If you think Facebook has no real power, think again. How about the Facebook campaign that succeeded in landing actress Betty White as a host for the comedy TV show Saturday Night Live, with neither White nor show producers having sparked the idea? In January, David Matthews, of San Antonio, launched a Facebook page petition after White appeared in a popular commercial for Snickers candy. The page went viral, and several hundred thousand Facebook users signed on by mid-March. SNL producers listened, and the
former Golden Girl hosted a special Mother's Day episode on May 8. And the show was a hit with fans.
This is why the Facebook campaign to add a nurse practitioner to the emergency department staff of a Peterborough, Ontario, hospital is so intriguing. A group of nursing students started a page called "Implement A Nurse Practitioner Into The Emergency Department at PRHC," and activity on the page caught the hospital's attention, not to mention the media. An article by the local newspaper doesn't mention how many fans the page had, and it has since been removed, but the hospital is considering hiring an NP with new funds it received as part of a program to reduce wait times.
Could Facebook petition pages be useful to NPs trying to increase their public visibility? If Betty White's story and the Ontario nurses' story are any sort of a barometer, I say it's certainly something for NPs to keep in mid when planning marketing activities.
This post serves as a friendly reminder that the deadline to enter ADVANCE for Nurse Practitioners' NP Entrepreneur of the Year Award contest is tomorrow, Friday July 30, 2010.
See profiles of our past winners:
2009 NP Entrepreneur of the Year: Teri Bunker, NP, Bridge City Family Medical Clinic, Portland, Ore.
2009 One to Watch: Tanya Sorrell, NP, Mental Health and Wellness Center, Yuma, Ariz.
2009 Outside the Box: Renee Mercer, NP, Enuresis Associates/The Bedwetting Store
2008 NP Entrepreneur of the Year: Scharmaine Lawson-Baker, NP, Advanced Clinical Consultants, New Orleans, La.
2008 One to Watch: Michael Lawler, NP, Angels on Call, Newport, Pa.
2008 Outside the Box: Helen Carcio, NP, Health and Continence Institute of New England
2007 NP Entrepreneur of the Year: KC Arnold, NP, The Diabetes Center, Ocean Springs, Miss.
2007 Runner Up: Juliet Santos, NP, Early Solutions Clinic, Rochester Hills, Mich.
2006 NP Entrepreneur of the Year: Elaine Henson, NP, Women's Medical Health Center, Lake Havasu City, Ariz.
2006 Runner Up: Greg Lind, NP, Lake Serene Clinic, Lynnwood, Wash.
AANP director of health policy Jan Towers, NP, addressed acrowd of several thousand yesterday at the 25th anniversary conference of AANP, with much to report on legislation that affectsNPs. After the session I caught up with Mona Counts, NP, who has served inalmost every leadership role for AANP. She agreed with Towers’ message thatalthough nurse practitioners are becoming a more familiar face, NPs mustcontinue educating the public and policymakers about their impact onhealthcare.
“The sacred cow has been opened,” she said – but that’s justa starting point. Be sure to stay current on legislation affecting NPs on alocal and national level, so that NPs are included to the fullest extent oftheir training in the healthcare of this country. Towers implored attendees to contact their legislators to ask them to support S 2814/HR 4993, which would change Federal statute to allow NPs to order home health care for Medicare patients. Senator Susan Collins from Maine and Representative Allyson Schwartz from Pennsylvania have introduced the bill into Congress, and it currently has 50 cosponsors, but Towers says she hopes for 100 cosponsors by August for a strong bill.
Greetings from Phoenix, Ariz., and the 25th anniversary conference of the American Academy of Nurse Practitioners! The conference has outgrown the Gaylord Resorts and this year there are some impressive crowds. At the opening session on Wednesday, the energy of the attendees was palpable as Mary Wakefield, administrator of the Health Resources and Services Administration of the U.S. Department of Health and Human Services, a nurse herself, took the podium. She assured the crowd that money has been and will continue to be allocated to the education and practice of nurse practitioners. And she described plans for nurses to become more involved in government agencies, because “nurses are an important expertise to inform our work,” she said. And she’s a supporter of NPs herself: her primary care provider for the last 8 years has been an NP.
