Laws in more than half the states are likely to prevent NPs from using their licenses in rural areas that need it most.
from The Pew Charitable Trusts
Confronting an opioid overdose epidemic that is killing at least 90 people every day, two federal agencies this month gave more than 700 nurse practitioners and physician assistants the authority to write prescriptions for the anti-addiction medication buprenorphine.
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.
Discussing end-of-life wishes is exceptionally difficult, for us as providers, as well as patients. However, if we can give a last bit of dignity to that person in the end of life, we’ve done an extraordinary thing.
by Kimberly Spering, MSN, FNP-BC
I met this patient on an early spring day. The snowstorm of the past month was but a distant memory. It took me a few passes by the driveway to realize that, yes, this was the home of my patient. I drove up to the house, spaced back from the main road, with parking signs noted about 50 feet from the abode.
Gathering my computer bag and backpack with my medical supplies, I walked up the graceful arch of the front walk. Ringing the doorbell, I braced myself for the inevitable nuances of a first visit in my palliative NP role.
After my introduction, the patient’s spouse graciously welcomed me into their home of 60 years. A medical professional in his past life, my role was understood and welcomed. That doesn’t always happen in my work… but I appreciated the ease with which I was accepted into their home.
After a dissecting thoracic aneurysm and subsequent severe CVA, the patient had spent months in a skilled nursing facility. Quite honestly, the patient had the proverbial “nine lives” of a cat, given her medical set-backs. The spouse journeyed to the nursing home three times daily to feed her. Why? “No one else will take the time.” After many long months of care, the insurance was running out. “It would cost me over $500 daily to keep her there. I want to care for her at home.” So, she was discharged from the skilled nursing facility to the home that she stayed in since her marriage.
I met this lovely woman, a shell of her previous existence, but yet…she maintained the spark of her intelligence, even if her body could not respond in kind. She had visual deficits and could only track from one side. I positioned myself on her good side to talk with her. Her words were few, her gestures limited… but still, I could sense the proud, dignified woman that she had been prior to her illness.
“I want to help you… to manage your symptoms, and to help you achieve your goals of care. Tell me what is most important to you at this time.”
Her words were limited. Her husband filled in the details. I sensed his exhaustion from the past many months of care… trying, unsuccessfully, to have her return to her former level of functioning. He was not initially willing to acknowledge her level of disability. Slowly, I discussed her overall status.
“I’m concerned that she is having symptoms that are not controlled. I am worried that her health situation is grave, and that if something unexpected happens, that she will not survive. Has she discussed her end-of-life wishes if her health deteriorates?”
Slowly, in a trance, he looked up at me. The emotion of relief washed across his face. “No one has talked about this… until now,” he said. “I’m worried about what will happen if she declines. I know that she will not survive.”
Gently, I discussed her end-of-life wishes. Reiterated that a “no code” status does not mean “no care.” I know that I personally would not want to live in that boxed-up state for any amount of time. He was frank, almost outspoken in his words about her wishes. I documented these issues for future use.
However, at this point, he wanted everything possible to be done at this point, including full code status. We discussed the ramifications of what running a code would entail for her. No matter — this was his wish. She agreed with him. And we will honor her wishes. However, honestly, the chance of survival in a code scenario is slim-to-none. All I could do is document this discussion and the response.
So what is a “life worth living?” Is it someone who is but a shadow of her prior experience? Is it someone with full capacity, but physical limitations? Or… is it someone who says “life is worth living in this moment,” no matter what that moment may be. It may not be your or my moment… nor our own decision, but rather, someone who chooses LIFE, no matter what the experience, what the cost. A life worth living is determined by EACH individual, in EACH situation. We may have a different perspective on that issue, but our own experiences affect our reactions. We owe it to our patients to ask those tough questions.
I encourage you to discuss these issues with your patients, particularly if they have an end-of-life illness. So often, I hear, “I don’t have time to discuss these issues.” I get it, having worked in an office setting most of my NP career. However, Medicare now reimburses you for these discussions, which, quite frankly, may be the most important ones you have with your patients.
Discussing end-of-life wishes is exceptionally difficult. Most of us don’t like to imagine that scenario. It’s uncomfortable for us as providers, as well as patients. However, if we can document a patient’s wishes, and give a last bit of dignity to that person in the end of life, particularly if he/she is unable to verbalize those wishes — we’ve done an extraordinary thing.
I challenge you to look at your chronically ill patients. Think about opening the conversation with these questions regarding serious illness:
These serious conversation questions are crucial to open conversations and begin dialog with patients. Try asking these questions. It gets easier, the more often you do it. And…your patients and families will thank you.
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.
Even physicians learn to love a program that could provide a lifeline for hospitals struggling to find doctors.
from Hospitals and Health Networks
Hospitalist programs, common in medium-sized and large hospitals for years, have been too costly for many smaller and rural hospitals to adopt. But a new model using nurse practitioners opens the door for small and critical access hospitals, in some cases with dramatic results for patient outcomes and patient satisfaction, as well as for physician retention rates. They could even be a key to the survival of some of America’s most challenged hospitals.
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 can guide patients to optimize care and support at the end of life.
NPs care for patients with chronic diseases such as heart failure, chronic obstructive pulmonary disease, cancer, and dementia. As the disease progresses or patients age, disease-related symptoms may become increasingly burdensome, and these patients may benefit from hospice or palliative care. NPs can guide individuals in this process to optimize care and support at the end of life.
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 and physician assistant salary and job satisfaction rates increased in 2016, a new survey found.
As nurse practitioner and physician assistant salary rates continue to rise, a recent PracticeMatch survey found that more advanced practitioners are also increasingly enjoying their jobs. The survey of over 1,000 nurse practitioners and physician assistants found that about half of the clinicians experienced a boost in income between 2016 and 2015, with 12 percent reporting an increase in compensation of 8 percent or higher.
