The Nurse Practitioner’s Place

It’s Nurse Practitioner’s Week and I hope that everyone has a favorite NP to congratulate! Enjoy the slideshow!

I try not to include entire posts while commenting on stories, but I felt it needed to be read in it’s entirety to understand my angst. Please look for my responses mixed into the article in bold.

Council for the Advancement of Comprehensive Care and National Board of Medical Examiners Announce New Certification Examination for Doctors of Nursing Practice

NEW YORK–(BUSINESS WIRE)–The Council for the Advancement of Comprehensive Care (CACC) and the National Board of Medical Examiners (NBME) today announced that they have reached an agreement to develop and administer a Certification Examination for Doctors of Nursing Practice (DNP). This competency-based examination, which will be administered to DNP graduates for the first time in November 2008, will assess the knowledge and skills necessary to support advanced clinical practice. It will be comparable in content, similar in format and will measure the same set of competencies and apply similar performance standards as Step 3 of the United States Medical Licensing Examination (USMLE), which is administered to physicians as one component of qualifying for licensure.

At first, I was very excited upon hearing about a DNP in order to help us advance to the next level but:

The Doctor of Nursing Practice degree was developed in 1999 to respond to a national need for increased access to comprehensive patient care. More than 200 schools have or plan to establish a DNP program. This degree builds on nursing licensure as an advanced practice nurse by adding expanded knowledge and skill in nursing and medical aspects of care for complex illness. The growing burden of chronic illness in the United States will require an even greater focus on collaborative and team-based care.

DNP certification is a three-part process. Candidates must attain licensure as advanced practice nurses, graduate from a DNP program, and successfully complete the CACC Doctor of Nursing Practice Certification Examination. In addition to completion of the DNP educational program, a passing score on the DNP Examination is intended to provide further evidence to the public that DNP certificants are qualified to provide comprehensive patient care. CACC will also focus its efforts on working within the nursing communities to define standards of care as well as develop and implement policies and procedures for monitoring the performance of individuals certified as DNPs, including their patients’ outcomes.

The Council for the Advancement of Comprehensive Care (CACC) was established in 2000 to further the development of standard clinical competencies for graduates of Doctor of Nursing Practice (DNP) programs. The Council determined that a national certification process would provide the public with a reliable way to identify advanced nurse clinicians with the DNP degree who can provide comprehensive care. Council membership is comprised of nurses, physicians, health care organization representatives and health and public policy experts.

The NBME is an independent, not-for-profit organization that provides high-quality examinations for the health professions. Protection of the health of the public through state of the art assessment of health professionals is the mission of the NBME, along with a major commitment to research and development in evaluation and measurement. The NBME was founded in 1915 because of the need for a voluntary, nationwide examination that medical licensing authorities could accept as the standard by which to judge candidates for medical licensure. Since that time, it has continued without interruption to provide high-quality examinations for this purpose and has become a model and a resource of international stature in testing methodologies and evaluation in health professions.

Rubenstein Communications, Inc.
Adam Pockriss, 212-843-8286
apockriss@rubenstein.com

This is implying that Master’s level NPs are not capable of giving comprehensive care to our patients? I am offended by this statement. I don’t feel the need to continue my education in a college setting in order to do what I already do on a daily basis very well. My patients receive comprehensive, family practice primary care without feeding the University machine. I don’t think taking a medical doctor type of exam is going to give us any more credence that an exam written specifically for NPs. Until I see a real need to go further, with real proof that we benefit from doing the DNP, I will watch and wait.

Come into office. Check phone and desk for messages. Check the labs that came across from the day before, and write out instructions on lab letters to be sent back to the patients. Draw labs on patients that my nurse can’t “hit”.

New pt visit 30-45 minutes: Complete history, including medical, surgical, and family history. Head to toe review of systems. Head to toe physical exam. Address any new symptoms or chronic symptoms. Refill or write any prescriptions needed. Educate about all disease processes and about what each prescription is for. Review if any preventative care has been completed such as mammogram, Pap, colonoscopy, bone density, etc. Request record release so that I can obtain prior records to review. Ask is there is anything else that they wanted to ask me. Explain our “open access scheduling (same day) to set up follow up. Off they go!

Next visit (established 15 minutes)- Medication review, ask if any changes in ROS since last visit. Address new problem or review established problems. Review any test results since last visit. Reinforce education about disease processes.

