DiversityNursing Blog

By Alvin Tran

More than 27 million Americans will soon gain health coverage under the health law. But who will treat them all?

With such a large coverage expansion, and with an anticipated shortage of primary care physicians available to serve them, some states have or are considering allowing so-called advanced practice nurses -- those with advanced degrees -- to treat more patients. David Hebert is at the issue’s center. Hebert, a veteran health care lobbyist and former CEO of the American College of Nurse Practitioners, is the first CEO of the American Association of Nurse Practitioners (AANP) -- a new group with 42,000 members recently formed from the merger of the American College of Nurse Practitioners and the American Academy of Nurse Practitioners.

Hebert says that despite doubts from some doctor groups, nurse practitioners are honing their craft in patient care and research to position themselves to help care for this new influx of patients, and they’re doing so without sacrificing the quality of care.

KHN's Alvin Tran sat down recently with Hebert to discuss the changing role nurse practitioners may soon have, as well as some physicians' efforts to stop them.

Here are edited excerpts of that discussion:

Q. As of 2012, 18 states and the District of Columbia allow nurse practitioners to diagnose, treat patients and prescribe medications without a doctor’s involvement. What is the biggest impediment to expanding to other states? How are you planning to expand that to the other states?

Well, the problem is that there are certain states that require physicians' supervision of nurse practitioners or there may well be some kind of restrictive collaborative agreement that is imposed upon the nurse practitioner. Often times, that makes it very difficult for nurse practitioners to practice. Sometimes there may be a physician who is unwilling to supervise. Other times you may have an issue where the physician chooses to not form a collaborative agreement with nurse practitioners. So, part of the issue is that we have anticompetitive regulations in place.

There are a number of things that we want to do at the federal level. We are hopeful that legislation is going to be reintroduced this Congress that will allow nurse practitioners in Medicare to admit patients for home health care. Right now, the admission can only be done by a physician. Given the fact that we've had research indicating that it would be cost effective, we can get people out of nursing homes and hospitals quicker. It really makes good public policy sense. Particularly, if you got a situation in a rural area where the nurse practitioner and the patient is waiting for the physician to sign the order to admit into home health.

Same thing is true on hospice. We've not been able to get legislation passed that allows nurse practitioners to admit to hospice. We’re not currently permitted by statute to formaccountable care organizations on our own. That opens up a lot of possibilities for safe and effective, cost effective health care.

Q. Physicians groups, including the American Medical Association, have opposed efforts to expand the scope of practice of nurse practitioners and raised concerns of patient safety, contending that physicians' extended training makes them more qualified to handle such issues. How do you make sure that patients are protected?

There have been studies over the years that shows that our outcomes are the same or better than primary care physicians. The fact is that it’s a total red herring. Nurse practitioners have been practicing safely and providing great outcomes for decades.

Q. Medicare’s reimbursement rate for NPs is 85 percent of the physician rate for the same services. Should these rates be the same for both providers?

One hopes that, when all is said and done, whether they're working with a physician or billing on their own, it should be 100 percent of what a doctor is paid because the fact is, they're providing the same services that a physician is providing. Quite frankly, it doesn't make any sense.

Q. What role do you think NPs will have once the federal health law takes effect in 2014?

I think that once you have a full implementation of the expanded Medicaid provisions of the ACA, you’re going to see increased demand for primary care. Unless there’s someone there to provide that care, the intent of the ACA will not be fulfilled. You’re going to see a lot of patients who may be insured or have coverage under Medicare and Medicaid, but may not be able to get services.

I think the major challenges will be to look at regulations that artificially restrict a nurse practitioner’s ability to practice within their scope. If patients want to choose a nurse practitioner, they should be free to do so.

Q. Your tenure as CEO began last month, what’s at the very top of your 'to-do list'?

We are looking at rebranding and a more enhanced public relations campaign. We're looking at increasing membership. Right now we’re about 42,000 members and there are 155,000 nurse practitioners in this country. So, we have room for growth. We’re going to be spending some time ramping up our association activities.

Source: Kaiser Health News

By Brian Womack - for Bloomberg

Facebook Inc., operator of the world’s largest social-networking service, is seeking a global head of diversity, as the quickly expanding company’s recruits people from different backgrounds to foster creativity.

The position includes responsibilities around employee recruitment, development and retention, the company said on its website. The diversity chief will build and manage a team focused on diversity, according to the posting.

Facebook, grappling with large rivals such as Google Inc. is ramping up hiring, growing 44 percent to 4,619 employees in the fourth quarter from a year earlier. Chief Executive Officer Mark Zuckerberg said last month the company plans to “continue to grow our headcount quickly in 2013.”

“We’re a fast-growing company, and this role will help us formalize processes that ensure we scale our diversity at the same rate,” Slater Tow, a spokesman for Facebook, said in an e- mailed statement. “In the past, our diversity and inclusion efforts were decentralized amongst many employees and, given our stage of growth, we are consolidating our work and people into one team.”