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.
from Clinician1
How do NPs and PAs measure their worth, when they can only bill at 85%?
by Dave Mittman, PA, DFAAPA
In all societies, consumers are generally able to judge what to pay for each service they request. And the market sets the fees. Shoe shining. Car repairs. Tires. A haircut. All are judged by their relative worth. Having someone clean your house is worth what it is worth to you because you have the money to pay someone for a service you can measure. A clean house is worth something to you. So are shined shoes or a good haircut.
We in medicine do not have that luxury.
How much each patient pays for a service has no natural relationship to the value of the product the health professional “provides”. How does the consumer ever get to judge whether the product they are buying is worth the price they are paying any healthcare provider? Treating hypertension successfully? Cholesterol? A spinal manipulation? Is it worth what the insurance company is billed and the patient’s co-pay? New glasses that are a bit better than your old glasses? Worth it? Psychotherapy you went to for six months at $180.00 an hour and your not even sure what you got out of it? Worth it? How about therapy that saved your child from cutting themselves or worse? Successful cancer treatment? Strep throat, seeing an NP or PA and getting Augmentin? What is really worth the price paid and the asking price of the practitioner? What is naturopathy worth when it does not work, or allopathic medicine for that matter?
How do you measure our worth? Is it what we charge? Clearly, we PAs and NPs, over the last 50 years, have kept health costs down. We would not have been hired had we not saved the system or our practice money. I know we doing that now but who ultimately benefits? Do we even know our own worth?
Does the consumer have any way to measure that worth at all? And is what NPs and PAs charge worth 85% for the same service charged at 100% by a physician? And if it is billed at 100% because of laws put into effect decades ago, is it really worth our professions being kept invisible?
So that is the crux of my question. Yes, we charge less for the same treatment if we give it “alone” in many cases. And, in theory that saves the system money. But it also robs us of our soul. Why, because most health systems don’t want us to charge less for the same service, so they have “the doctor” pop in for what amounts to less than one minute and “consult” thereby presumably guaranteeing the 100% reimbursement to the system. It also guarantees us two things. One is that we look like we are being checked up on. I see NPs and PAs for my care. Invariably, at least now in Florida, a physician will say hello and ask me one question. The PA or NP will determine my treatment and diagnosis and write the prescription, invariably before the physician pops her head in. But it seems like they consent. And that is not really the case. WE also become invisible to the government, to Medicare or Medicaid, to the private insurers who think (seemingly so) that the patient in question was seen by a physician. The biller knows no less. This has to end.
I can’t think of any other professions where that happens in the same way. It’s time we PAs and NPs worked together to change it. It keeps all of us invisible. It was never the intent of the 85% rule. It confuses patients and it robs us of our soul. And that my colleagues, is never a good thing.
Dave Mittman has been a PA and later NP leader for thirty years. He co-founded the LIU PA Program student society, was President of the New York State Society of PAs from 1978-1979 and served on the American Academy of Physician Assistants (AAPA) Board of Directors from 1981-1983. Dave was also the first USAF Reserves PA permitted to practice. Dave spent 9 years in primary care in Brooklyn, N.Y. and left to begin a career in medical publishing with Physician Assistant Journal. Dave has also won the AAPA Public Education award for leading the march in Trenton NJ to establish PA practice. Dave left PA Journal to co-found Clinicians Publishing Group (1990) and Clinician Reviews Journal in 1991. Dave has authored papers in publications as diverse as “Chicken Soup for the Expectant Mothers Soul”, “U.S. Pharmacist”, “The British Medical Journal” and others. Dave¹s paper in the BMJ was the first internationally written paper written on PA practice. Dave and a few very close PA colleagues co-founded the PAs For Tomorrow”” in 2012 which is a new national professional organization representing and advocating for PAs in an different way. Dave as spoken at hundreds of NP and PA meetings and always has some interesting thoughts on the future of both professions. Most recently Dave has been busy launching another dream; Clinician 1, the first internet community for PAs and NPs. Dave is married to his sweetheart Bonnie for 32 years and has two wonderful children.
In community health centers, PAs and NPs deliver care equivalent to that of primary care physicians, according to a new first-of-its-kind study.
from Contemporary Clinic
Under the Affordable Care Act, there’s a growing dependence on community health centers in the United States—particularly among medically underserved areas that typically serve low-income, uninsured, minority, and immigrant populations. As a result, the health care system is increasingly relying on non-physician clinicians to provide primary 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.
AANP applauds South Dakota for aligning with neighboring states to provide patients full and direct access to nurse practitioners.
from AANP
The American Association of Nurse Practitioners commends Governor Daugaard and the South Dakota Legislature for enacting into law Senate Bill 61, which provides patients with full and direct access to nurse practitioners. By adopting the law, South Dakota becomes the 22nd state to authorize nurse practitioners to provide the full scope of services they’re educated and clinically prepared to deliver, and it retires the Board of Medicine oversight of nursing practice. These changes will significantly enhance patient access to high-quality health care.
“Jobs at the top end, like doctors, surgeons, specialists, highly qualified nurses, physician assistants and others, will continue to be in demand for years.”
from The Chicago Tribune
“While it’s true that there are numerous jobs in health care that will be in demand for years, if not decades, because of an aging community, people often overlook jobs because they focus on the inner workings of hospitals and medical facilities — the technologists, the assistants, the technicians,” says Joan Stanley, analyst for the U.S. Department of Labor. “Jobs at the top end, like doctors, surgeons, specialists, highly qualified nurses, physician assistants and others, will continue to be in demand for years.”
