, most likely, go undetected until the patient exhibits symptoms. There needs to be a test to identify these cells before they cause harm, before they create a physical manifestation that will lead to costly, unpleasant, and oftentimes painful treatments to eradicate them. Funding efforts and public perception need to be shifted away from finding a cure to the more feasible prospect of detecting cancer earlier and stopping it from developing into a life-changing beast.


Jason Blackson is a Clinical Laboratory Specialist, who lives in Washington, D.C., and has worked in Cytogenetics for nearly two decades. When he is not busy in the lab, he enjoys traveling the world, especially for concerts, staying fit, and telling what some would consider to be “dad jokes.”

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

3 Common Rehab Therapy Credentialing Mistakes

If your clinic and therapists aren’t properly credentialed with insurance providers, your bottom line could very well suffer.

from WebPT

Proper credentialing is a crucial step in running a successful physical therapy clinic. If your clinic and therapists aren’t properly credentialed with insurance providers from the get-go, your bottom line might suffer. And it’s not just new clinics that are susceptible to making credentialing mistakes; in fact, any clinic that has gone through a change in ownership, rapid growth phase, or any other transition might find itself mired in credentialing headaches.

Read More →

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Occupational Therapists and the Benefits of Yoga

A new study finds that incorporating the positive holistic influence of yoga practice into your OT practice could have many benefits for patients.

Over the past few decades, practicing yoga—the 5,000-year-old practice of asanas, or postures, designed to align your skin, muscles, and bone—has significantly caught on for many in the Western world, not only as a means of staying fit, but as a method of self-care. For Occupational Therapists, an increased knowledge of yoga may help to prepare them to meet the needs of clients in today’s ever-changing health care landscape. A recent study explored the perceptions of OTs and yoga practitioners on the health benefits of practicing yoga, as well as the role yoga could play within the scope of Western medicine, and found that, given the long history of yoga as a self-care strategy and its proven health benefits, there is a need to further explore incorporating yoga into the scope of traditional OT practice.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Patients Have Spoken: Online Presence Is More Critical than Ever in Healthcare

It’s official: word-of-mouth referrals are no longer sacred in healthcare.

from Becker’s Hospital Review

Eighty-one percent of patients revealed that they still conduct online research on providers they’ve been referred to, and 90 percent will choose another provider entirely if they don’t like what they see online. This shift in behavior, what some call the “Amazon effect,” marks a significant turning point in the healthcare industry.

Read More →

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

7 Opportunities for Medical Professionals to Practice Overseas

If you’re a medical professional, there are many opportunities for you to put your skills to work in another country, from working at a foreign hospital to joining the military.

by Deborah Swanson

Studying or working abroad can be a life-transforming experience, whether it’s a temporary trip or a permanent move. If you’re a medical professional, there are many opportunities for you to put your skills to work in another country, from working at a foreign hospital to joining the military.

Depending on which route you go, you may have to pass an additional licensing exam so you are certified to practice in whatever country you are going to work in, so don’t start packing your medical bag quite yet. This isn’t necessary for short volunteer trips or those working for the military (in the military, your medical license allows you to practice anywhere), but it will be required if you’re going to work for a foreign hospital or government agency. And whatever option you choose, knowing the local language is always helpful for anyone going overseas.

From the myriad options available, we’ve put together seven ways that U.S. medical professionals can practice overseas:

1. Get a Job Through the CDC

The Centers for Disease Control and Prevention (CDC) may be a U.S. government agency, but it does offer global health opportunities for U.S. citizens looking to work abroad. The CDC provides several different avenues for staff to work overseas: career civil service, U.S. Public Health Service Commissioned Corps, contracts and fellowships or internships.

The Commissioned Corps is a uniformed nonmilitary service that employs officers in 11 disciplines: dentistry, diet and nutrition, engineering, health service, nursing, pharmacy, physician practice, sanitation, science and research, therapy and veterinarian medicine. For medical students and recent graduates looking for a less permanent experience abroad, the CDC also offers internships and fellowships.