“We as nurses have a once-in-a-lifetime chance to make a difference,” she said. She also quoted President Obama from a recent healthcare meeting in which he addressed nurses: “I will forever be in debt to the women and men of your profession – you are the beating heart of the healthcare system.”
Cofounder of the NP role, Loretta C. Ford, NP, also spoke. She reminded the attendees that in the face of a great demand for NPs, they must stick together for the good of patients: “The most important word in theNP lexicon is the word nurse,” she said. And she called on the memory of the NPs who blazed the trail for today’s NPs: “They would say this is a piece of cake.”
NPs saw a video about the 25-year history of AANP, and director of the Office of Health Policy for AANP, Jan Towers, NP, celebrated how far the role has come: “On the hill we don’t have to explain who we are anymore … someone always has a mother, a girlfriend, who is an NP.”
Outgoing President Dee Swanson, NP, passed on the gavel to president-elect Penny Kaye Jensen, and then attendees enjoyed a performance and blessing by a Native American drummer and dancer from Native Spirit. Stay tuned for further coverage of the event.
A recent op-ed in The Washington Post calls for prevention of an unmanageable influx of newly insured patients to emergency departments. In Keeping Routine Medical Care Out of Hospital Emergency Rooms, Jennifer Brokaw, an emergency department physician, makes several very sensible suggestions for solutions, two of which point directly toward nurse practitioners:
One, increase numbers of convenient care and urgent care clinics. This of course means NPs, when we think about who staffs the 1,200 convenient care clinics and urgent care centers.
Two, invest in education of healthcare providers other than physicians. "Training more primary-care physicians will not be enough," she writes.
She also suggests making use of social networking to help patients learn about their health and find providers. This doesn't directly call on NPs, but NPs can play a big part in achieving this, too, considering how well nurse practitioners get to know their patients and communities. You can direct patients to the right places to look for healthcare information. Are you already doing this? If so, what do you tell your patients?
Wow! Nurse practitioners are getting a lot more attention now that
healthcare reform will be bringing millions more patients into the taxed primary care market. But
just because the media is paying more attention to NPs does not mean
NPs have sat quietly by until this point. You've been out there telling
patients who you are, telling your local papers about nurse
practitioners, talking with legislators about the care you provide, and
lobbying the state and federal government for increased authority. And
we want to recognize you for it. That's why we want to remind you to enter the NP Shout Out Award contest to share with us your efforts to increase
awareness of the NP role.
We want you to submit articles, photos, interviews - some sort of evidence of your or your NP organization's efforts. And then you, our readers, will be the judge of which campaign was most effective. Enter the contest here: The NP Shout Out Award. We've already got a couple of entries, but we want to hear from more of you!
A primary care practice of five physicians in Philadelphia set out to count all that "invisible" work that doesn't get reimbursed. With the help of their electronic health record, they counted phone calls, prescription refills, e-mail messages, and lab, imaging and consultation reports.
One interesting upshot of the study is that the practice redefined the job description of "full-time physician" to be a provider who offers 24 scheduled visit hours per week. The practice's internal compensation system now counts phone calls and e-mailing in its productivity metric.
So, below is how the five physicians spent their time in 2008 with an active caseload of 8,440 patients. I imagine numbers for nurse practitioners in primary care are similar or that the proportion of "invisible" work is even higher for NPs.
Read Baron, RJ. What's Keeping Us So Busy in Primary Care? A Snapshot from One Practice. NEJM. 362:1632-1636.
- 16,640 patient visits
- 21,796 phone calls
- 11,145 prescription refills
- 15,499 e-mail messages
- 17,974 lab report
- 10,229 imaging reports
- 12,822 consultation reports
We heard from Maine nurse practitioner Virginia LaNoce, who surrendered her NP license to the Board of Nursing after several complaints about her prescribing practices. Read our first story here. We also reported that she was heading back to practice. But that doesn't seem to be in the cards just yet. LaNoce's license was reinstated early this year, but she says that she's still unable to find a physician to work with her on site, a requirement by the Board of Nursing for her to continue to practice. Because her family practice was in rural Maine, there are very few providers nearby who are able to work on site with her.
