Whereas previously NPs were only accepted as part of a new discount family insurance plan, (New Discount Plan to Include NPs), now the company plans to include and reimburse NPs directly. This is a great move toward full recognition of NPs' abilities in Florida, one of two remaining states that does not allow nurse practitioners to prescribe medications. Florida NPs were asked to send in registration information by July 15.

A letter was sent to providers in Florida by BCBS that tells the good news, with one frustrating twist: the company is calling the group of new accepted providers (which includes physician assistants and all advanced practice nurses) "physician extenders." Florida NP groups have started talks about creating an educational letter for BCBS requesting that the language be changed. Get involved! Contact the Florida Nurse Practitioner network by visiting www.fnpn.org.

The media has been bombarding us with news about Michael Jackson's death, which hasn't been noteworthy for our blog until today, when California nurse practitioner Cherilyn Lee spoke up in defense of Michael Jackson, who Lee says sought sedatives from her as a sleep aid but not to abuse. Lee had been providing nutrition advice to MJ.

The Associated Press reported the news about Michael's NP, who said that Michael asked her repeatedly for the IV sedative Diprivan, and she refused because of its risks. She also said she feared he'd been able to obtain the drug from another provider.

The article was a bit murky about whether Lee was a registered nurse, an NP, or a nutritionist, but it does seem that, according to listings on the California Association of Nurse Practitioners Web site, that she is in fact a nurse practitioner.

Lee said she tried repeatedly to educate Jackson about the cardiac risks of using the IV sedative but he waved her off.

Lee said she spoke out now to protect Jackson:

Lee said she decided to speak out to protect Jackson's reputation from what she considers unfounded allegations of drug abuse or shortcomings as a parent.

"I think it's so wrong for people to say these things about him," she said. "He was a wonderful, loving father who wanted the best for his children."

It looks like Lee did her best to protect and educate him before and after his death.

Earlier this month the American Medical Association held its House of Delegates meeting, during which it discusses what issues are important to their profession and sets the stage for political action to be pursued by the organization. The American Academy of Family Physicians published an article about testimony made against the DNP certification exam developed by the American Board of Comprehensive Care/Council for the Advancement of Comprehensive Care (ABCC/CACC).

If you visit this article on the AAFP's web site, you can listen to the testimony. AMA is very concerned that the National Board of Medical Examiners, whose pool of test items the DNP was drawn from, has not held up its promise to be clear that the DNP exam is not equivalent to an MD exam.

So, now that we've seen strong opinions against the exam from the AMA as well as the hard-hitting NP organizations, itseems the only person still championing the exam is Mary Mundinger, dean of the Columbia University school of nursing and member of the ABCC/CACC. Do any of you believe it will help NPs prove their abilities? Are those crickets I hear?

This is the third post in a series by first-time AANP conference attendees. Cheryll N. Simmons is a family nurse practitioner student at the University of Miami. At the completion of her program in August of 2009, she will continue her studies at UM, pursuing her doctorate of nursing practice degree. Here are Cheryll's impressions of the conference:

Guest blogger Cheryll N. Simmons, NP-S

I had no idea what to expect from my first American Academy of Nurse Practitioners (AANP) conference in Nashville, Tennessee. I was totally prepared to struggle through understanding technical jargon geared toward experienced nurse practitioners and not a soon-to-be graduate. As I thumbed through the conference guide, I was overwhelmed by the number of options available ranging from Twelve-Lead EKG interpretation to perfecting gynecological assessment.  I decided to take my chances at participating in a wound care seminar. Walking through the elaborate Gaylord Opryland Hotel, which resembled Disney's Epcot Center, gave the impression of regality; however, the atmosphere warmed by genteel smiles and shared passions for the direction of medicine made it feel like home. 

In my session on wound care held in the Governor's Ballroom, I found a seat close to the podium. As I sat quietly, trying not to call attention to my slowly increasing anxiety, a nurse practitioner sat next to me and must have noticed the purple color of my badge. She turned to me and asked when I expected to graduate. I told her August and expressed my feelings of nervousness and apprehension. She immediately began to console me, sharing her first experiences as a nurse practitioner and having the same moments of doubt. It was exciting to listen to scholarly didactics from the podium, but reassuring to engage in personal conversation on my level.  I was going to be fine.

