Hot Topics in NP Practice

1. Hot Topics in NP Practice Margaret A. Fitzgerald DNP, FNP-BC, NP-C, FAANP, CSP President Fitzgerald Health Education Associates, Inc. Family Nurse Practitioner Adjunct Faculty, Family Practice Residency Program Greater Lawrence (MA) Family Health Center Editorial Board Member The Nurse Practitioner Journal, Prescriber’s Letter, American Nurse Today © 2009 Fitzgerald Health Education Associates, Inc.

2. May you live in interesting times. © 2009 Fitzgerald Health Education Associates, Inc.

3. Advances in Health Care • Lifestyle • Pharmaceutical • Surgery © 2009 Fitzgerald Health Education Associates, Inc.

4. “Routine” angioplasty while Vice President, now LVAD © 2009 Fitzgerald Health Education Associates, Inc.

5. New diseases, new threatsH1N1 influenza A, Dengue Fever © 2009 Fitzgerald Health Education Associates, Inc.

6. Helping to create • Chronically critically ill • New-form acutely ill • Groups who have not historically lived in the community © 2009 Fitzgerald Health Education Associates, Inc.

7. Opportunity: We can look at where we have come as the NP and PA professions. © 2009 Fitzgerald Health Education Associates, Inc.

8. What else happened in 1965? © 2009 Fitzgerald Health Education Associates, Inc.

9. The Medical Board was persuaded to allow nurses to read ECGs, diagnose life-threatening arrhythmias, and administer emergency medications as well as defibrillation – a revolutionary step at the time. (www.cornell.edu)

10. 1965Feminine ForeverDr. Robert Wilson • Menopause is a "living decay," he wrote, which often destroys a woman’s "character as well as her health." He added, "The unpalatable truth must be faced that all postmenopausal women are castrates. … © 2009 Fitzgerald Health Education Associates, Inc.

11. 1965Feminine ForeverDr. Robert Wilson • A man remains a man until the very end. The situation with a woman is very different. Her ovaries become inadequate relatively early in life. She is the only mammal who cannot reproduce after middle age." © 2009 Fitzgerald Health Education Associates, Inc.

12. 1965 vs 2010 • Type 2 DM therapy 1965 • Chlorothiazide • Orinase • About $8/ month in 2009 dollars • Death within 5 years of diagnosis © 2009 Fitzgerald Health Education Associates, Inc.

13. 1965 vs 2010 • Type 2 DM therapy 2010 • TZD (perhaps) • Biguanide • SU or DPP-4 inhibitor or some combination of insulin secretagogues or insulin • Statin • ACEI or ARB or direct renin inhibitor • ASA • Up to $400-500/ month in 2009 dollars, as little as $16/ month with 4, $4 per month Rxs • Living decades post diagnosis © 2009 Fitzgerald Health Education Associates, Inc.

14. 1965 vs. 2010 © 2009 Fitzgerald Health Education Associates, Inc.

15. Sound Familiar? • A time of.. • Societal change • Social unrest • US involvement in military action overseas • Desperate need for healthcare providers, particularly in primary care • The institution of healthcare insurance plan that was a source of great debate. © 2009 Fitzgerald Health Education Associates, Inc.

16. In 1965… Dr. Loretta Ford, the cofounder of the first NP program, and Dr. Eugene Stead, attributed to be the founder of the PA profession, were NOT concerned about physician shortage but WAS concerned about the lack of primary health care services. © 2009 Fitzgerald Health Education Associates, Inc.

17. In 1965.. Both professions had their start. © 2009 Fitzgerald Health Education Associates, Inc.

18. What did they all face?Is this 1965 or 2010? • Opposition for nursing and medicine • Public misunderstanding of role and intent • Consumer acceptance of the role © 2009 Fitzgerald Health Education Associates, Inc.

19. NPs and PAs: Today, by the Numbers • Number of PA programs • 140 • Number eligible to practice in USA • 72,433 • Source- www.aapa.org • Number of NP programs • 325 • Number reliable to practice in USA • 135,000 • Source- www.aanp.org © 2010 Fitzgerald Health Education Associates, Inc.

20. NPs and PAs by the Numbers • PA • Average 2009 full time salary= $93,486 • www.aapa.org • NP • Average 2009 full time salary= $94,142 • http://nurse-practitioners.advanceweb.com © 2010 Fitzgerald Health Education Associates, Inc.

21. Opportunity: Our professions’ salaries are approximately double that of the average US wage earner. © 2010 Fitzgerald Health Education Associates, Inc.

22. Pitfall: We often do not take home a representative portion of the income we generate. © 2009 Fitzgerald Health Education Associates, Inc.