2. Recruit with Foreign Government Agencies

Similar to the CDC, health-focused government agencies in other countries are also in need of medical professionals. For example, many U.S. doctors find themselves drawn to the U.K., where the National Health Service (NHS) provides free healthcare at the point of use across England, Scotland, Wales and Northern Ireland. In fact, the NHS offers guidance on working in the U.K. for non-U.K. doctors. Not every country has a government agency that oversees care on that scale, so research what countries you’d like to live in to see if this is an option.

3. Go Through a Staffing Company

Just as there are staffing firms for other types of jobs, there are recruiting companies that solely focus on medical providers. For instance, International Medical Recruiting helps place doctors in a wide range of specialties and seniorities across Australia and New Zealand. Different staffing firms focus on different medical professions (nurses, general practitioners, etc.) as well as different countries, and there are many options out there: Google “recruiting agency” alongside your desired positions and country to bring up a whole list of options.

4. Contact a Hospital Directly

Large hospitals and medical centers have recruiters just like government agencies and foreign countries do. If there’s a particularly renowned hospital you’d like to work at, you can look up the recruiter for your specialty and reach out directly about opportunities for workers from outside the country. If the facility is large enough, it probably has its own public-facing job board that you can review regularly for open positions that might fit your skills and experience.

5. Volunteer on a Service Trip

Making a humanitarian aid trip to another country is a great way to provide much-needed medical care abroad without having to abandon your practice at home. Probably the best-known international medical non-governmental organization is Médecins Sans Frontières (MSF), known in English as Doctors Without Borders. MSF has offices in 28 countries, and its medical personnel provided 9,792,200 patient consultations in 2016, according to the website.

Doctors Without Borders is far from the only organization to offer international medical and disaster relief, and there are many other NGOs, religious organizations and even hospitals that coordinate such volunteer trips. Be sure to talk to your supervisor about time-off policies before committing to participate in a trip.

6. Join the Military

The United States military offers overseas opportunities for medical professionals, whether you’re a full-time active-duty officer or a part-time reserve officer also working in the civilian world. Missions take three forms: military medical facilities, deployments and humanitarian relief in the wake of natural disasters. All three of these missions offer the opportunity to work in another country.

Most U.S. military medical facilities are based in the U.S., but the military does maintain bases in countries such as Germany, Japan and Peru as well. For deployments and humanitarian missions, you’ll be sent where the need is greatest, which often takes service members around the world.

7. Try Out Telemedicine

The growing world of telemedicine offers a chance for you to consult on international cases — without leaving the country. While telemedicine is still developing and much of its potential remains untapped, doctors and other medical professionals are already exploring its capacity to unite healthcare providers half a world away.

In fact, in 2012 the chief of cardiology at the University of California at Davis was able to consult on a cardiology patient at Shanghai East International Medical Center in China. The doctor accomplished this by utilizing a telemedicine robot with a video screen and instruments such as an ophthalmoscope and stethoscope. The possibilities of telemedicine will only continue to expand as the technology matures, opening new ways to care for patients both stateside and overseas.

As a medical professional, you are uniquely poised to help others around the world. Given the growing global shortage of medical professionals — including physicians, nurses and other healthcare workers — many countries are actively recruiting from other nations, including the U.S. No matter how long you’ve been practicing in the U.S., it’s never too late to make a change and do medical work in another country, and this list will help you start thinking about your options.


Deborah Swanson is a Coordinator for the Real Caregivers Program at allheart.com. A site dedicated to celebrating medical professionals and their journeys. She keeps busy interviewing caregivers and writing about them and loves gardening.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

10 Interview Tips for Nurses

Interviewing for a new nursing job? Here are 10 tips to help you make sure you are well-prepared and set up for success on the big day.

by Deborah Swanson

Interviewing for a job can be nerve-wracking, especially if it’s your first job out of nursing school. However, there are several steps you can take to make sure you are well-prepared and set up for success on the big day. Here are 10 tips that can help make any nursing interview go smoothly:

1. Plan Ahead for the Interview

Research parking options and plan out your route beforehand. Google Maps desktop version has a feature that lets you forecast how long it will take to get your destination at particular times of day, such as rush hour. Check the weather and try on clothing the night before to decide on an outfit. You should wear professional clothing — suits for men and a dress or a blouse and skirt or pants for women — rather than scrubs to the interview.

