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Dermatology Practice Today

Q & A with Dr. Debra: NADNP

Published August 28, 2014 2:06 PM by Debra Shelby

Dear Dr. Shelby,

My name is Ligita Centorino. I am a family nurse practitioner student in Phoenix, Arizona. I was researching NP national organizations and I was impressed to learn about your developed organization. I have chosen to promote your organization in my school, however, I have some additional questions I was not able to find answers on the website. Would you mind help me by answering those questions below please?

1. Could you please tell me more about residency program? Who is qualified? How long is the residency program? Is residency program available only in Florida?

Family and Adult NPs with at least one year of experience are qualified to apply. The residency includes 1,000 dermatology hours. Please read the article I wrote "The development of a standardized dermatology residency program for the clinical doctorate in advanced nursing" that was published by the Dermatology Nursing Journal. This program is only available at the University of South Florida. Please see the USF DNP website for other information relating to the program.

Shelby D. (2008).The development of a standardized dermatology residency program for the clinical doctorate in advanced nursing. Dermatology Nursing. Dec;20(6):437-47: quiz 438.

2. What are main dermatology-related issues?

In my opinion, the main dermatology issue we have is developing a cohesive dermatology team. There still seems to be some dermatologists that continue to write articles that are detrimental to relationships between dermatologists and dermatology PAs and NPs. There are many good dermatologists that support NPs and PAs, but there are some who criticize our practice without actual facts that support their views. Here is the link sent to me from one of my board members:

http://dermcast.tv/sdpa-rebuts-inaccurate-jama-article-about-pa-billing-practices-and-education

For instance, some dermatologists are critical about NP and PA dermatology education. Ironically, when I developed the first DNP dermatology residency program in 2006, I was attacked by the dermatology community. Not only did the physicians personally attack me and the program, but I also had dermatology nurses spread false information about the program and inaccuracies on the purpose of this program.

What many people may not know is that I support the AAD and the dermatologist led team. I also believe that NPs should have formal training prior to practicing ANY specialty. This was the inspiration for me to develop the concept of the dermatology residency program for NPs. Not only was it the first dermatology residency program, but to my knowledge, it was also the first specialty residency program in the country. This spawned many controversies over nurses using the term "residency" in our education. This program was not developed to replace dermatologists. The intention was to give NPs a foundation in dermatology so they could team up with a dermatologist and continue their training. In addition, the primary care NP may complete this residency to gain dermatology knowledge they can use in their practice. For those NPs who practice in states independently, this is a great opportunity to get the formal education you need to help support your practice.

The second dermatology issue is the HB699 Bill that was passed in Florida. To summarize, this limits the use of PAs and NPs in satellite offices. This bill was passed without any facts to support that NPs and PAs practicing in satellite offices pose a patient safety issue based on practice location and practice without direct supervision. Patient access is limited because a group of Florida dermatologists "felt" that the public safety was in jeopardy. No evidence to support this "feeling", but the bill still passed. Perhaps the real issue may be that dermatologists need to make sure that the PAs and NPs they employ are safe to practice wherever they are located. On the flip side, I also feel that PAs and NPs have a responsibility not to practice in any situation without proper education. Regardless what the dermatologist says, the NP/PA is a professional responsible for their own standards of practice. I have met NPs who have allowed themselves to practice dermatology under general supervision after only 1 week of training.

The third dermatology issue that is important to me involves the dermatologists who allow their MAs to perform biopsies and suture on patients. I cannot speak for all states, but I know it is illegal in Florida. I hope that the AAD with focus their attention on this patient safety issue.

I realize some of these issues are controversial, but they are real and valid. Standardization in education and practice is the key to safe practice. Core competencies should be met prior to any provider seeing patients on their own. I believe a plan for direct dermatologist support is important for the first two years of specialty practice. After that, the "team" can determine the strengths and weaknesses of each provider and develop their own plan for patient care, not by those with political agendas and turf wars.

3.  How has the Affordable Care Act affected nurse practitioners practicing in dermatology?

I think it is too early to tell the affects of the Affordable Care Act on the profession as a whole. We have not gathered any data regarding this topic. As far as my practice, people may have insurance, but the deductibles are so high. Some patients are not seeking dermatology services because they are unable to meet these deductibles, some as high as $10,000. The geriatric population, especially those in extended living facilities, seems to have fewer benefits. This is especially true with medications. I am still waiting for the "affordable" part of this act.

4. What core competencies in advance practice nursing and how the organization support those competencies?

NADNPs mission is to support NPs education, research, leadership, practice and political issues. We have reached out to all NPs throughout the country and internationally. The NADNP conference, Advance for NPs and PAs blogs, webinars, and articles, USF DNP dermatology residency program, and forming the dermatology planning committee with the National Nurse Practitioner Symposium to develop a dermatology track for their annual conference. All support the core competencies for advanced practice. Not to mention, the two new announcements just made by NADNP regarding the NADNP/American College of Dermatology NPs Fellows Program (FACDNP) and the post-masters certificate program being developed for 2015.

While we are a fairly new organization, we have made connections with our South East Asia and European dermatology nursing communities. NADNP is excited to work with our international colleagues and help unite the dermatology nursing community worldwide.

5. How many NPs belong to the organization?

We fluctuate with membership and have 1,500-2,000 members from all of the country. We also have affiliations with international nursing communities.

 

Debra Shelby, PhD, DNP, FNP-BC
President and Founder NADNP

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    Occupation: Physician assistant and nurse practitioners
    Setting: Various dermatology settings
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