23. Nice to hear that a new high school grad is thinking about becoming a nurse practitioner…… Opportunity © 2009 Fitzgerald Health Education Associates, Inc.

24. A recent high school graduate, as quoted in local Louisville, KY newspaper • I dream of: becoming a nurse  practitioner…. • and living a life without worry. • Married, with children and stable for the rest of my life. © 2009 Fitzgerald Health Education Associates, Inc.

25. Pitfall and Opportunity: Our profession is dynamic. • NP by 2016 • NCSBN Vision Statement= NPs as autonomous providers • NP by 2016 • AACN= DNP as entry degree to the profession © 2009 Fitzgerald Health Education Associates, Inc.

26. Pitfall:But we still have a long way to go… © 2009 Fitzgerald Health Education Associates, Inc.

27. © 2009 Fitzgerald Health Education Associates, Inc.

28. What is our collective responsibility? Opportunity: Much legislative work has been done. Pitfall: Much needs yet to be done. © 2009 Fitzgerald Health Education Associates, Inc.

29. Arkansas State Medical Board Proposal • Regulation 30 outlines protocols and responsibilities of physicians and nurse practitioners who have a collaborative practice agreement. In the proposed rule, doctors and nurse practitioners must provide its method of management and protocols of authorizing prescriptions to the Arkansas State Medical Board. © 2009 Fitzgerald Health Education Associates, Inc.

30. Kaplan and Brown (2006) in NPJ • Barriers range from receiving a lower rate of reimbursement than physicians to seemingly small acts of exclusion, such as not being able to authorize disability parking permits. © 2009 Fitzgerald Health Education Associates, Inc.

31. Pitfall and opportunity Not enough of us belong to our professional organizations. © 2009 Fitzgerald Health Education Associates, Inc.

32. Opportunity:Caring for people in need © 2009 Fitzgerald Health Education Associates, Inc.

33. The US Uninsured • No health insurance • 46.3 million Americans • 15.4% of the population • Gaps in insurance during 2009 • 60 million Americans • 1 in 5 of the population • Source- Cohen RA, et al "Health insurance coverage: Early release of estimates from the National Health Interview Survey 2009" NCHS Brief 2010. © 2009 Fitzgerald Health Education Associates, Inc.

34. USA Estimated Consequences of No Health Insurance • Estimated 45,000 people die annually in part because they lack health insurance and healthcare © 2009 Fitzgerald Health Education Associates, Inc.

35. NP and PAs (APCs)= Growth industry

36. Pitfall:Have we “flooded the market” with NPs and PAs? © 2009 Fitzgerald Health Education Associates, Inc.

37. NP and PAs educated as PCP, anticipated yield per annum ~3500 + 2500= 6000 Potentially 6000 new primary care providers per annum Strength in numbersDo the math!!! © 2009 Fitzgerald Health Education Associates, Inc.

38. Opportunity: We have caught the eye of people in power. © 2009 Fitzgerald Health Education Associates, Inc.

39. Patient Protection and Affordable Care Act • $15 million for the operation of 10 nurse-managed health clinics that help educate nurse practitioners • $5 million for states to expand their primary care workforce by between 10 and 25 percent over a decade • $168 million for more than 500 new primary care physicians by 2015 © 2009 Fitzgerald Health Education Associates, Inc.

40. Donna Shalala, former Secretary of Health and Human Services • “NPs are going to be key to health care reform and must be at the health care reform tables. • “If you look at where our big costs are—chronic care management—that’s where you’re going to see nurses and physician assistants.” • “It’s a solution in plain sight.” © 2009 Fitzgerald Health Education Associates, Inc.

41. PitfallWhose pie is it, anyway? © 2009 Fitzgerald Health Education Associates, Inc.

42. Opportunity: Plenty of pie! • Old thought • We are taking work (therefore income) from other healthcare providers, especially physicians. • New thought • We are creating opportunities to provide healthcare for populations that had no care or have not previously existed. © 2009 Fitzgerald Health Education Associates, Inc.

43. So we need to… • Restate our argument. • We are not replacing physicians. • We are caring for people in need. • This is an opportunity that will take many forms and be influenced by a number of factors. © 2009 Fitzgerald Health Education Associates, Inc.

44. We are operating from a state of strength, caring for people of great need. We are not simply “filling in”. For many people, in many places, we ARE healthcare! © 2009 Fitzgerald Health Education Associates, Inc.

45. May you live in interesting times. May you come to the attention of those in authority. © 2009 Fitzgerald Health Education Associates, Inc.

46. May you find what you seek. © 2009 Fitzgerald Health Education Associates, Inc.

47. End Presentation • Thank you! • peg@fhea.com • www.fhea.com © 2009 Fitzgerald Health Education Associates, Inc.