I listened to a podcast of an interview with Mike Leavitt, the Secretary of Health and Human Services, which addressed improving health care in America. Leavitt said he wants health care to "achieve economic system status," meaning that consumers should pay for quality.

Leavitt also mentioned electronic medical records (EMRs), which he said could be even more secure than paper records because access to electronic records is tracked, whereas a paper file could be peeked at by any number of people. He also mentioned Ghealth, which Google is currently developing. Here is a YouTube video of a keynote speech delivered by Eric Schmidtt of Google which (although a little long) discusses what Google Health does. Essentially, patients can use it to consolidate their health records by retrieving EMRs from their providers. You can also read about it here.

Leavitt believes that HIPAA has it wrong and that patients should be the true owners of their health records. He mentioned Ghealth as an option for patients in the future. NPs working with EMRs, such as those working in retail health clinics, will be providers in the trenches dealing with this issue. Do you use an EMR? Has it improved your ability to provide care? Post your comments below!

I previously posted about a bill that passed the senate in Arizona banning NPs from performing abortions. Recent news from the Arizona Daily Star's Web site states that despite legislative movement, the bill is being vehemently fought by the state board of nursing.

The article reports that an advanced practice council of the board of nursing recommends that NPs be allowed to perform first-trimester abortions. Many NPs in the state already do so. The board of nursing will vote Wednesday on the measure.

The governor has vetoed two abortion-related bills this session, indicating that she might do the same for this bill, which brings hope to NPs wishing to continue doing the work they do.

PhysiciansNews.com published an article titled "Growing Role of Nurse Practitioners" last week, which addressed the doctorate of nursing practice and retail health clinics, two "hot buttons" that many nurse practitioners have been concerned about recently.

The article explains the new requirement of a DNP degree as entry to practice by the year 2015, and describes the certification developed by Mary O. Mundinger and others at the Council for for the Advancement of Comprehensive Care (see the post about my interview with Dr. Mundinger).

The article's author, Christopher Guadagnino, stresses that these developments are not an indication that NPs want to start a turf war. Rather, they are simply a reflection of the expansion of curriculum that already exists in master's programs for NPs. He states that current curriculum has grown "to a level that constitute a doctoral degree in most other professions."

The article also notes that the importance of the issues of autonomy and collaboration will be eclipsed by the need for care. "The U.S. will need 40 percent more primary care physicians by 2020, according to ACP and AAFP projections." The supply of NPs cannot meet its demand, either. Only 6,000 NPs graduate yearly, according to the article, and those numbers will not nearly make up for the projected primary care shortage.

DNP competencies are listed in the article, with a caveat noted by Polly Bednash, executive director of the American Association of Colleges of Nursing: "We are not reconceptualizing the role of advanced practice nurses. ... It is clear that changing demands of practice require taking more coursework to stay safe and current."

A phyisican interviewed for the article says NPs "don't come close to the level of training" of physicians, and that "there has to be an understanding of that within the nursing profession."

Physician groups are working to enact or maintain legislation that keeps NPs from providing care to the best of their ability, such as collaborative practice laws and regulations on retail health clinics. Removing those barriers will provide more access to care, especially because of the rapid growth of the retail health industry. Take Care Health, for example, currently operates 168 clinics across the country, all staffed by NPs who are able to provide care and refer patients to other providers as necessary.

Last year, Pennsylvania Governor Ed Rendell signed into law a bill that expands the role of the NP in the state. Nurse practitioners in Pennsylvania still work under a collaborative practice agreement in the state, so it is still difficult to work in underserved areas, but NPs are becoming more respected by the general public. An article in the Times Leader of northeastern Pennsylvania quoted one enthusiastic patient who visited am NP-led women's health clinic:

“I feel that she listens. Her hand is not on the doorknob. She’s not on the clock. She really listens before doing anything,” Carey said. “Physicians tend to be extremely busy, and they don’t usually want to get anyone else’s opinion. The nurse practitioners are more than willing to call in a physician if there is anything they feel they need another opinion on.”

A nurse practitioner interviewed noted that it's insurance companies that they fight most for recognition, not physicians:

“I think in Pennsylvania the word has spread out there that it is easier to get an appointment with a nurse practitioner and they take more time with you, particularly in women’s health. The word is spreading and people are beginning to ask for nurse practitioners, who have a bit more time to spend with people and can offer health promotion and education,” Fuller said.

“We are getting more and more physicians’ support as well; but that was a battle in the 1980s. They have totally turned around. They really understand what we’re doing more,” Fuller said.

This says something about the fact that many NPs and physicians work together collaboratively in a very collegial way. It may be easy to lose sight sometimes of a generally easy relationship when publicity is given mostly to those who disagree with allowing NPs further autonomy and scope.

Attached at the bottom of this post is a letter from the Pennsylvania Child Death Review Team about safe sleep for infants. The PCDRT is working to distribute this letter to all NPs, because many NPs care for infants. Click on the link below to read the letter, which urges practitioners to promote safe sleep practices, such as never allowing an infant to sleep in a bed with an adult.

