Survey: Most Nurse Practitioners Help Decode Medical Info for Their Patients

88% of NPs surveyed said they spend at least half of appointment times educating patients on diagnoses, treatments, and prescriptions.

from Drug Store News

Nurse practitioners play a crucial role in helping patients decode medical information, according to the findings of a recent Merck Manuals survey. The survey of 210 NPs, conducted at a recent medical conference, revealed that most (88%) believe they spend at least half of appointment times educating patients on diagnoses, treatments and prescriptions.

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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.

NPs Get Stressed, Too! How They Can Manage It.

Being a Nurse Practitioner can be physically taxing and emotionally arduous. Here are 11 self-focused strategies to reduce that stress.

from Contemporary Clinic

In recent years, nursing and advanced practice nursing have made great strides in the public’s awareness of their profession. Nurse practitioners are appearing more often in the media, greater numbers of college students are choosing nursing as a career, and more patients have an NP as their health care provider. A career in nursing also has become well known for its job security, opportunities for growth, and competitive wages. In addition to these excellent job attributes, the public often views nursing in a favorable light, as evidenced by a consistent number-one ranking in the Gallup poll for most trusted profession and some positives stereotypes, such as the nurse angel or hero. But at what cost?

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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 NPs Choosing Primary Care

In 2017, more than 89% of NPs were prepared in primary care programs.

from Clinical Advisor

Nurse practitioners are choosing primary care at a higher rate than physicians and physician assistants, according to data from the American Association of Nurse Practitioners.

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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.

Nurse Practitioners Can Ease Discharge Process

A meeting with a nurse practitioner prior to discharge could improve the discharge process for patients.

from FierceHealthcare

A meeting with a nurse practitioner prior to discharge could improve communication between hospital staff and primary care providers, easing the transition after hospitalization and improving patient outcomes.

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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.

Does a Doctorate of Nursing Practice Make a Difference in Patient Care?

The question of whether the DNP impacts patient care has arisen among many NPs who hold those DNPs.

from JNP

To date, a large number of doctorate of nursing practice (DNP) degrees have been earned by nurse practitioners (NPs) with experience as master’s prepared clinicians. Among those of us who find ourselves in this situation, the question of whether that DNP has affected our patient care has arisen. In my own case, as a graduate of a DNP program designed specifically for experienced master’s prepared nurses, I like to think that my DNP program changed my thinking, my approach to problems, and maybe even to life generally. That is what doctoral degrees are supposed to do—orient us toward knowledge synthesis and development and, in the case of nursing, to develop and apply theoretical contexts that help us to understand our work and deliver care. Do those same contexts apply to our clinical knowledge and approach to our patients?

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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.

Nurse Practitioner Demand Eclipses Doctors As States Lift Hurdles

Nurse practitioners are more in demand than most physicians as states allow direct access to patients for these increasingly popular health professionals.

from Forbes

Only family physicians, psychiatrists and internists are more in demand than nurse practitioners, according to the latest snapshot into the U.S. health care workforce from MerrittHawkins, a subsidiary of AMN Healthcare. Merritt’s annual analysis of its database of more than 3,200 searches over a year’s time shows nurse practitioners cemented in the top 5 most requested searches.

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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.

Kim’s Blog: What Patients Want: Recognize My Individuality Despite My Chronic Illness(es) and Value Me as a Patient

We need to look at people individually. Get to know the person behind the office or hospital visit. Ask the questions to help provide the best care.

by Kimberly Spering, MSN, FNP-BC

All is not as it may seem… on first appearances.

I met J., a gentleman not one decade older than I am, on the first real “spring” day in May. I’d reviewed his extensive chart and multiple hospitalizations before I did the visit. What I read was disheartening, sad, and oh-so-hopeless at first.