There were over 4,500 people gathered together to talk about the future of health care. In the general sessions, we talked about the importance of being politically active in order to promote nurse practitioners.  We also discussed health care reform and the vital role that nurse practitioners play in actualizing it. Though I didn't think I'd have much to contribute I was astounded at how much I had absorbed through my program of study at the University of Miami. All participants seemed eager to offer advice and to listen to new ideas.

My first experience at the AANP conference will be indelibly etched in my memory. I expected to attend this conference with my mind rattled by the depth of information collected. However, I was astounded by the amount of information I digested. I feel ready to enter the world of nurse practitioners, partly because I feel more prepared and partly because a stranger made me feel better. I think that was the heart of this conference-believing that what we are doing is valuable and believing in the value of each other. And as one speaker put it, "Nurse practitioners are the best kept secret in health care." I concur; however, after this conference I dare say the secret is out.

Thank you, Cheryll!

This is the second in a series of blog posts on the ADVANCE Voice NP blog by guest bloggers who were first-time attendees to the American Academy of Nurse Practitioners (AANP) annual conference, held this year in Nashville. This post comes from Deborah Varnum, NP, who was designated this year as the North Carolina AANP representative.

Kick Up Your Heels in Nashville With AANP

Guest blogger Debbie Varnum, NP, visiting the ADVANCE booth

Over 4,500 NPs have converged upon the Gaylord Opryland to attend this well-planned event. AANP has outdone themselves! This is my first year at a national NP conference despite having been an NP for almost 10 years. Expectations have been surpassed at every turn. First, just walking into the convention center is unlike anything I have ever seen. The registration area with the PAC, AANP Foundation booths along with every office of AANP is filled with energy and enthusiasm. 

The Gaylord Opryland is a massive resort with an expansive conference center. I have lost count of the number of times I have lost my way. By the time I figure it all out, it will be time to return to NC.

The quality and assortment of CE classes is excellent and offers a topic of interest for everyone. My favorite class so far, media training came complete with camera, lights, action and a professional producer to critique our work.  Barbara Dehn, NP, and Beth Freeman, clearly leaders in their field, provided excellent guidance for aspiring television and print interviewees.  We now speak the lingo and can walk the walk. Alright, perhaps we are more at the toddler stage of the walk but we are getting there!

Opportunities for networking abound. So far I have met NPs from every state in the nation, talked with other business owners like myself and have learned about my new role as the new NC AANP representative. This new volunteer endeavor will prove to be challenging and rewarding in many ways. One very important piece of knowledge gleaned from the state representative meeting is that some states have been successful in removing "supervision" language from their general statutes.  I am hopeful that NC will soon be among the success stories!

Balance between work and play is difficult for me and many of my colleagues. So this year, I am working diligently to find balance during convention so that I don't return home exhausted. Every NP knows that to take a week off from patient care is equivalent to working twice as hard the week before and the week after to make up for it. So this time, my philosophy has been to enjoy the Gaylord and the conference. We (myself, my daughter and granddaughter) have enjoyed delicious food, swimming and kicking up our heels with the talented country dancers at Summerfest on Delta Island. It has been a successful week!

I highly recommend all NPs who are not AANP members consider it a priority to join right away. Member benefits are expanding all the time and AANP is making efforts to become more involved with social networking sites like facebook and twitter. The website, http://www.aanp.org/ is a wealth of information and www.webnp.org is a new social networking site offering blogs and other enticing information and resources. AANP, I learned this week, is making every effort to meet NP members where they are and to be THE national organization for NPs. I think they are doing a great job and the success of this conference is testament to that success.

Thank you very much, Debbie, for sharing your thoughts with ADVANCE.

It's time once again to fill out the ADVANCE National Salary and Workplace Survey of Nurse Practitioners. Although it's called the ADVANCE survey, all the magazine does is provide the questions and crunch the numbers. ADVANCE readers are the real force behind this biennial survey.

I'm sure many of you have responded to our questionnaire several times in the past. More of you, though, are probably new to the survey, and here's why you should participate: The more you know, the better you can negotiate.