If the clothing needs to be washed, ironed, steamed or starched, starting the night before will give a chance to take care of that. If you wear jewelry or makeup, choose what you’re going to wear so you’re not scrambling to figure it out the morning of.

2. Get Plenty of Sleep

Interview jitters can keep you up at night, but try to sleep as much as possible the nights leading up to the interview so you can look fresh and think more clearly. If you have trouble falling asleep, a hot bath, caffeine-free tea, eye mask and melatonin can help you relax and fall or stay asleep. Try to avoid drinking alcohol, watching TV right before bedtime and other activities that can decrease or disturb your sleep.

3. Eat and Drink the Smart Way

You don’t want your stomach to growl loudly during the entire interview, so even if you’re nervous, try to eat a few hours before the appointment. Stick to nourishing foods that you know won’t upset your stomach or otherwise cause discomfort. Try not to overly caffeinate yourself, as this will only make you jittery, and drinking too much soda can cause belching and other stomach upset. Bring a bottle of water with you in case your mouth gets dry during the interview, and get there early enough that you have time to use the bathroom if necessary.

4. Research the Company and/or Position

Knowing as much as you can about the facility and the nursing position will give you concrete information to ask questions about during the interview. It will also demonstrate to the interviewer that you are truly interested in the job and did your research beforehand — they won’t hire someone who didn’t care enough to learn about the company before the interview.

5. Ask Your Network for Advice

If you have nursing contacts who have worked at this particular company or facility, reach out to them to ask about their experience and what you should know about the company going into the interview. Even if you don’t know anyone who works at the place you’re interviewing, you should still reach out to your more experienced nursing friends for advice, especially if you’re interviewing for your first nursing job after school. They’ll be able to advise you on what questions to prepare for.

6. Practice Your Interview Answers

No matter what kind of job you’re interviewing for, you can expect some questions to pop up over and over again: Why do you want this job? What makes you qualified for this position? What are your strengths and weaknesses? Why did you choose to become an RN? Where do you see yourself in five years? Make a list of expected questions and outline some bullet points that you can use to answer them. Then practice your answers, either by yourself or with a willing helper. The point is not to memorize the answers, but rather to feel comfortable discussing the content so you won’t suddenly go blank during the interview.

7. But Remember There Will Be Some Curveball Questions

There’s no way to anticipate every single question an interviewer might ask you, so no matter how much prep work you do in advance, there will probably be one or two surprises. When this happens, take a sip of water or write down a note to give yourself a moment to think. If that’s not a possibility, you can even tell the interviewer, “That’s a really good question; give me a minute to think about it,” to buy yourself a few seconds to gather your thoughts.

8. Be Prepared to Ask Questions of Your Own

In most job interviews, the hiring manager will leave time at the end to answer any questions you may have. If you don’t have any questions ready to ask, it can seem like you haven’t done your homework on the company or that you weren’t paying attention during the interview — neither of which makes a good impression. Using your research, make up a list of questions you can ask beforehand about relevant topics, such as training programs for new nurses or scheduling requirements and patient ratios.

9. Don’t Forget That You’re Interviewing Them, Too

During interviews, it can feel like you’re on trial for a new job. But don’t forget that you’re also interviewing the company or facility to figure out if the job would be a good fit for your professional goals and interests. Asking questions will not only show that you’re active and engaged in the interview; it will also help you determine if the culture and job duties are in line with what you’re looking for.

