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© 2009 Fitzgerald Health Education Associates, Inc.
Hot Topics in NP Practice
Margaret A. Fitzgerald DNP, FNP-BC, NP-C, FAANP, CSP
President Fitzgerald Health Education Associates, Inc.
Family Nurse PractitionerAdjunct Faculty, Family Practice Residency
ProgramGreater Lawrence (MA) Family Health Center
Editorial Board MemberThe Nurse Practitioner Journal, Prescriber’s Letter,
American Nurse Today
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May you live in interesting times.
© 2009 Fitzgerald Health Education Associates, Inc.
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© 2009 Fitzgerald Health Education Associates, Inc.
Advances in Health Care
Lifestyle Pharmaceutical Surgery
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© 2009 Fitzgerald Health Education Associates, Inc.
“Routine” angioplasty while Vice President, now LVAD
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New diseases, new threatsH1N1 influenza A, Dengue
Fever
© 2009 Fitzgerald Health Education Associates, Inc.
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© 2009 Fitzgerald Health Education Associates, Inc.
Helping to create
Chronically critically ill
New-form acutely ill
Groups who have not historically lived in the community
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Opportunity: We can look at where we have
come as the NP and PA professions.
© 2009 Fitzgerald Health Education Associates, Inc.
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© 2009 Fitzgerald Health Education Associates, Inc.
What else happened in 1965?
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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)
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© 2009 Fitzgerald Health Education Associates, Inc.
1965Feminine Forever
Dr. 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. …
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© 2009 Fitzgerald Health Education Associates, Inc.
1965Feminine Forever
Dr. 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."
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© 2009 Fitzgerald Health Education Associates, Inc.
1965 vs 2010
Type 2 DM therapy 1965–Chlorothiazide–Orinase
About $8/ month in 2009 dollars–Death within 5 years of diagnosis
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© 2009 Fitzgerald Health Education Associates, Inc.
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
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1965 vs. 2010
© 2009 Fitzgerald Health Education Associates, Inc.
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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.
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© 2009 Fitzgerald Health Education Associates, Inc.
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.
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In 1965..
Both professions had their start.
© 2009 Fitzgerald Health Education Associates, Inc.
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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.
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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.
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© 2010 Fitzgerald Health Education Associates, Inc.
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
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Opportunity: Our professions’ salaries are approximately
double that of the average US wage earner.
© 2010 Fitzgerald Health Education Associates, Inc.
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Pitfall: We often do not take home a representative portion of the income
we generate.
© 2009 Fitzgerald Health Education Associates, Inc.
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© 2009 Fitzgerald Health Education Associates, Inc.
Nice to hear that a new high school grad is thinking about
becoming a nurse practitioner……
Opportunity
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© 2009 Fitzgerald Health Education Associates, Inc.
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.
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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.
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© 2009 Fitzgerald Health Education Associates, Inc.
Pitfall:But we still have a long way to
go…
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© 2009 Fitzgerald Health Education Associates, Inc.
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© 2009 Fitzgerald Health Education Associates, Inc.
What is our collective responsibility?
Opportunity: Much legislative work has been done.
Pitfall: Much needs yet to be done.
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© 2009 Fitzgerald Health Education Associates, Inc.
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.
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© 2009 Fitzgerald Health Education Associates, Inc.
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.
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Pitfall and opportunity
Not enough of us belong to our professional organizations.
© 2009 Fitzgerald Health Education Associates, Inc.
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© 2009 Fitzgerald Health Education Associates, Inc.
Opportunity:Caring for people in need
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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.
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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.
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NP and PAs (APCs)= Growth industry
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Pitfall:Have we “flooded the market”
with NPs and PAs?
© 2009 Fitzgerald Health Education Associates, Inc.
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© 2009 Fitzgerald Health Education Associates, Inc.
Strength in numbers
Do the math!!!
NP and PAs educated as PCP, anticipated yield per annum–~3500 + 2500= 6000
Potentially 6000 new primary care providers per annum
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Opportunity: We have caught
the eye of people in power.
© 2009 Fitzgerald Health Education Associates, Inc.
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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.
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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.
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PitfallWhose pie is it, anyway?
© 2009 Fitzgerald Health Education Associates, Inc.
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© 2009 Fitzgerald Health Education Associates, Inc.
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.
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© 2009 Fitzgerald Health Education Associates, Inc.
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.
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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.
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© 2009 Fitzgerald Health Education Associates, Inc.
May you live in interesting times.
May you come to the attention of those in
authority.
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© 2009 Fitzgerald Health Education Associates, Inc.
May you find what you seek.
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© 2009 Fitzgerald Health Education Associates, Inc.
End Presentation
Thank you! [email protected] www.fhea.com