Ebola and Project Cure

Over the past months, the tragedy of Ebola can be viewed each evening on our televisions. To date it is estimated that 9000 people in west Africa in the countries of Liberia, Sierra Leone and Guinea have been infected with 4000 having died from the desease. It is estimated that for every four cases there are six that are unreported. 230 health care workers have died in Africa caring for the sick. There is concern that this Ebola epidemic may reach the proportions of the AIDS epidemic if it continues to progress on the current course. Project Cure was founded in 1987 and is the largest provider of medical supplies and equipment to 130 developing countries around the world. Project Cure's headquarters is in southwest Denver. The organization has 17,000 volunteers. They have been given a charity navigator four star rating as well as recognition by Forbes as one of the 20 most efficient large charities in the U.S. 98.3% of their budget goes to programs/donations and .3% to administrative expenses. 1.2% of budget goes to fundraising. Project Cure has contributed supplies to the Ebola crisis with one dozen 40 foot containers worth 4.5 million of PPE. Project Cure is in need of continued supplies and support, especially duct tape to secure gloves to gowns. December 2 is a day of giving for Project Cure and donations will be generously matched with dollars for those who choose to give. Our hospital facility in south Denver regularly donates expired supplies to Project Cure. Because of the current needs, a group of us conducted a thorough sweep of the hospital for any expired supplies to be delivered to the warehouse. The warehouse is huge! It is amazing the number and amount of supplies that they have to distribute to those in need. It is also striking the amount of supplies that the U.S. deems unusable because of a manufacturer expiration date. The obvious question is why is something not good enough to use in the U.S. because it is 'expired product' but it is good enough to use in 130 countries in the world? If you live in Denver, please save your expired supplies for Project Cure! If you have a few extra hours, they need volunteers! A very worthy organization that will fully utilize your donated goods or money!

Update on APN Scope of Practice

There are continued efforts by the Colorado Center for Nursing Excellence to advocate for APRN's to practice to the full extent of their license.  Why is this important?

• There is a projected 130,000 shortage of primary care physicians in the year 2025
• In New Mexico this past year there was a shortage of 2306 RN's and 284 APRN's
• In 2012 there were 154,000 APRN's in the U.S and 65,000 are providing primary care

Access to care for rural and inner city populations is at stake.

To date, 19 states in the U.S. have fully independent APRN practice, 19 have reduced practice and 12 have restricted practice requiring supervision by a physician.  100 bills related to scope of practice have been introduced in 22 states between 2011 and 2013.  25% of the bills have passed. 

In October 2014, recommendations were brought forward to amend the Colorado requirements to

6 months of full time or 1000 practice hours with a physician or experienced APRN to gain full prescriptive authority.  

The resulting access to care for Coloradans would have positive impact for vulnerable populations in the state.  This comes at a time when APRN's are growing in number and practicing more independently:

• The ACA of 2010 supports training for APRN's, team based models of care and retail health clinics
• The VA recommended permitting APRN's to practice independently because of physician shortages
• CVS pharmacies currently have 1000 clinics employing 2500 APRN's in the U.S.  They plan for 1500 clinics by 2017
• Target has opened 150 clinics with plans to expand

What can you do?  Join your state nursing association in order to successfully lobby for APRN's to practice to the full scope of their practice in your state!  

A good link to learn more:

http://www.nihcm.org/images/pdf/Meeting-the-demand-for-primary-care-nurse-practitioners-answer-the-call-John-Iglehart-Expert-Voices-10-2014.pdf

Update on APRN Scope of Practice from the Colorado Center for Nursing Excellence

Advanced Practice Nurses:  Improving   Access to Health Care for Coloradans

The need for primary care in the U.S.

As the American population ages and more citizens have access to obtain health insurance it is unclear how the existing population of practitioners can meet this increasing demand.  In a recent Federal Trade Commission (FTC) study it was determined that the U.S. faces a growing shortage of primary care physicians which will reduce access for our poorest citizens, including Medicare beneficiaries and those who live in rural communities (1).  The National Governor’s Association (NGA) determined that by the year 2019, the demand for primary care in the U.S. will increase by between 15 and 25 million visits per year requiring 4,000 to 7,000 more physicians to meet this demand (2).