10. Send a Thank You Note

If you have a phone interview, a quick email thank-you within 24 hours will show that you’re still interested in the position and grateful for the interviewer’s time. If you were called in for an in-person interview — especially if it’s the final round — you should send an email thank you within 24 hours as well, followed by a written thank-you within the week if you haven’t heard back.

Some people advocate for only handwritten thank-yous, but if the hiring manager is trying to make a decision within a few days, snail mail might not reach him or her in time. In all thank-you notes, be sure to reference something specific that you talked about to jog the interviewer’s memory.

Planning ahead can make the day of a big interview much less stressful. Follow these 10 steps to make sure you’re prepared to ace your nursing job interview.


 

Deborah Swanson is a Coordinator for the Real Caregivers Program at allheart.com. A site dedicated to celebrating medical professionals and their journeys. She keeps busy interviewing caregivers and writing about them and loves gardening.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

One Nurse’s Take On Travel Nursing

Jennifer Corona, BSN, RN, CCRN, sat down for an interview with us to offer some insight into the trials and triumphs of her experience with travel nursing.

We spoke with Jennifer Corona, BSN, RN, CCRN, about her decision to give travel nursing a try. Read on for some insight into the trials and triumphs of her experience.

Why did you decide to get into travel nursing?

I worked as a nurse in Connecticut for 5 years, splitting my time between Medical-Surgical nursing and Intensive Care nursing. As I was going through the nursing program, I’d encountered several experienced nurses who taught me about what travel nursing entailed. It intrigued me, as a single woman, to go see the world and enhance my career while traveling to different areas, and seeing how policies/procedures may differ. For me, the straw that broke the camel’s back was a particular shift I had in the ICU that led me to actually start researching travel companies. I got tired/burnt out of having, at times, 3 ICU patients. No matter how critical, if it’s your turn to triple, it’s your turn. We did not have laws regarding nurse/patient ratios, nor a union to fight for such a law. Later, I learned this to be true in other states.

Could you us a bit about your first assignment, and what the process was like?

My first assignment was in Los Angeles. I was annoyed at first, because I wanted to be in San Diego, which was tough at the time of the year I was trying to get there. (November was when I had inquired about travel). I knew nothing about the areas. Did not know much about the hospitals at all. I took a CCU/ICU float pool travel position. I once flew to Anaheim, CA for a nursing conference while in nursing school, but didn’t know enough about anything in CA. I knew, however, with my short stay for the conference, it was definitely something I wanted to explore further. I just didn’t know when I would pull the trigger on actually going. Once I signed the contract, I was nervous and scared. That meant it was final, and that it was time to give my notice at my job in CT, which was hard because it was my first nursing job ever. It was where I met my friends and learned everything I knew. Just picking up and moving across the country alone isn’t easy. I kept telling myself, “It’s only 13 weeks. I could always come back.” In fact, I kept my apartment in CT, just in case I hated it, so I could move back. However, it worked out. 13 weeks turned into me living in LA for 6 years and meeting my husband.

What are the benefits and drawbacks of being a travel nurse? What was most challenging? Most rewarding?

The benefit of being a travel nurse is that nothing is permanent. You’re only there for as long as you signed your contract—8 weeks, 13 weeks, not forever. The most challenging is adapting to the new hospital. Nursing is nursing, no matter where you are. As long as you know where supplies are/code cart/med room and how to get a hold of the doctor, you’re golden. It can be difficult, if you don’t have a good team of people working with you, though. A good charge nurse and fellow nurses make all the difference. When a patient acutely declines, you cannot do it all, you depend on your fellow coworkers to help, and you have to instill trust in these people, who you may have just met when you started the day before. The challenge is trusting their knowledge. The rewarding factor is the same, no matter where you work. It’s the foundation of why we become nurses. It’s all about helping and advocating for patients. Guiding them through their hospital stay. Teaching them what needs to be done or what they need to watch out for when they leave the hospital. Rewarding is watching a patient, who you thought may not make it, or someone who just arrested in front of you, end up walking out of the hospital weeks later. Knowing you were a part of that puts a reward in your heart that can’t be explained.