This process happens throughout the morning until 12:00 when we break for lunch. I usually eat in 30 minutes (left over from the hospital days- eat fast whatever is available). Use the rest of the lunch break to do any of the never ending paperwork.. I REALLY HATE THIS PART!

See patients throughout day varying from pediatrics to geriatrics. I also see minor emergencies such as I&D, suturing, stapling etc. Refer to Emergency Department any cases needing such expertise (You’re up all you emergency room nurses! Keep my patients safe and healthy!) We often get cases as a walk in basis that are serious because patients wait too long before being seen. That’s a story for the next edition..

04:15-05:00- Email or call my collaborating MD to discuss any difficult cases dealt with during the day. Return other physician phone calls if arise. Read through consultation notes received. Discuss the cases encountered during day with my nurse to encourage her to expand her knowledge base as well as pick her brain when needed.

That’s pretty much a day in the life of a Family Nurse Practitioner. I love my job and really enjoy building relationships with my patients and watching them respond to the treatments I recommend. I am taking care of entire families now and that’s what it’s all about!

I had a question at my other blog site that I thought would be a great post for this one. 

If an individual is a Respiratory Therapist (RT) with an associates degree (with the possibility of doing an online completion program to make it a bachelors degree) is it possible to become a Nurse Practitioner without having to completely start from scratch in a nursing program? Like, go directly into the NP masters program? I do understand it is required to be an RN before going to NP school…but there must be SOME route around having to start all over…

Joe, You do have to become an RN before advancing into the Master’s level as a nurse practitioner. The good thing is that it is fast tracked in a much shorter program in many such as the one below that I found online. If you Google the subject, you will find many programs available. 

In an article that I recently read, I saw an interesting level of payscale for nurse practitioners. In the following table, NPs was supposed to be making an average of 87,000. I’d like to know where? I certainly don’t make that much money yearly, even with bonuses. Over at Nurse Practitioner View , he lamented the same subject (unfortunately, I can’t seem to find his article). I’m sure that the RNs are wondering where they are paid 60,000 on average as well?

A family nurse practitioner often sees complicated patients. There are two types of patients on a daily basis. The first is the younger patient who is usually seen for sick visits such as sore throat, ear infection, cough, and urinary tract symptoms. The other type is more complicated and has many morbidities such as diabetes, hypertension, hyperlipids, and COPD, usually in a combination of them. This patient is often labeled as noncompliant.

It is also a battle trying to obtain old records to see what testing has already been done or if there are any conditions that they forgot to tell me about. Sometimes they have been treated for a condition that they weren’t even aware of. Imagine that!

Education is one of the things that Nurse Practitioners do best. My patients have often told me that they learned more in 15 minutes than they have been taught in several years. It’s very important to explain disease processes in easy to understand terms. Too often we forget to “come down to the laymen’s level.” Too much information at one sitting can be too much to focus on and the patient will tune you out. Consider bringing them into the office for separate teaching visits. I am currently working on finding easy to understand patient education handouts.

I am a Family Nurse Practitioner that works in a rural setting providing care to many types of patients. I see pediatric patients all the way up to geriatric. I really like seeing entire families and learn something new every day about family dynamics.  I enjoy the different aspects of being a Nurse Practitioner. Some of them include:

Teaching- I teach my patients about their health conditions and how to better take care of themselves. I encourage all of my patients to “help me help you!” This engages the patient and lets them know that their health is ultimately their responsibility. The old saying “You can lead a horse to water, but you can’t make them drink” is very true on our profession. This leads to some frustration at times! 

Clinical investigation- This is the part of being a Nurse Practitioner that I learn the most from. Every day patients present with a mystery of some kind. Sometimes, it’s a really difficult process to finally put a name to a diagnosis because of very similar symptoms to other diseases. You must remain open to all potentials and never arbitrarily rule out things right off the bat. This is also the scariest part of my job because of the fear of misdiagnosis. I would NEVER want a patient to have a bad outcome because I missed an important clue to their problem. This is one reason why I take so much time with my patients. Yes, it makes me run behind, but I think they really appreciate it when it’s their turn.

Appreciation- I enjoy receiving the thank yous for taking such good care of my patients. I look forward to a smiling face coming back to tell me that they feel better than ever. There is also nothing better than seeing smiling children’s faces when they run up to hug their favorite NP. It still inspires me and gives me goose bumps and I pray that I never lose that feeling.

I hope you enjoyed hearing about why I enjoy my practice and look forward to any comments! Please feel free to let me know if there are any subjects that you would like to see covered.

Until next time, Stay healthy and happy!