Colorado’s need: The Colorado Health Access Survey conducted by the Colorado Health Institute (2013)

·         14.3%  are uninsured

·         9.3% are Medicare beneficiaries

·         7.3% are Medicaid recipients

·         15% indicate they are unable to obtain an appointment as timely as their perceived need

·         8.2% experience providers that do not accept their insurance

·         8.4% have been told by practices that they are not accepting new patients

·         54.1% reported using an E.D. for their last visit because an office visit was not available as timely as their perceived need

·         50-100% of primary care is provided by NP’s in 4 Colorado counties and 25-50% in an additional 18 Colorado counties (3)

The Solution

Advanced Practice Registered Nurses (APRN’s) including Nurse Practitioners (NP’s) are a key strategy to alleviate provider shortages in primary care in medically underserved areas and for medically underserved populations.  Fortunately, the number of APRN’s per capita grew an average of more than 9% annually between the mid 1990’s and mid 2000’s compared to a 1% annual growth of primary care physicians (PCP’s) during the same time (1). The APRN solution to increase access to care has been endorsed by:

·         The Federal Trade Commission Policy Perspectives: Competition and Regulations of Advanced Practice Nurses (2014; 1)

·          The NGA; The Role of Nurse Practitioners in Meeting Increasing Demand for Primary Care (2012; 2)

·         The Institute of Medicine National Academy of Sciences, The Future of Nursing:  Leading Change, Advancing Health (2011; 4)

·         The RAND Health Report Submitted to the Commonwealth of Massachusetts (2009, 5)

·         The Kaiser Family Foundation; Improving Access to Adult Primary Care in Medicaid (2011, 6)

·         The Robert Wood Johnson Foundation; How Nurses are Solving Some of Primary Care’s Most Pressing Challenges (2012, 7)

Colorado’s next steps

After the sun downing of the Nurse Practice Act in 2008, the Nurse Physician Advisory Taskforce for Colorado Healthcare (NPATCH) was formed to make recommendations for policy making entities (8). NPATCH determined that APRN’s in Colorado may receive full prescriptive authority only after completing

1.       An initial 1800 hour preceptor ship to obtain Provisional Prescriptive Authority –and

2.       An 1800 hour mentorship and one time articulation plan signed by a physician within 5 years

No other state has this requirement in place (9).  An unintended consequence of this regulation is that many APRN’s are not able to find physician mentors, are unable to find employment and are therefore moving out of the state of Colorado where there are less restrictive oversight requirements (8).

Constrained supervision requirements in the state of Colorado will result in decreasing the pool of available APRN’s to provide access to care for vulnerable populations in the state seeking primary care services. 

(1)     Federal Trade Commission (2014). Policy Perspectives: Competition and Regulations of Advanced Practice Nurses.  Available at: http://www.ftc.gov/reports/policy-perpectives-competition-regulation-advanced-practice-nurses

(2)     National Governor’s Association, NGA Paper: The Role of Nurse Practitioners in Meeting Increasing Demand for Primary Care (2012), http://www.nga.org/files/live/sites/NGA/files/pdf/1212NursePractitionersPaper.pdf

(3)     Colorado Health Access Survey (2013),  Courtesy of the Colorado Health Institute, www.ColoradoHealthInstitute.org/health/colorado-health-access-survey-1

(4)     Institute of Medicine, National Academy of Sciences,  The Future of Nursing: Leading Change, Advancing Health (2011).

(5)     Christine E. Eibner, et al., RAND Health Report Submitted to the Commonwealth of Massachusetts, Controlling Health Care Spending in Massachusetts:  An Analysis of Options (2009), http://www.ran.org/content/dam/rand/pubs/technical_reports/2009/RAND_TR733.pdf.

(6)     Kaiser Family Foundation, Improving Access to Adult Primary Care in Medicaid:  Exploring the Potential Role of Nurse Practitioners and Physician Assistants (March 2011), http://kaiserfamilyfoundaton.files.wordpress.com/2013/01/8167.pdf

(7)     Robert Wood Johnson Foundation, How Nurses are Solving Some of Primary Care’s Most Pressing Challenges (2012), http://www.rwjf.org/content/dam/files/rwjf-web-files/Resources/2/cnf20120810.pdf.

(8)     Hoback, J. (2014).  ‘Unfettered nursing’ required for Coloradans desperate for care.  http://www.healthnewscolorado.org/2014/02/26/unfettered-nursing-required-for-coloradans-desperate-for-care/

(9)     Pearson, L. J. (2012).  The Pearson Report, www.pearsonreport.com

Colorado APRN Prescriptive Authority; Continued work with the Colorado Center for Nursing Excellence

Advanced Practice Nurses:  Quality Health Care for Coloradans

The need for primary care in the U.S.