What surprised you the most about travel nursing? What did you learn from being a travel nurse?

I learned you have to make sure you research your travel company to the fullest. The big names aren’t always the best companies. Some of them may try to withhold money from you. You have to be firm, more direct, when negotiating your contracts with your recruiter. If not, you may be walking away with the bare minimum for pay. We, as the nurses, are the middle people; we are the demand or the pawn, in the eyes of the recruiter/hospitals, so our moves are very important, as far as what we want in our contracts.

What advice do you have for those considering becoming a travel nurse? What questions should someone ask before taking an assignment? Any tricks of the trade? Any common misconceptions about travel nursing you want to clear up?

I highly recommend researching multiple companies. Write out what each is offering—bonuses, housing stipend, moving expenses, parking, etc. You can use what other companies offer as a bargaining tool. I suggest getting your own housing. Going with the housing offered through the travel company will usually use the entire stipend—a mistake I, admittedly, made. It was nice not having to worry about paying rent, because the travel company handled that, but if you take the housing stipend, they will send you a full check and you keep whatever is left over, even if your rent is cheaper. As a former traveler, you do get floated a lot. You’re normally first to go. That is a drawback. I didn’t know that when I signed up. Also, the hospital that I first signed with is notorious for such behavior—I would even float 3-4 times a shift. Not every hospital is like this, though. I strongly recommend travel nursing. You get to see the world—literally. What other position will provide the relocation, housing, and the job? None. I encourage nurses to take this opportunity and see how other hospitals function, other parts of the world. For me, I learned the West coast is the place for me, including their nurse/patient ratio laws. Hence the reason a 13 week assignment turned into 6 years for me.

Interested in sharing some insight about your specialty and experience with your fellow nurses? Email us to set up an interview.


Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

A “Well-regulated Militia”: Can Doctors Prevent Gun Violence?

Family physicians have long recognized that gun violence is a national public health epidemic. Do they also hold the key to stopping it?

from Common Sense Family Doctor

Family physicians have long recognized that gun violence is a national public health epidemic. In 2015, a coalition of nine medical, public health, and legal organizations, including the American Academy of Family Physicians and the American Bar Association, endorsed several specific recommendations for preventing firearm-related injury and death. These measures included universal criminal background checks for all firearm purchases; educating patients about gun safety and intervening in those at risk of self-harm or harm to others; improving access to mental health care; regulating civilian use of firearms with large capacity magazines; and supporting more research on evidence-based policies to prevent gun violence. A 2014 editorial in American Family Physician also reviewed the role of primary care clinicians in counseling about gun safety based on the best available evidence.

Read More →

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Are Doctors Bribed by Pharma? An Analysis of Data.

An in-depth look at a recent paper that explores correlational data relating opioid prescribing to opioid manufacturer payments.

from The Health Care Blog

Association studies that draw correlations between drug company-provided meals and physician prescribing behavior have become a favorite genre among advocates of greater separation between drug manufacturers and physicians. Recent studies have demonstrated correlations between acceptance of drug manufacturer payments and undesirable physician behaviors, such as increased prescription of promoted drugs. The authors of such articles are usually careful to avoid making direct claims of a cause-effect relationship since their observations are based on correlation alone. Nonetheless, such a relationship is often implied by conjecture. Further, the large number of publications in high profile journals on this subject can only be justified by concerns that such a cause-and-effect relationship exists and is widespread and nefarious. In this article, we will examine a recent paper by Hadland et al. which explores correlational data relating opioid prescribing to opioid manufacturer payments and in which the authors imply the existence of a cause-and-effect relationship.

Read More →

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

More Nurse Practitioners Now Pursue Residency Programs To Hone Skills

There is a growing cadre of nurse practitioners who tack on up to a year of clinical and other training, often in primary care.