He was diagnosed over 20 years ago with a disorder causing idiopathic arterial clotting. In the subsequent two-plus decades, he had multiple amputations… starting from the toes, to feet, to lower and upper limbs. At the time of my visit, he was a triple-amputee with one thumb and forefinger remaining. Of note, he could not USE those digits, being “frozen” of sorts. He has chronic, unrelenting pain. A horrific, stage 4 sacral and gluteal ulcer that has been surgically debrided multiple times. A colostomy and suprapubic catheter to divert stool and urine away from the ulceration. Anxiety and depression (and who wouldn’t have this, given everything?).

Incidentally, he had signed out AMA on multiple occasions after surgical debridement of the sacral/gluteal wound. What was worse, he was labeled “non-compliant on many occasions.” He tried to leave AMA on this last admission (mind you, without legs) and fell to the floor from his hospital bed.

I sensed the frustration in the hospital notes from multiple providers. The feeling I got, reading these notes, was “Oh well, he left AMA.”

The first thing his wife said upon my introductions was, “I bet you want to ask about why he left AMA.”

“Actually, no — that wasn’t going to be a topic initially. Would you like to talk about it?” I asked.

It turns out, he felt most comfortable being cared for by his wife and daughters…not strangers whom he felt “judged him,” looked at him as though he was a circus side-show act, and doctors who he felt didn’t make an effort to understand his rationale for leaving AMA. I’d daresay, if I had suffered the indignities he had, I’d have left AMA as well.

“The fact is, after he has his surgical debridement, he just wants to go home. That’s it. He’s not trying to be difficult,” his wife told me.

Unfortunately, he has needed multiple debridements of this wound. Upon my exam today, it was obvious it needed surgical debridement again. Despite a wound-vac placement, the amount of drainage and odor was unbelievable. I can say this was the worst wound that I’ve personally witnessed in 26+ years of nursing.

We discussed the barriers to his getting care, to his leaving AMA, his protein deficiency, dietary limitations, and likeliness that this wound would never heal. His wife started crying, then thanked me. “I’ve asked the doctors to be straight with me about this wound. I’ve been told, ‘it will heal.’ All I want is the truth.”

Couple this with the fact that he has chronic pain with a myriad of sources: embolization, DVT, neuropathy, ulcerations, etc. He uses marijuana 1 – 2 times per day to help with his pain and anxiety. He has multiple allergies to narcotics. His daughter, seeing him writhing in pain one day, told him, “I can’t stand to see you like this,” and gave him one of her Percocet. This helped his pain. Ironically, when he and his wife told this to providers, he was immediately labeled as a “drug addict” and abuser. As a result, no one was comfortable prescribing narcotics.

I found myself getting angry about how this had panned out. I’m not one to judge another provider, and honestly, I know if I had only seen the “AMA” sign-out multiple times, hearing about using a narcotic from someone else, without hearing the “whole” story, I’d be jaded as well.

Let’s think about this situation for a moment. A virtual quadriplegic patient that has no use of any limbs. Chronic pain. Severe muscle spasms and restless leg syndrome. Severe depression and anxiety. No end of this pain in sight, and likely to endure multiple more debridements, more amputations, and a lower quality of life than any of us could imagine.

Is it any wonder why the patient and his wife were frustrated? And yes, I GET that I, in my palliative, home-based NP role, I have the luxury of time to spend, to figure out the nuances of the individual situation, and to SEE the WHOLE person.

One cannot easily determine these issues during an office visit or hospital stay, without spending a lot of time getting the information. I GET it.

However, his case proves again (to me at least) that we need to look at people individually. Get to know the PERSON behind the office or hospital visit. ASK the questions to help provide the best care.

Anyone with chronic pain will tell you…there are days where you will do ANYTHING to get relief – legal or not. I don’t really care if he’s using marijuana to help his symptoms. I don’t care if his daughter, out of desperation, gave him one Percocet. I AM willing to work with him to develop a comprehensive plan for managing his pain, depression, and anxiety. I counseled him on the need for ONE provider to prescribe pain medication. No diversion, lost prescriptions, or “excuses.”