As the American population ages and more citizens have access to obtain health insurance it is unclear how the existing population of practitioners can meet this increasing demand.  In a recent Federal Trade Commission (FTC) study it was determined that the U.S. faces a growing shortage of primary care physicians which will reduce access for our poorest citizens, including Medicare beneficiaries and those who live in rural communities (1). 

Colorado’s need: The Colorado Health Access Survey conducted by the Colorado Health Institute (2013)

·         14.3% of Coloradan’s  are uninsured, 9.3% are Medicare beneficiaries and 7.3% are Medicaid recipients  

·         54.1% reported using an E.D. for their last visit because an office visit was not available as timely as their perceived need

·         50-100% of primary care is provided by NP’s in 4 Colorado counties and 25-50% in an additional 18 Colorado counties (2)

The Solution:  High Quality Care for Coloradans

An Advanced Practice Registered Nurse (APRN) is a Nurse Practitioner with a graduate nursing degree who has trained to provide a broad range of services, including the diagnosis and treatment of acute and chronic illnesses.  APRN’s hold masters’ or doctoral degrees and pass national certification exams.  There are four types of APRN’s; Nurse Practitioners (NP’s), Nurse Midwives (NMW), Certified Registered Nurse Anesthetists (CRNA’s) and Clinical Nurse Specialists (CNS).

A thorough systematic review in the publication Nursing Economics (2011) of 107 published studies from 1990 to 2008 examined the impact of APRN’s on primary care patient outcomes.  The results indicated that APRN’s deliver high quality patient care and can safely augment physician resources to support reform efforts to enhance the access to primary care.  Additionally, patient outcomes provided by APRN’s are similar and in some ways better than care provided by physicians alone. (3)

The National Governor’s Association (NGA) confirms these findings by examining process outcome measures to include patient satisfaction, time spent with patients, prescribing accuracy and the provision of preventative education.  In each of these categories, APRN’s performed at least equal in quality of care compared to traditional health care models. (4)

The Federal Trade Commission also supports these findings stating that empirical research strongly suggests that APRN’s are safe and effective providers of diverse primary care services. (1)  

 

Colorado’s next steps

After the sun downing of the Nurse Practice Act in 2008, the Nurse Physician Advisory Taskforce for Colorado Healthcare (NPATCH) was formed to make recommendations for policy making entities (5). NPATCH determined that APRN’s in Colorado may receive full prescriptive authority only after completing

1.       An initial 1800 hour preceptor ship to obtain Provisional Prescriptive Authority –and

2.       An 1800 hour mentorship and one time articulation plan signed by a physician within 5 years

No other state has this requirement in place (6).  An unintended consequence of this regulation is that many APRN’s are not able to find physician mentors, are unable to find employment and are therefore moving out of the state of Colorado where there are less restrictive oversight requirements (5).

Constrained supervision requirements in the state of Colorado will result in decreasing the pool of available APRN’s to provide access to care for vulnerable populations in the state seeking primary care services. 

(1)     Federal Trade Commission (2014). Policy Perspectives: Competition and Regulations of Advanced Practice Nurses.  Available at: http://www.ftc.gov/reports/policy-perpectives-competition-regulation-advanced-practice-nurses

(2)     Colorado Health Access Survey (2013),  Courtesy of the Colorado Health Institute, www.ColoradoHealthInstitute.org/health/colorado-health-access-survey-1

(3)     Newhouse, R. P., Stanik-Hutt, J., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G. & Weiner, J. P. (2011).  Advanced Practice Nursing Outcomes 1990-2008:  A systematic Review.  Nursing Economics, 29 (5), 230-251.

(4)     National Governor’s Association, NGA Paper: The Role of Nurse Practitioners in Meeting Increasing Demand for Primary Care (2012), http://www.nga.org/files/live/sites/NGA/files/pdf/1212NursePractitionersPaper.pdf

(5)     Hoback, J. (2014).  ‘Unfettered nursing’ required for Coloradans desperate for care.  http://www.healthnewscolorado.org/2014/02/26/unfettered-nursing-required-for-coloradans-desperate-for-care/

(6)     Pearson, L. J. (2012).  The Pearson Report, www.pearsonreport.com

Advanced Practice Nurses:  Quality Health Care for Coloradans

The need for primary care in the U.S.

As the American population ages and more citizens have access to obtain health insurance it is unclear how the existing population of practitioners can meet this increasing demand.  In a recent Federal Trade Commission (FTC) study it was determined that the U.S. faces a growing shortage of primary care physicians which will reduce access for our poorest citizens, including Medicare beneficiaries and those who live in rural communities (1). 