"There are just no opportunities in rural Maine, which is why my services are so needed," she told me in an email. "I have gotten many many calls from my patients asking me when I am opening and, if not at the office, where, because they will follow me. I doubt, however, that they would follow me 2 hours away which is where some of the places are that I have been looking to apply. Even some of the hospitals won't take me because of the 'encumbered' license."
LaNoce's husband, active in state politics, is hoping to spearhead efforts to submit a bill that would add nurse practitioners to the Board of Nursing, because currently there are none. "This is certainly not a Board of my peers. ... Nursing is so multileveled that everyone really needs some representation."
The common and rousing thread in many sessions at last week's NAPNAP conference (National Association of Pediatric Nurse Practitioners) was the call to action on healthcare reform, specifically the provisions for healthcare medical homes.
The legislation contains language authorizing the creation of demonstration projects for this model, which aims to create a seamless healthcare continuum - with the primary care provider at the helm - for each patient. As several presenters explained, the model was first proposed by the American Academy of Pediatrics for children with chronic health conditions or special needs. As it evolved, nurse practitioners emerged as the competent and most appropriate leaders of healthcare homes.
It's great that the Patient Protection and Affordable Healthcare Act includes language and appropriations to expand the availability of the healthcare medical home and school-based healthcare centers. Unfortunately the legislation didn't go far enough. It doesn't name nurse practitioners as leaders of these homes. Although language lists NPs as appropriate providers in these projects, it doesn't specifically state that NPs can be the primary care leaders.
The good news is that this need can still be addressed. The implementation of the Patient Protection and Affordable Healthcare Act is going to start evolving quickly (the companion appropriations bill designates some grant funds to be available later this year), and the details are going to be hammered out on the state level.
Now is the time for you to join your state and national NP organizations. Get keyed in to their political action committees, their health policy committees and any similar bodies working on legislative issues. A brass ring of sorts has presented itself. Make sure your grab it.
I'm here at the annual conference of the National Association of Pediatric Nurse Practitioners (NAPNAP), where pediatric NPs have set a new record for conference attendance. About 1,500 pediatric NPs are here in Chicago to network, earn CE credits and discuss current issues. The conference officially kicked off yesterday with a moving opening ceremony featuring the Children's Choir of Chicago, a teen advocate for minority health issues (and apparently a future nurse!), and a trailblazer for children and families, Cynthia Barnes-Boyd, PhD, RN. NAPNAP president Michelle Beauchesne, NP, welcomed attendees and commented that the trio of presentations was an ideal and uplifting way to celebrate children and open the meeting. I agree!
The issues raised by the speakers, particularly the need for continuity of care for families and good health role models for families, are at the core of the healthcare medical home model. This model is a common thread throughout the sessions here. The healthcare medical home model, whose roots are with the American Academy of Pediatrics, is an important component of healthcare reform legislation. To ensure that NPs are recognized as leaders of the healthcare medical home, you will have to take action. The federal bill does not specify NPs in the language, and medical interests already are hard at work to make sure physicians are the only recognized leaders for this model. Yet NPs have been leading these "homes" successfully for years. NAPNAP will be providing tools to help state NP groups take action on this issue; it appears that implementation details for the model will be up to the states at this point. Visit our Web site often for more coverage ...
Two weeks ago I wrote about some preliminary results of our ongoing survey of new grads and NP students. Specifically, 58% of those respondents said they do not plan to earn a DNP degree in the future. Now, with 76 responses, 51% say they will not pursue a DNP degree, even though that degree will be required for all new NPs very soon (starting in 2015).
Some other interesting findings from the survey so far are below:
- 70% say they belong to a national, state or local NP professional organization.
- 37% say that none or almost none of their NP program is/was online, and 34% say that all or almost all of their NP program is/was online.
- 42% say their program requires students to find their own preceptors.
- 22% had 0 to 2 years experience as an RN before entering an NP program, 24% had 3 to 5 years, and 14% had more than 20 years.
- 85% say they are pretty confident or very confident in their ability to perform in the NP role.
- 58% say they have an NP mentor.
We've been conducting the survey of recent (since 2008) grads and students since the beginning of April. If that's you, please fill out the survey here. You can see how others responded at the end of the survey.
Lately some NPs have let me know that potential employers in rural areas might be discounting pay rates based on the assumptions that published NP wage rates are for urban areas and that urban sites pay more. The NPs have asked whether I know the rate for rural practices in their state.