His wife cried. “I am so grateful that you believe us.”

I changed his antidepressant to one to affect his depression, anxiety, and neuropathy. I prescribed his Dilaudid under strict parameters. I corresponded with his PCP and surgeon about his worsening wound and need for debridement. I also counseled the patient that, when he was admitted again, it would be a good idea to try to stay for the duration of treatment, rather than sign out AMA. Not everyone (if anyone) will read my notes about his reasons for signing himself out. He deserves comprehensive, NON-JUDGEMENTAL care from all arenas.

I daresay none of us can imagine the living HELL that he experiences on a daily basis. We don’t want to personally experience his intimate details of his pain, depression, anxiety, or perceived bias from other health care providers.

Perhaps, we should just remember the following:

I have a chronic illness.

It’s not contagious.

I’m not lazy.

I’m not faking.

I hate to cancel plans.

I’m not a hypochondriac.

I’m not crazy.

I’m not weak.

I want to work.

I don’t enjoy this.

I’m not an addict.

I’m not looking for attention.

I have a chronic illness.

Don’t judge.

Show support.


Kim Spering has been a nurse for over 25 years and worked as an NP over the past 15 years in Family Medicine, Women’s Health, Internal Medicine, and now Palliative Medicine. She serves as an editorial board member of Clinician 1 and submit blogs to the website, with a goal of highlighting both the clinician and patient experience in health care.

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.

Do NP, PA Ordering Habits Lead to Higher Healthcare Costs?

A study found that primary care provider ordering habits may result in higher healthcare costs versus the habits of nurse practitioners and physician assistants.

from RevCycleIntelligence

Nurse practitioners and physician assistants did not contribute to higher healthcare costs by ordering more ancillary or expensive services compared to primary care providers, a recent American Journal of Managed Care study uncovered.

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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.

Kim’s Blog: Circling Around Difficulties in Obtaining Patient Care

Advocating for patients’ needs is crucial. Are you up to the task?

by Kimberly Spering, MSN, FNP-BC

It was a late winter day when I met “J,” a patient who had already endured so much in her lifetime, and one who made me shudder with the thought of someday meeting the same fate.

“J” had suffered a CVA in 2002, resulting in dysphagia, aspiration, and the placement of a PEG tube for nutritional support. Over the years, she went from being ambulatory to bed-bound for the past three years. “She just stopped walking one day,” I was told. She had expressive aphasia, severe extremity contractures from immobility, and the worst unstageable skin ulcer I’d seen in 26 years of practice.

The unbelievable stench of that wound met me as I walked half-way up the steps of the row home. Let me say, there is very little that makes me nauseous. After all, working in critical care, trauma, and in patients’ homes with less-than-stellar cleanliness, it takes an awful lot to make my stomach turn. I’ve discussed autopsy results and trauma incidents during dinner without batting an eyelash. But my stomach twisted and churned on that day.

I sat on the floor of the tiny, 8-foot square bedroom, because there was no room for a chair, and I was afraid to sit on the bed, which had seen better days and probably had a plethora of bacteria and secretions. Unfortunately, that also meant that I sat by the waste basket which held the soiled wipes and dressings from the wound care change. No matter. I set out to do what we palliative home-based NPs do.

Her left hip wound was unstageable, bleeding, and draining purulent drainage. She would only lie on her left side; the aide and family noted that she grimaced and appeared to silently scream while lying on her right side, so they kept her on the left side, no matter what. We discussed her poor nutritional status, the unlikeliness for the wound to ever heal, and the possibility of signing on to hospice care, which she definitely qualified for. Her daughter wanted to discuss the issues with her siblings. On the follow-up visits, they wished for the patient to remain home and not pursue hospice at that point.

Over the course of three visits, her situation and wound worsened. I had asked for her PCP to order home-based wound care nurse visits to try to help the wound bed as much as possible. Despite multiple phone calls and messages through the EMR, every time I returned, no wound care was ordered.