Colorado’s need: The Colorado Health Access Survey conducted by the Colorado Health Institute (2013

)

·         14.3% of Coloradan’s  are uninsured, 9.3% are Medicare beneficiaries and 7.3% are Medicaid recipients  

·         54.1% reported using an E.D. for their last visit because an office visit was not available as timely as their perceived need

·         50-100% of primary care is provided by NP’s in 4 Colorado counties and 25-50% in an additional 18 Colorado counties (2)

The Solution:  High Quality Care for Coloradans

An Advanced Practice Registered Nurse (APRN) is a Nurse Practitioner with a graduate nursing degree who has trained to provide a broad range of services, including the diagnosis and treatment of acute and chronic illnesses.  APRN’s hold masters’ or doctoral degrees and pass national certification exams.  There are four types of APRN’s; Nurse Practitioners (NP’s), Nurse Midwives (NMW), Certified Registered Nurse Anesthetists (CRNA’s) and Clinical Nurse Specialists (CNS).

A thorough systematic review in the publication Nursing Economics (2011) of 107 published studies from 1990 to 2008 examined the impact of APRN’s on primary care patient outcomes.  The results indicated that APRN’s deliver high quality patient care and can safely augment physician resources to support reform efforts to enhance the access to primary care.  Additionally, patient outcomes provided by APRN’s are similar and in some ways better than care provided by physicians alone. (3)

The National Governor’s Association (NGA) confirms these findings by examining process outcome measures to include patient satisfaction, time spent with patients, prescribing accuracy and the provision of preventative education.  In each of these categories, APRN’s performed at least equal in quality of care compared to traditional health care models. (4)

The Federal Trade Commission also supports these findings stating that empirical research strongly suggests that APRN’s are safe and effective providers of diverse primary care services. (1)

   

Colorado’s next steps

After the sun downing of the Nurse Practice Act in 2008, the Nurse Physician Advisory Taskforce for Colorado Healthcare (NPATCH) was formed to make recommendations for policy making entities (5). NPATCH determined that APRN’s in Colorado may receive full prescriptive authority only after completing

1.       An initial 1800 hour preceptor ship to obtain Provisional Prescriptive Authority –and

2.       An 1800 hour mentorship and one time articulation plan signed by a physician within 5 years

No other state has this requirement in place (6).  An unintended consequence of this regulation is that many APRN’s are not able to find physician mentors, are unable to find employment and are therefore moving out of the state of Colorado where there are less restrictive oversight requirements (5).

Constrained supervision requirements in the state of Colorado will result in decreasing the pool of available APRN’s to provide access to care for vulnerable populations in the state seeking primary care services. 

(1)     Federal Trade Commission (2014). Policy Perspectives: Competition and Regulations of Advanced Practice Nurses.  Available at: http://www.ftc.gov/reports/policy-perpectives-competition-regulation-advanced-practice-nurses

(2)     Colorado Health Access Survey (2013),  Courtesy of the Colorado Health Institute, www.ColoradoHealthInstitute.org/health/colorado-health-access-survey-1

(3)     Newhouse, R. P., Stanik-Hutt, J., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G. & Weiner, J. P. (2011).  Advanced Practice Nursing Outcomes 1990-2008:  A systematic Review.  Nursing Economics, 29 (5), 230-251.

(4)     National Governor’s Association, NGA Paper: The Role of Nurse Practitioners in Meeting Increasing Demand for Primary Care (2012), http://www.nga.org/files/live/sites/NGA/files/pdf/1212NursePractitionersPaper.pdf

(5)     Hoback, J. (2014).  ‘Unfettered nursing’ required for Coloradans desperate for care.  http://www.healthnewscolorado.org/2014/02/26/unfettered-nursing-required-for-coloradans-desperate-for-care/

(6)     Pearson, L. J. (2012).  The Pearson Report, www.pearsonreport.com

Advanced Practice Nurses:  Improving   Access to Health Care for Coloradans

The need for primary care in the U.S.

As the American population ages and more citizens have access to obtain health insurance it is unclear how the existing population of practitioners can meet this increasing demand.  In a recent Federal Trade Commission (FTC) study it was determined that the U.S. faces a growing shortage of primary care physicians which will reduce access for our poorest citizens, including Medicare beneficiaries and those who live in rural communities (1).  The National Governor’s Association (NGA) determined that by the year 2019, the demand for primary care in the U.S. will increase by between 15 and 25 million visits per year requiring 4,000 to 7,000 more physicians to meet this demand (2).