Among Facebook’s efforts is a new search service the company began to roll out last month. The company is also bolstering its mobile offerings, including an upgrade to its application for smartphones based on Google’s Android software.

While Facebook’s staff is growing quickly, it’s still much smaller than some of its rivals. Google, for example, has more than 10 times as many people.

The diversity position will be based at Facebook’s headquarters in Menlo Park, California.

“We’ve always focused on recruiting the very best and brightest,” Tow said. “We are big believers that creativity happens with people who have different perspectives and background.”

By Laura Krantz

A new regional public health nurse will help three local towns tackle a big problem: making sure residents take their medications properly, officials said Tuesday.

Thanks to a wellness grant administered by the MetroWest Regional Collaborative, nurse Alyssa Kaiser has been hired part time to run preventative medicine programs in Ashland, Hopkinton and Medway. The programs will range from mental health to concussion safety to fall prevention for the elderly, local health agents said Tuesday.

"I’m able to be creative and implement a lot of programs I don’t think just being a clinical nurse you’re able to do," said Kaiser, 30, recently graduated from the Mass. College of Pharmacy and Health Science’s Worcester campus.

She said she is eager to begin learning the major health needs of each town.

"What I’m trying to do is trying to take a look at all of the town sand trying to see what are the issues…in each one of the towns and what can we do to help solve that problem or prevent these issues?" she said. "I don’t think that has been addressed before."

The nurse is meeting with local officials this month. Once her work is in full swing, one of her main goals will be to encourage residents, especially seniors, to properly administer their medications.

"There’s such a large amount of the elderly population that becomes sick from either taking too little of their drugs or too much," said Stephanie Bacon, Medway’s health agent.

According to a 2010 article in the New England Journal of Medicine, as many as half of all patients do not adhere faithfully to their prescription medication regimens, resulting in more than $100 billion spent annually on avoidable hospitalizations.　

The article said unorganized care as well as psychological issues, health literacy and side effects can lead to people not taking their medicine properly.

Kaiser said many adults, not only seniors, struggle to take medicine properly. They can receive dangerous combinations of medicines from two different doctors or have dietary restrictions that interfere with a medicine, for example.

"It’s a huge, huge issue," she said.

Kaiser will work with seniors, schools and sports groups on topics including mental health and abuse, disease prevention and nutrition.

She was at the Medway senior center Tuesday talking with seniors about medicine adherence, Bacon said.

Hopkinton Public Health Administrator Ed Wirtanen Tuesday said he is thrilled to have a nurse in an era of shrinking budgets and an uncertain future of public health. He said the town hasn’t had a nurse since at least 2008.

"We’re desperately trying to get a nurse," he said.

Bacon said Kaiser will also help the elderly prevent themselves from falling. For seniors, a single fall can cause health complications from which many never recover.

"Literally, a fall can be the end of their life," Bacon said.

Those who do recover often live in fear of falling again, she said. The nurse Tuesday gave out spike-type tools to put on the bottom of canes to help prevent falling in icy weather, Bacon explained.

Mark Oram, Ashland health agent, said people often set up pillboxes but don’t always adhere to the plan.

He said the nurse will also film public service announcements for local cable access channels in the three towns. The part-time position is scheduled to run through July but Oram said they have asked that it be extended through the end of 2013.

Source: MetroWest Daily News

BY SCRUBS EDITOR

Every week we scour the Internet for controversy, quotes and stories related to nursing and the things you care about. Tune in to read our roundup every week!

1. Does your fatigue have anything to do with the length of your shift? According to this study — YES. It does! 

So how did this happen in the first place? Amy Witkoski Stimpfel, a fellow at the University of Pennsylvania School of Nursing, explains:

“Nurses traditionally worked eight-hour days. Then in the 1980s and 1990s, when some structural changes in health care and cost containment measures [were] put in, it was actually less expensive to have nurses work 12-hour shifts, because that [meant] only two nurses per day [were needed] instead of three. So nurses began working these 12-hour shifts. In fact, they decided that they really liked it because it offered better work life balance. Nurses could work three days instead of five, so they had more time off with their family and friends and fewer commutes. And they had more time to go back to school. So it’s really become very prevalent.”

Source: Knowledge @ Wharton

2. Nurses love their career choice, but 30% say they aren’t happy with their jobs.

Harvard Business School professor and author Clayton Christensen describes motivation like this: “[It] means that you’ve got an engine inside of you that drives you to keep working in order to feel successful and to help the organization be successful. It causes you to keep at it through thick and thin. Motivators are things like, ‘I have the opportunity to achieve important things,”I learn ways to be better,’ and ‘I’m an important part of a team.’ If you have those kinds of experiences every day, you’re motivated, and you’ll be satisfied.”