Employers and NPs rely on the survey in job negotiations. The online survey results article gets thousands of hits every month, and I get phone calls and e-mail requests with specific questions throughout the life of a survey -- often from employers who aren't experienced in hiring NPs. They want to know what a new pediatric NP working in a family practice in Des Moines, for example, should expect to earn. The survey results can get them close to an answer.

The more NPs who respond to the survey, the more accurate the results will be. The 2007 survey had more than 6,000 respondents, and we're shooting for 10,000 for the 2009 survey. And our new survey platform will allow us to provide specific, more accurate results for many more cities than in the past. We're only limited by the number of respondents. Fill out the survey now.

If you've used the ADVANCE salary survey in job negotiations in the past, let us know in the comments section below.

This is the first of a series of guest blog posts from first-time American Academy of Nurse Practitioners conference-goers. This post is written by new family NP LaTasha M. Jarnagin, who works at Hamblen Family Medicine in Tennessee:

My first American Academy of Nurse Practitioners (AANP) Conference - Very Exciting!  

First, I must mention that this was the largest group of NPs to ever meet together - 4,500 plus.  With a variety of hot topics currently affecting the NPs practice, what a time for us all to meet together - the DNP degree, healthcare reform, and multiple legislative issues, just to mention a few. 

Guest blogger LaTasha Jarnagin, NP, at the ADVANCE booth

Not only am I new to the AANP conference, I also recently started my career as a FNP.  I have been practicing for one year now in a small rural practice. The conference provided such a wide variety of topics that any NP, no matter what area of practice would have benefited from the conference and topics covered. The conference truly provided practical education. I gained useful information from all the presentations I attended. However, I did have a few favorites - I was able to attend two presentations by Thomas W. Barkley Jr. and a presentation by Margaret Fitzgerald (who helped me pass my boards...Thanks!).

The conference provided an array of networking opportunities. The exhibit hall was filled with an assortment of vendors. I had the opportunity to pick up some exceptional educational material for patients. It was also convenient that Medicare and Medicaid services were there because being a new NP, I have lots of questions there. Billing and so forth was not covered in detail in my program and I have yet to learn these procedures. The exhibit hall would have not been complete without various NP invited poster presentations, which were new presentations daily. Time had also been allotted for the annual membership meeting and regional meetings. The regional meeting provided the opportunity to see what other NPs in my region have concerns about and allowed us to brainstorm among one another how best to work toward a better NP practice. During the annual membership meeting a commercial was shown which is to be released soon on public television. The commercial was very informative and a great way to communicate with the public exactly who NPs are and what NPs do. I am amazed at the number of people who have no idea what a nurse practitioner is and what role we serve to our communities.

I must mention the AANP Foundation's Round-Up which sure got participants wound up! The first 2,000 NPs who visited each cosponsor's booth in the exhibit hall and returned a completed card received a cowboy hat. I passed on this - I am from East Tennessee; therefore naturally I own a variety of cowboy hats!

Overall, I feel the conference gave me more self-assurance in my daily practice! Being new to practice, I received added confidence in knowing that I was already knowledgeable in the areas that were covered in many of my sessions. However, I was able to expand my understanding on a selection of topics and gained valuable information which will enhance not only my clinical practice as an FNP but my professionalism as an NP within the community.

ADVANCE would like to thank LaTasha for her feedback!

The first day of sessions at the largest NP conference in history has come to a close. There are officially over 4,500 NPs attending the 24th National Conference of the American Academy of Nurse Practitioners, and even in the largest Gaylord resort in the country, with 1,800 rooms, there was spill-over to other hotels. The place is really abuzz with NPs. Everyone filled the general session room early this morning for opening remarks and watched the posting of the colors and then heard an overview of political action affecting NPs from AANP health policy director Jan Towers. Conference organizers handed out a book to each attendee listing each state's legislators and which committees they belong to.

Posting of the colors

In the afternoon, Towers presented a session on the doctorate of nursing practice. The room was packed, with attendees craning their necks to hear from standing room in the back. It was clear that NPs still have many questions about the degree and what its implications will be for their practice.

Inside one of the courtyards at The Gaylord Opryland, the original Gaylord resort, with 1,800 rooms and 16 restaurants!