Colorado’s need: The Colorado Health Access Survey conducted by the Colorado Health Institute (2013)

·         14.3%  are uninsured

·         9.3% are Medicare beneficiaries

·         7.3% are Medicaid recipients

·         15% indicate they are unable to obtain an appointment as timely as their perceived need

·         8.2% experience providers that do not accept their insurance

·         8.4% have been told by practices that they are not accepting new patients

·         54.1% reported using an E.D. for their last visit because an office visit was not available as timely as their perceived need

·         50-100% of primary care is provided by NP’s in 4 Colorado counties and 25-50% in an additional 18 Colorado counties (3)

The Solution

Advanced Practice Registered Nurses (APRN’s) including Nurse Practitioners (NP’s) are a key strategy to alleviate provider shortages in primary care in medically underserved areas and for medically underserved populations.  Fortunately, the number of APRN’s per capita grew an average of more than 9% annually between the mid 1990’s and mid 2000’s compared to a 1% annual growth of primary care physicians (PCP’s) during the same time (1). The APRN solution to increase access to care has been endorsed by:

·         The Federal Trade Commission Policy Perspectives: Competition and Regulations of Advanced Practice Nurses (2014; 1)

·          The NGA; The Role of Nurse Practitioners in Meeting Increasing Demand for Primary Care (2012; 2)

·         The Institute of Medicine National Academy of Sciences, The Future of Nursing:  Leading Change, Advancing Health (2011; 4)

·         The RAND Health Report Submitted to the Commonwealth of Massachusetts (2009, 5)

·         The Kaiser Family Foundation; Improving Access to Adult Primary Care in Medicaid (2011, 6)

·         The Robert Wood Johnson Foundation; How Nurses are Solving Some of Primary Care’s Most Pressing Challenges (2012, 7)

Colorado’s next steps

After the sun downing of the Nurse Practice Act in 2008, the Nurse Physician Advisory Taskforce for Colorado Healthcare (NPATCH) was formed to make recommendations for policy making entities (8). NPATCH determined that APRN’s in Colorado may receive full prescriptive authority only after completing

1.       An initial 1800 hour preceptor ship to obtain Provisional Prescriptive Authority –and

2.       An 1800 hour mentorship and one time articulation plan signed by a physician within 5 years

No other state has this requirement in place (9).  An unintended consequence of this regulation is that many APRN’s are not able to find physician mentors, are unable to find employment and are therefore moving out of the state of Colorado where there are less restrictive oversight requirements (8).

Constrained supervision requirements in the state of Colorado will result in decreasing the pool of available APRN’s to provide access to care for vulnerable populations in the state seeking primary care services. 

(1)     Federal Trade Commission (2014). Policy Perspectives: Competition and Regulations of Advanced Practice Nurses.  Available at: http://www.ftc.gov/reports/policy-perpectives-competition-regulation-advanced-practice-nurses

(2)     National Governor’s Association, NGA Paper: The Role of Nurse Practitioners in Meeting Increasing Demand for Primary Care (2012), http://www.nga.org/files/live/sites/NGA/files/pdf/1212NursePractitionersPaper.pdf

(3)     Colorado Health Access Survey (2013),  Courtesy of the Colorado Health Institute, www.ColoradoHealthInstitute.org/health/colorado-health-access-survey-1

(4)     Institute of Medicine, National Academy of Sciences,  The Future of Nursing: Leading Change, Advancing Health (2011).

(5)     Christine E. Eibner, et al., RAND Health Report Submitted to the Commonwealth of Massachusetts, Controlling Health Care Spending in Massachusetts:  An Analysis of Options (2009), http://www.ran.org/content/dam/rand/pubs/technical_reports/2009/RAND_TR733.pdf.

(6)     Kaiser Family Foundation, Improving Access to Adult Primary Care in Medicaid:  Exploring the Potential Role of Nurse Practitioners and Physician Assistants (March 2011), http://kaiserfamilyfoundaton.files.wordpress.com/2013/01/8167.pdf

(7)     Robert Wood Johnson Foundation, How Nurses are Solving Some of Primary Care’s Most Pressing Challenges (2012), http://www.rwjf.org/content/dam/files/rwjf-web-files/Resources/2/cnf20120810.pdf.

(8)     Hoback, J. (2014).  ‘Unfettered nursing’ required for Coloradans desperate for care.  http://www.healthnewscolorado.org/2014/02/26/unfettered-nursing-required-for-coloradans-desperate-for-care/

(9)     Pearson, L. J. (2012).  The Pearson Report, www.pearsonreport.com

Learning Blogging!

I have had technical difficulties...figuring out how to blog!  I think this is a breakthrough!

I created a blog! What next?