Source: Health Leaders Media

3. San Francisco nurse wins national award for her book detailing her transition to life coaching.

On why she flipped careers:

“I wanted to help people who wanted to make transformative, positive change in their own lives,” said Linda Bark, who runs the Alameda-based Bark Coaching Institute. “Coaching can be for life transitions, business decisions, health–either way, it is about helping a person make a change by listening to one’s whole self. What I invite people to do is to see what information they’re getting, not just from their thinking minds, but from their bodies.”

Source: The Oakland Tribune

Article Source: Scrubs Magazine

BY SCRUBS EDITOR 

There are lots of medical dictionaries out there, but it seems that Taber’s Medical Dictionary for Mobile + Web–which is used a ton in nursing schools–is one of the top choices. If what they claim is true (“including 30% more medical terms than any other app,” “used most amongst healthcare professionals”), then we can see why!

Taber’s contains more than 60,000 terms, 1,000 photos, and 600 patient care statements, making it a hugely comprehensive health science dictionary. The iTunes page boasts that “Taber’s goes beyond in-depth definitions with nutrition and alternative therapy coverage, medical abbreviations, symbols and units of measurement, immunization schedules, nursing diagnoses, links to pronunciations, and more. This powerful app contains the information you need to answer critical questions at the bedside, in the classroom, at home, or in the office.”

What nurses love about Taber’s: 

“The index is super easy to use. Very nice to be reading my nursing e-textbook and switch to my e-Taber’s and get more info. I highly recommend this!” – Space Queen, Amazon.com

Taber’s Medical Dictionary for Mobile + Web features for all iOS devices:

• Optimized interface
• Universal Index Search – find topics across all indexes
• Personalized favorites
• Superior navigation

Taber’s Medical Dictionary for Mobile + Web features for iPad:

• iPad-specific interface – not just an enlarged iPhone app
• Side-by-side reading and navigation panes

PLEASE NOTE: This application requires a paid subscription to the online Taber’s Medical Dictionary for Mobile + Web service.

Source: Scrubs Magazine

New delivery models will bring an increase in community-based facilities

With population health gathering momentum in the wake of health care reform, more hospitals are either constructing community-based settings or are including them in their plans. The goal is to offer sophisticated levels of care at patient-friendly sites and reduce costs with fewer hospital admissions.

Montefiore Medical Center is a perfect example of what is expected to become a growing trend. It recently announced plans to lease a new 11-story, 280,000-square-foot building at Hutchinson Metro Center, a mixed-use development in New York City.

The project, scheduled for completion in the third quarter of 2014, will provide space for multidisciplinary care and integrate technology that allows Montefiore to provide necessary treatments without the need for hospitalization.

"This new tower will allow Montefiore to bring the health care of tomorrow to our patients here in the Bronx," says President and CEO Steven M. Safyer, M.D. "We are reshaping outpatient care and establishing leading practices that provide Montefiore's world-class treatments through multidisciplinary teams at a hospital without beds."

The decision to develop a freestanding ambulatory facility emerged because of several factors, including the ability to provide high-tech imaging and surgical procedures in an outpatient setting, says Ed Pfleging, vice president of engineering and facilities.

The site will include 12 operating rooms and four procedure rooms that will allow difficult cases requiring a hospital-type setting to be scheduled more easily and completed quickly, he says.

While not all new off-campus facilities will be as large as this one, the 2013 Hospital Construction Survey conducted by H&HN's sister publication, Health Facilities Management, and the American Society for Healthcare Engineering also identifies a trend involving increased community-based health care.

Of the 612 survey respondents — who include vice presidents and directors of facilities management and operations at U.S. hospitals — future facility development plans and construction projects include:

• 11 percent, ambulatory surgery centers, 
• 11 percent, satellite offices catering to specialities;
• 15 percent, outpatient facilities in neighborhood settings; 
• 12 percent, urgent care facilities in neighborhood settings;
• 15 percent, new medical office building construction.

According to the National Association of Community Health Centers, the number of Americans who rely on community health centers for care is expected to double to an estimated 40 million by 2015 — from about 20 million in 2010. The Affordable Care Act allocated $11 billion to expand these centers, including $1.5 billion for construction.

Richard Taylor, managing director, health care solutions group, Jones Lang Lasalle, a real estate services firm based in Chicago, says health care systems are evolving into integrated delivery systems that reach out to their customers through a variety of facility types.

"It's all part of that overall trend that you can track back to the health care legislation and consumer preferences," he says. Lower cost of delivery and competition are two other key factors in the trend, he adds.

Marisa Manley, president, Healthcare Real Estate Advisors, agrees that the drive is in full swing for hospitals to move urgent, ambulatory and primary care to community-based sites to meet patient preferences and to cut costs.

Another positive outcome of the trend is that hospitals likely will start to utilize some of the empty buildings and office spaces caused by the Great Recession in addition to building new facilities when necessary, she says.

Source: H&HN