One day, I opened up my EMR to find a message from nurse who worked with the PCP. “J” has not had a visit in two years; we will not write orders for wound care.”

Um, never mind that the patient was bed-bound and getting her out of bed to a wheelchair was impossible. Never mind that I offered to document the face-to-face visit to demonstrate the need for care. My repeated pleas fell on deaf ears.

I messaged a wound care NP and asked for a “curb-side consult” about treatment, after describing her wound in detail. She was gracious enough to lend her expertise and advice, and the medication was ordered. However, I wanted someone in the home to evaluate the patient and follow-up on her care.

So, as we do when faced with obstacles, I had my staff order the nursing wound care consultation under my collaborating physician. I don’t like to do that, but frankly, I’ll do what needs to be done for the patient’s benefit. Since Medicare does not allow us home-based NPs to order wound care, we sometimes work around the system in a legal fashion.

Fast forward a few weeks. I received a phone call from the clinical manager of the home care agency. “My nurses went out and are appalled at the home situation and gravity of “J’s” wound. Do you think it would be appropriate to admit her to the hospital for evaluation & treatment, then pursue hospice?”

I agreed with this request. She and the nurse made a home visit to the patient & daughter, explaining their concerns about the need for more advanced care and hospice services. The patient was admitted. I facilitated an inpatient palliative consultation with the patient and family. Ultimately, hospice services were initiated, and the patient was transferred home to receive this extra layer of supportive care.

What frustrates me to no end is the lack of continuity of care in this case. The PCP was the one to order our home-based palliative care consultation. My information and notes were shared with him monthly. I sent separate messages and made phone calls to the PCP…without getting any orders.

The biggest hold-up, from what I can tell, was from the clinical staff nurse who looked at her appointment history and decided, on her own, that no orders were to be given. I reviewed all of those notes: the physician was NEVER informed of my phone calls requesting orders; or at least, there was no mention of his notification in the chart. To make matters worse, IMHO, the person making this decision to not provide a consultation was a NURSE. Not an MA or other assistant. But someone who should have clinical decision-making to look at an individual case and decide to take it further with the provider. What was equally as disturbing is that all of my personal emails to her PCP went unheeded.

Yes, there are “rules” about giving orders, refills, etc., for patients who have not been seen recently.

However, c’mon! A bed-bound, frail, 70-pound lady who can’t get into a wheelchair? Can you, say, be an advocate for personalized care?

I’m frustrated at the nurse’s lack of understanding…compassion…whatever you want to call it. I’m frustrated by the “system” who reportedly makes these “rules” about not ordering things if the patient hasn’t been seen. Yes, I get the liability factor. I’m frustrated at the multiple attempts at communication to this PCP – unheeded.

When, if ever, will the health care “system” look at patients individually? I do, every day. I have to. My position necessitates it, because patients will fall “out of the box” frequently. I suspect most of us try to do that. But the “system” obstacles can seem insurmountable.

Ultimately, the patient had to be admitted to secure hospice services and the extra layer of support. How much did that cost?

Look at your own practice. Do you see issues that you can intervene to make a difference? It may not be a severe wound in a bed-bound patient. It may be a barrier that patients face – getting appointments to specialists, ordering DME equipment, coordinating care, ordering necessary medications, etc.

We cannot afford to just follow the “status-quo.” These are patients with multiple, often seemingly-insurmountable problems. Lend your voice to those who need one. Support your patients to get the care that they need and deserve.

If our efforts help even one patient, stuck in the quagmire of medicine “rules,” our patients and our own conscience will thank you for your efforts.


Kim Spering has been a nurse for over 25 years and worked as an NP over the past 15 years in Family Medicine, Women’s Health, Internal Medicine, and now Palliative Medicine. She serves as an editorial board member of Clinician 1 and submit blogs to the website, with a goal of highlighting both the clinician and patient experience in health care.

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.