Michelle Andrews

The patient at the clinic was in his 40s and had lost both his legs to Type 1 diabetes. He had mental health and substance abuse problems and was taking large amounts of opioids to manage pain. He was assigned to Nichole Mitchell, who in 2014 was a newly minted nurse practitioner in her first week of a one-year postgraduate residency program at the Community Health Center clinic in Middletown, Conn.

In a regular clinical appointment, “I would have been given 20 minutes with him, and would have been without the support or knowledge of how to treat pain or Type 1 diabetes,” she said.

But her residency program gives the nurse practitioners extra time to assess patients, allowing her to come up with a plan for the man’s care, she said, with a doctor at her side to whom she could put all her questions.

A few years later, Mitchell is still at that clinic and now mentors nurse practitioner residents. She has developed a specialty in caring for patients with HIV and hepatitis C, as well as transgender health care.

The residency program “gives you the space to explore things you’re interested in in family practice,” Mitchell said. “There’s no way I could have gotten that training without the residency.”

Mitchell is part of a growing cadre of nurse practitioners — typically, registered nurses who have completed a master’s degree in nursing — who tack on up to a year of clinical and other training, often in primary care.

Residencies may be at federally qualified health centers, Veterans Affairs medical centers or private practices and hospital systems. Patients run the gamut, but many are low-income and have complicated needs.

Proponents say the programs help prepare new nurse practitioners to deal with the growing number of patients with complex health issues. But detractors say that a standard training program already provides adequate preparation to handle patients with serious health care needs. Nurse practitioners who choose not to do a residency, as the vast majority of the 23,000 who graduate each year do not, are well qualified to provide good patient care, they say.

As many communities, especially rural ones, struggle to attract medical providers, it’s increasingly likely that patients will see a nurse practitioner rather than a medical doctor when they need care. In 2016, nurse practitioners made up a quarter of primary care providers in rural areas and 23 percent in non-rural areas, up from 17.6 and 15.9 percent, respectively, in 2008, according to a study in the June issue of Health Affairs.

[khn_slabs slabs=”790331″ view=”inline”]

Depending on the state, they may practice independently of physicians or with varying degrees of oversight. Research has shown that nurse practitioners generally provide care that’s comparable to that of doctors in terms of quality, safety and effectiveness.

But their training differs. Unlike the three-year residency programs that doctors must generally complete after medical school in order to practice medicine, nurse practitioner residency programs, sometimes called fellowships, are completely voluntary. Like medical school residents, though, the nurse practitioner residents work for a fraction of what they would make at a regular job, typically about half to three-quarters of a normal salary.

Advocates say it’s worth it.

“It’s a very difficult transition to go from excellent nurse practitioner training to full scope-of-practice provider,” said Margaret Flinter, a nurse practitioner who is senior vice president and clinical director of Community Health Center, a network of community health centers in Connecticut.

“My experience was that too often, too many junior NPs found it a difficult transition, and we lost people, maybe forever, based on the intensity and readiness for seeing people” at our centers.

Flinter started the first nurse practitioner residency program in 2007. There are now more than 50 postgraduate primary care residency programs nationwide, she said. Mentored clinical training is a key part of the programs, but they typically also include formal lectures and clinical rotations in other specialties.

Not everyone is as gung-ho about the need for nurse practitioner residency programs, though.

“There’s a lot of debate within the community,” said Joyce Knestrick, president of the American Association of Nurse Practitioners. Knestrick practices in Wheeling, W.Va., a rural area about an hour’s drive from Pittsburgh. She said that there could be a benefit if a nurse practitioner wanted to switch from primary care to work in a cardiology practice, for example. But otherwise she’s not sold on the idea.

A position statement from the Nurse Practitioner Roundtable, a group of professional organizations of which AANP is a member, offered this assessment: “Forty years of patient outcomes and clinical research demonstrates that nurse practitioners consistently provide high quality, competent care. Additional post-graduate preparation is not required or necessary for entry into practice.”

“We already have good outcomes to show that our current educational system has been effective,” Knestrick said. “So I’m not really sure what the benefit is for residencies.”


Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.