Towers was also very vocally against the Council for the Advancement of Comprehensive Care exam for DNP graduates, the first of which was administered at Columbia University to 40 DNP graduates in October. Towers' stance got a hearty round of applause from a very emotionally charged crowd, who quickly fired question after question about it and broke out into chatter. "We hope, due to its unpopularity, that it will die a quiet death," said Towers.

Tomorrow's events include industry-sponsored breakfasts, more informative clinical and professional presentations, poster presentations, and the grand opening of the exhibit hall. Keep checking in for updates! 

Well, here's an example of more complex influences of the economy on that decision. A report from the Seattle Eyewitness News Web site, kirotv.com, states that tuition at University of Washington nursing programs is rising to cover $1 million in budget cuts.

 Here's what the report says: "But for now, the nursing program will cost students more than $26,000 a year. That makes it more expensive than studying to become a doctor. Medical school tuition is now just under $21,000 a year." The article doesn't elaborate on what "the nursing program" includes.

On May 12, Representative Allyson Schwartz from Pa. introduced, with 106 cosponsors, the Preserving Patient Access to Primary Care Act of 2009. The bill aims to increase primary care access for patients and includes nurse practitioners as leaders of patient-centered medical homes.

Stephen Ferrara, NP, who writes the blog A Nurse Practitioner's View, wrote an excellent post about this. Click here to read it. You can also read the full text of HR 2350 here.

The bill seems to be very inclusive of nurse practitioners, and defines a "Primary Care Provider" as follows:

(7) PRIMARY CARE PROVIDER- The term ‘primary care provider’ means--
(A) a nurse practitioner; or
(B) a physician assistant practicing as a member of a physician-directed or nurse-practitioner-directed team;
who provides first contact, continuous, and comprehensive care to patients.

Some NPs have expressed hopes that the term "medical home" will be changed to "healthcare home." Loretta Ford, NP, cofounder of the NP role, even said the same to me when we spoke in May. "I don't think we're going to be part of a medical home, we're going to be part of a health home."

The bill is now being reviewed by several committees, and we will keep track of any amendments.

Drug Store News conducted a survey of pharmacists and retail healthcare providers and found that almost 86% of retail clinic providers found patients asking more about swine flu since the media started covering it.

Visit www.advanceweb.com/NP on Monday to download ADVANCE's newest Convenient Care Q & A podcast, in which we interviewed NPs in convenient care about how they handled swine flu testing and patient concerns. The Convenient Care Q & A series of podcasts covers trending topics in the industry; visit "How Recession Affects Retail Healthcare" here.

A study published in the Archives of Internal Medicine found that retail health clinics gravitate toward more affluent neighborhoods. They could, therefore, not be serving the under- and uninsured or poorer populations that are in more need of healthcare. All this comes down to is profitability for the companies operating the clinics.

Hopefully as the model expands and these companies become more stable, they'll move into areas that will serve more needy populations.

San Antonio News business columnist David Hendricks spoke out in favor of a law allowing NP prescribing rights in Texas, which was shut down in the Texas Legislature this legislative session:

Despite better protections from malpractice lawsuits and lower malpractice premiums, Texas has a doctor shortage. Nevertheless, the Texas Medical Association took every step to ensure physicians will have a tight rein on the activities of well-trained nurses.

The requirement of physician supervision in Texas prohibits the expansion of retail health clinics for logistical reasons, further reducing access to health care. Unfortunately, Hendricks says, nothing will change until 2011, at the next Legislative session.

NPs will be the primary providers at walk-in clinics in Australia, according to a news item in The Australian. The clinics will be housed in public hospitals, and the prime minister of Australia said, "I think it is fantastic that we have a greater role for nurses."

It's good news that other countries are catching on to a model of healthcare that answers patients' calls for more convenient care. The problem with the article is that its title contributes to the confusion about roles for NPs and physicians: "Nurses to be doctors at walk-in clinics." Read the article here.

The American Academy of Nursing (AAN) is burning the midnight oil working toward recognition of nurse practitioners as primary healthcare providers. This is especially important as President Obama prepares to consider healthcare reform in the United States.

The media is continuing to catch wind of these efforts. Here's another example: "Expanding Nurse Practitioners Primary Care Role Could Lower Medical Bad Debt Balances" from insideARM.com. This is great for NPs' goals!