A nurse practitioner weighed in on the concept of "slow medicine" in a New York Times article published May 5.

Joanne Sandberg-Cook, an NP who works at the Kendal at Hanover retirement home in New Hampshire, says that each geriatric patient's circumstances"demand the time to think about all the what-ifs."

The what-ifs include whether, for example, it is practical for a patient to have surgery to remove a tumor if he also has early-stage Alzheimer's, because the anesthesia may accelerate his dementia.

Sandberg-Cook is an advocate of slow medicine for the elderly, because, as the article points out, many older patients are harmed more by addressing all health concerns immediately. Some call this "death by intensive care." Physicians, however, are paid per procedure, not to discuss whether a patient wants the procedure.

Residents of the Kendal facility have a great deal of choice regarding whether to receive health care. Nurse practitioners are an obvious choice as caregivers in this setting, because they are able to counsel each patient on what procedures may or may not improve their quality of life.

Social networking Web sites are not and have not been just for gossiping teenagers for years now. Groups formed on sites like MySpace and Facebook serve all kinds of purposes, from political campaigning to fundraising for charities. And in the last few years, users of these sites have been able to come together to talk about health care.  

For example, DailyStrength.org is a networking site for patients and caregivers to share information about many different health issues, including mental and physical health as well as other "personal challenges" such as divorce or bereavement. Yahoo! and WebMD have ramped up their user communities. There are also many sites meant to provide a community for those with specific diseases, such as PatientsLikeMe.com. ICYou.com has been called the YouTube of health care. And organizations like the American Cancer Society have been experimenting with sites such as SecondLife.com, which aims to help increase awareness about nutrition, cancer screenings, and infectious disease prevention. The American Cancer Society even used the site to raise money for the Relay for Life, a large-scale yearly fundraising event for cancer research and prevention. And here at ADVANCE we're starting to do the same: creating forums and blogs so NPs can communicate, and ADVANCE for Physician Assistants even has its own Facebook group!

An article published recently by iHealthBeat encourages providers to steer consumers toward social networking sites for health care information. The author, Jane Sarasohn-Kahn, makes a very important observation:

The erosion of peoples' faith in government and business leads us to find trust elsewhere. The first place we're going to look is with our peers.

Edelman, a global communications firm, has conducted the annual Trust Barometer survey since 2000. Two years ago, Edelman cited a new trend in its 2006 Trust Barometer: the steady decline of trust in traditional figures of authority, and the increase in the credibility of the "average person." The beginning of the trend was a huge spike in trust for a "person like yourself or your peer" from 22% in 2003 to 68% in 2006.

Sarasohn-Kahn notes also that there could be a risk of misinformation. If people trust their peers and their community more than they trust institutions, health care providers need to be sure they are part of that community to ensure they provide quality care. Patients are going to continue accessing these sites for help and information, so a good way to ensure they receive corrent information is becoming involved in these rapidly growing health care netoworking sites.

After a somewhat disheartening article in which the DNP was continually referred to as "doctor nurse" (which I blogged about here), this article from the St. Louis Post-Dispatch seems to have done a better job of portraying the doctorate of nursing practice.

While it may not be necessary or even appropriate now for all NPs to obtain the DNP, Fay Raines, the dean of the College of Nursing at the University of Alabama at Huntsville and president of the American Association of Colleges of Nursing, weighed in with a very valid point:

"It's a different world than when I started my career," said Fay Raines, dean of the College of Nursing at the University of Alabama in Huntsville and president of the American Association of Colleges of Nursing. "As the demands have become greater, it's important that we continue to have the very best prepared nurses possible."

This should result in better patient care in the end, according to another source interviewed in the article. And isn't more education always better?

Nurse.com published an article today targeted to nurse practitioners in the D.C./Maryland/Virginia area. It breaks out which retail health clinics are operating in the area and concisely notes the importance of NPs to the idustry. They quote Karen Frye, Richmond district manager for RediClinic in the following passage:

The success of convenient care clinics is increasing visibility of NPs and their skills while presenting an opportunity for them to play a driving role in developing a new dimension in health care. In addition to staffing clinics, NPs fill roles as managers and directors of operations who are responsible for local and regional management of CCCs.

“NPs are very well known for teaching and preventative care, and our company incorporates that into the way we give care,” says Frye. This includes the development of programs for smoking cessation and screenings for high cholesterol, diabetes, heart disease, liver and kidney function, thyroid disease, allergies, prostatic specific antigen (PSA), and osteoporosis.

“This is an excellent opportunity for NPs to do all those things they do so well,” says Frye. “It’s a unique place for NPs to stretch their wings.”

According to this article, the area has 44 MinuteClinics, 9 RediClinics, 5 Target Clinics, and a few other, smaller retail clinics peppered throughout. Out of the almost 1,000 clinics in operation in the country now, this is a fairly sizeable number, so press that promotes NPs' work in these clinics can only be a good thing for promoting NPs.

A survey done by the American Journal of Public Health revealed that one-quarter of Americans shares prescrition medications with family and friends. The survey polled residents across the country, and found that about 23% said they shared medications and 27% said they borrowed them.

