All Entries Tagged With: "nurse practitioner"
NPs filling in for PCPs in rural areas—What does it mean for hospitalist-PCP communication?
It’s a funny thing—if you ask me what I ate for breakfast this morning, I couldn’t tell you. But if you ask me if I’ve ever written an article about OB hospitalists, I can tell you in what issue the article appeared and who I interviewed. I can also recall whether I was in the office, at home, or on the road when I wrote that article. A recent article on Kaiser Health News triggered memories from early 2009 when I wrote about how hospitalists and PCPs should develop consistent communication strategies to ensure safe follow-up care. Yes, it was raining and cold that day, and I sought out a quiet spot to write amid a houseful of guests.
But I digress. Kaiser Health News reports that nurse practitioners are often playing the role of primary care physicians in rural areas. Of course, the debate whether nurse practitioners are qualified to perform the functions of a physician still rages, but I wont’ delve into that debate here. The question that popped up for me was how hospitalist-PCP communication would change (if at all) if nurse practitioners were the PCPs, so to speak. Should hospitalist-PCP communication checklists contain more or different information depending on the restrictions that states place on NPs licenses? In states that require NPs to have physician supervisors, will physician supervisors need to be looped into that communication?
If any of you have experience with communicating patient care needs and follow-up care recommendations to NPs, we’d love to hear from you! Tell us whether you adjusted your communication strategies and why. NPs are welcome to chime in as well! I’m interested to hear about your experiences communicating with hospitalists as opposed to traditional, non-employed physicians.
Pennsylvania CRNPs granted greater prescribing authority
The Pennsylvania State Board of Nursing may have just paved the way for certified registered nurse practitioners (CRNP) to practice side by side with hospitalists and primary care physicians to ease the strain caused by the physician shortage. Although perhaps not explicitly for this reason, the state recently granted CRNPs greater drug prescribing authority, according to The Pennsylvania Bulletin. Our friends at the Med Law Blog sum it up nicely:
- CRNPs can now prescribe Schedule II controlled substances for up to a 30-day supply, an increase from the previous limit of 72 hours
- CRNPs are no longer required to notify their collaborating physician within 24 hours of prescribing a Schedule II controlled substance
- CRNPs may now prescribe Schedule III and IV controlled substances for up to a 90-day supply, up from the previous 30-day limit
Kirk Mathews said in a recent blog post, “It is clear that more and more hospital medicine programs are turning to NPs to supplement their practice in the face of a very challenging recruiting environment. I believe this is both logical and appropriate as the demand for hospitalists continues to grow.” (He goes on to offer a few words of caution that hospitalist programs should consider before throwing open the doors for NPs.)
One of our readers also chimed in on the topic of including NPs in the hospital medicine setting: “The goal of easing the burden on PCP’s is an important goal, but there are differences in training, and to ignore these compromises patient care.” Needless to say, there is a debate raging in the field.
If you’ve worked in healthcare for more than a day, you know there are no black or white answers—whether a hospitalist program opens the doors for NPs depends on the program, and, apparently, whether state regulations pave the path.
We’d like to hear your arguments for or against giving NPs greater authority to treat patients and what you think about Pennsylvania State Board of Nursing’s decision.
Nurse practitioners as hospitalists: A few things to consider
I read with great interest a recent question-and-answer article in the November issue of The Hospitalist regarding the use of nurse practitioners (NP) in hospital medicine. This article did a very nice job of presenting the topic from the NP’s perspective. It is clear that more and more hospital medicine programs are turning to NPs to supplement their practice in the face of a very challenging recruiting environment. I believe this is both logical and appropriate as the demand for hospitalists continues to grow.
However, here are a few things to consider when making the decision to add NPs to your hospital medicine team:
1. What is the level of medical staff and referring physician acceptance that NPs enjoy in the inpatient setting?
More and more specialties are using NPs and advanced practice nurses to assist them in the hospital, so NPs are clearly more visible than in previous generations. However, are the referring primary care physicians in your community expecting their patients to be seen by a physician when they are admitted to the hospitalist service? This is an important question to answer before adding NPs to your staff.