Based on data from the 2009 National Salary and Workplace Survey of Nurse Practitioners, we found that nationally NPs in rural areas made about 7% less per hour than their urban counterparts (median $43/hour urban vs. $40/hour rural). But that doesn't tell the whole story.
When examined state by state, the generalization doesn't necessarily hold. Below are median hourly part-time wage rates for NPs in each state broken down by rural and urban settings (the urban figures are on the right and in italics, and blanks indicate areas where there were fewer than 5 responses).
In 16 of the 39 states with data available, rural NPs made a higher part-time hourly wage than urban NPs did. Can we draw any generalizations from these figures?
Median Hourly Part-Time Wages by State for NPs Working in Rural vs. Urban (in italics) Settings
AK: $56 $45
AR: $49 $45
AZ: $40 $49
CA: $44 $50
CO: $41 $35
CT: $45 $45
FL: $40 $42
GA: $40 $42
IA: $41 $36
IL: $39 $42
IN: $36 $39
KS: $41 $42
KY: $40 $44
LA: $60 $45
MA: $54 $43
ME: $38 $33
MI: $38 $38
MN: $96 $45
MO: $38 $36
MS: $48 $48
MT: $35 $45
NC: $45 $40
NH: $40 $36
NJ: $45 $47
NM: $60 $53
NY: $34 $48
OH: $36 $40
OK: $35 $45
OR: $50 $45
PA: $33 $39
SC: $32 $47
TN: $40 $43
TX: $44 $42
VA: $41 $53
VT: $44 $37
WA: $55 $42
WI: $40 $40
Local news media covered the Rally in Tally Wednesday, and the following video is an excellent view of how the rally's efforts tie in to the recent passage of the healthcare reform law. Senator Mike Bennett is quoted as saying that enacting a law to allow NPs to prescribe controlled substances in Florida could save the state at least hundreds of millions of dollars. Does that sound like a no-brainer? Click the link below to watch the video from Tampa Bay Online.
Nurses could save millions
Just two days after the Rally at Tally, Jean Aertker, NP, of the
Florida Nurse Practitioner Network, reported back to ADVANCE with some
details from the "front lines."
"It was very successful, and I
hope you can send out a cheer to the 300
NPs who gathered in Tally March 24 - The signs and white coats were able
to sell our message to all but the House chairman Nick Thompson!" She
explained that Thompson refused to hear their case because he had not
heard from his own constituents that NP prescribing of controlled
substances was a necessity. "As he
plans to leave the House after this session, and vies for an elected judge position in Lee County, we all wonder how a man who will need to
balance the scales of justice will bring fair and balanced opinions to
his county if he takes only one side of the argument."
There were many groups in rally form in Tallahassee on Wednesday,
Aertker said, and an education bill received the largest spotlight.
"Bottom line, we have
more work to do to convince the legislators who are unfamiliar or
unwilling to listen to us. 13,500 voices must rise and get more
attention. This was a good thing."
FNPN met with leadership in both House and Senate, and budget was
clearly top priority for the state. "We countered that this bill is
needed to save dollars ... we can save Florida
millions of health care dollars."
Here are some links to the news media coverage of the rally:
No matter what you think about the new healthcare reform package as a voter and taxpayer, one thing appears certain: It will be good for your profession.
You might not see it tomorrow, or even at that 6-month benchmark when the first key elements of the law take effect. But over the next few years, a tight NP job market should open up considerably as more people access healthcare services. More NPs will be at the helm of nurse-managed health centers, which will grow in number under the legislation. And, it appears that NPs will be recognized as full providers in the healthcare home demonstration projects that will be created to improve healthcare quality and access.
As a long-time advocate for nurse practitioners, I am thrilled by the opportunities that now lay before your profession. As a voter, however, I was saddened by the process to get there. Insults and epithets, whether shouted at a town meeting, on the capitol steps or in the House chamber, were too often a feature of this "debate." I watched a great portion of the Senate action a few months ago, as well the House vote (and its prelude) last Sunday. They say politics is messy. So is the aftermath. After the dust settles, I think the nurse practitioner profession will be front and center, ready for whatever emerges.