The researchers pointed out the severe risks of taking medications that aren't prescribed, such as birth defects caused when pregnant women take Accutane or increased antibiotic resistance when patients don't finish their course of antibiotics.

With so many Americans are sharing their prescriptions, NPs have the opportunity to showcase their skills and training in patient education to remind patients about the risks associated with sharing prescriptions.

This is O'Donnell's opportunity to explain that an NP often can be your primary care provider — and even better, that there are studies that show that NP care is as good as physician care. The article "Choosing a Primary Care Physician," published April 29 on Newsday.com (Long Island and New York City), gives the four opening paragraphs to O'Donnell.

Instead, the article attributes this information to her: "A good primary care physician — who could be a family practitioner, an internist, a specialist in adolescent or geriatric medicine or an obstetrician-gynecologist — communicates well with patients, says O'Donnell, who is also president of the Long Island chapter of the Nurse Practitioner Association of New York State."

To be fair, the article content isn't O'Donnell's fault. It's possible that she mentioned or even emphasized the opportunity for patients to develop a primary care relationship with an NP. Sometimes mainstream press reporters just don't get it.

That means that it's up to you to educate them. With all the press about retail health clinics — "They're staffed by NPs, but be sure you have a primary care physician!" — do patients understand that they can see an NP as their primary care provider?

This is what the article does say about nurse practitioners, which is something, I guess: "O'Donnell works for a doctor affiliated with South Nassau Communities Hospital in Oceanside. She cares for more than 100 patients a week, doing work once reserved for doctors — prescribing medicine, diagnosing illnesses and administering physicals."

I am a patient of Peggys, and I can tell you this, I MUCH rather be seen by her then seen by a doctor. I ALWAYS go to her first. She really takes the time to listen to her patients, and talk to them, rather then just ask 'what medicine do you need' and get pushed out the door. A physical exam with her lasts 30 minutes sometimes! Nurse practicioners are definetly MUCH better IMO.

Target, which once partnered with MinuteClinic in its stores now operates its own clinics in Maryland and the twin cities area of Minnesota. Target Clinic follows the same quick, convenient-care model as other retail health clinics, and are staffed by nurse practitioners through a medical staffing company called Target Clinic Medical Associates.

Target seems to have an uncanny sense of what people want (and maybe that's why my car seems to drive me there on auto-pilot fairly regularly). And it doesn't stop at milk, eggs, and batteries (or those cute shoes I bought last week). For example, a mailer they sent out to customers in the twin cities area offered a $10 gift card to those who visited the clinic, as well as information about other health-related tools available at Target, such as their health spending receipt, which marks and totals spending on items that may be eligible for coverage through a health savings account. Target Pharmacy also has $4 generic drugs and a ClearRx program, with color-coded bottles and large-print labels. They even have an automatic refill system so that pharmacists refill the prescription and patients get an email or phone call when it's ready. Pretty neat.

According to a press release today by PDQ Care (Patients Deserve Quality Care), the first-ever retail health clinic/pharmacy duo to operate in a shopping mall opened its doors at The Mall at Wellington Green in Wellington, Florida.

This is another logical step in the evolutionary path of the retail health industry. Locations with high traffic are going to be successful because they provide health care where patients already are. Retail health clinics already exist in grocery stores, drug stores, airports, and big-box retail stores.

The PDQ Care clinics will operate just as other retail health clinics do, with one interesting and crucial twist: if there is a wait, patients will receive a beeper that will go off when the NP is free (like in a restaurant). Patients will be able to continue their shopping until -- voila! -- the beeper goes off. If you ask me, that sure beats staring at the walls of the primary care office waiting room for an hour!

Here is another example of a nurse practitioner bringing good press to the profession. Tamara Michelle Robertson, assistant professor of nursing at the Austin Peay State University of Tennessee, was given the 2008 Socrates Award. The award is given to faculty recognized by their peers and students as excellent educators.

In a nomination letter, the director of the school of nursing said the following about Robertson: "She is one of the most popular instructors we have. Ms. Robertson teaches health assessment—when you walk by her class you can hear them singing a song to help students learn the content in the lab. In the classroom, you will see her using cutting-edge technology such as YouTube and classroom response clickers."

Are NPs better prepared as educators to more effectively communicate ideas? In this case, the answer seems to be "yes."

In Chicago, nurse practitioner Patricia Carr staffs the city's largest mobile pediatric care unit. The Care-A-Van provides immunizations, physicals, hearing and vision screenings, pulmonary function testing, asthma assessments, childhood health promotions, injury prevention and education. 

“It’s an amazing program,” Carr told Chicago's Medill Reports. “It’s just like a regular doctors visit, and there’s no rush. I get to individualize my time with each child.”

The van provides opportunities for care that children otherwise wouldn't get. “It’s providing health care to some of these families who are afraid, perhaps, to seek health care,” Carr told Medill Reports. "I know that we have a lot of people who are here illegally—that doesn’t matter to me. I go home every night knowing I gave healthcare to families that wouldn’t otherwise get it. And, that’s important to me.”