2. What are the rules in your hospital (and state) regarding the physician oversight/supervision of NPs?
One of our client hospitals required a physician to cosign every progress note made by our NP. This made the use of the NP less attractive from a practical and financial standpoint.
3. How comfortable are the physicians on your hospital medicine team in the supervision of NPs?
In our experience, not every physician easily adapts to the role of supervising NPs. This can create scheduling challenges when trying to match up compatible providers.
4. What cases will the NPs be assigned?
In some of our practices, our physician and nurse director of hospitalist operations work hard to assure that the NPs are assigned less challenging cases. This not only increases the comfort level of all parties involved but is good risk management as well.
All in all, I believe nurse practitioners are serving, and will continue to serve, a very valuable role in hospital medicine but require a certain set of circumstances to maximize their effectiveness.
How about your practice? Do you currently use NPs? What challenges/successes have you seen? Comment below and let us know!
Bright ideas: Hospital-based training for NPs and PAs
Nurse practitioners (NP) and physician assistants (PA) have traditionally practiced in the outpatient setting, but they are increasingly making their way into hospital-based medicine. Educational programs are still catching up with the trend, but there are some great ways for NPs and PAs to gain inpatient experience.
In an interview I did recently with Laura Rosenthal, MSN, ACNP, she told me about the nurse practitioner fellowship that the hospitalist medicine service at the University of Colorado Health Sciences Center launched in January. Currently, one NP is participating, and the program has received a couple dozen more resumes from all over the country.
Looking for a NP or PA to join your hospitalist practice?
Inviting nurse practitioner (NP) or physician assistant (PA) students onto your hospitalist team is a great way to recruit a strong staff, says Allan Platt, PA-C, MMSc, a faculty member at Emory University School of Medicine’s Physician Assistant Program. “I think having students on board is a no-risk way to recruit PAs,” he said in a recent interview.
By inviting students to train with your program, you have the opportunity to introduce them to the hospitalist’s role and teach them about practicing in a hospital setting. This is important because most NP and PA programs focus on outpatient, clinic-based care. Students that do a good job and make a good fit for the program’s culture can potentially walk right into a job after graduation.
Patients confused about NPs and PAs practicing in hospitalist programs
Anecdotal evidence and some studies show that patients who are treated by nurse practitioners (NP) and physician assistants (PA) are satisfied with their care—but do they really understand the relationship NPs and PAs have with the hospital or hospitalist service? For that matter, do they really understand the roles NPs and PAs play in their care?
Laura Rosenthal, MSN, ACNP, director of nurse practitioners in the hospitalist medicine service at the University of Colorado Health Sciences Center, has encountered more than a few patients who, after several days in the hospital, report to her that they haven’t seen a physician yet. “I explain that I am their care provider, but if they would like to see an attending physician, I’d be happy to arrange for one to stop by.”
First NP granted privileges: A new twist to the hospitalist-PCP relationship
We’ve covered the hospitalist-PCP relationship extensively in recent months, including an article in Hospitalist Leadership Advisor, an insert to Medical Staff Briefing, that discusses how good communication between hospitalists and PCPs enhances patient care.
Here’s a new twist to the hospitalist-PCP relationship: According to Medical Biznow, a nurse practitioner in Washington, D.C., opened her own practice in 2004 and became the first nurse practitioner in private practice to be granted hospital privileges in 2007.
As the shortage of PCPs deepens, I think we are going to see more advance practice professionals, such as nurse practitioners and physicians assistants, take on different roles in patient care and even open private practices. There are certainly pros and cons to consider, but given the current crisis surrounding quality and access to care, doesn’t it make sense to give someone who is trained as a nurse and a clinician the authority to treat patients to take some of the pressure off of PCPs?
