Posts Tagged ‘nurses’

Nurse Practitioners Slowly Gain More Access to Patients; Could Relieve Anticipated Physician Shortage

June 5th, 2014 by Cheryl Miller

Patients are slowly gaining access to care provided by advanced practice registered nurses (APRNs) as a number of states have taken steps to loosen restrictions on highly educated nurse practitioners (NPs).

Minnesota became the 19th state, plus the District of Columbia, tooffer patients full and direct access to NP service. According to the American Association of Nurse Practitioners (AANP), it is an important step that improves access to care and more effectively uses NPs to meet the state’s growing healthcare needs. Officials state the following in a press release:

This comes at a time when the changing demographics of health care, especially primary care, necessitates that states make full use of the nurse practitioner workforce. The nursing community is committed to addressing these challenges in future sessions to ensure that patients have a choice of health provider and receive full access to the health services they need.

Maryland was one of the first states to loosen existing restrictions, according to a story from the Robert Wood Johnson Foundation (RWJF). In 2010 the state replaced its requirement for lengthy collaborative agreements between NPs and physicians with less cumbersome “attestation statements” that identify a physician who is willing to collaborate when clinically necessary but do not require physician signatures.

The law eliminated situations where patients were left without care if their physician died, retired, or left the state. NPs can now open practices and serve larger patient populations. This has helped with the primary care shortage in Maryland.

And the shortage is not limited to Maryland. As the Healthcare Intelligence Network reported in a previous news story in 2013, the RAND Corporation predicted that as more Americans seek health services once newly insured under the Affordable Care Act (ACA), physician shortages could worsen, and reach as high as 45,000 by 2025.

And the recent Veterans Affairs problem that is making headlines around the world has been attributed to a shortage of primary care physicians (PCPs), as documented here in the New York Times.

Expanding the role of nurse practitioners and physician assistants could help eliminate the anticipated shortage of PCPs over the next decade, the RAND report suggested.

Other states that have taken steps to ease NP restrictions in recent years include the following:

  • In Utah, state Medicaid officials agreed to recognize and reimburse NPs for primary care services for beneficiaries.
  • Oregon’s governor signed a law that allows NPs and clinical nurse specialists to dispense prescription drugs.
  • In Iowa, the state Supreme Court ruled that NPs can supervise fluoroscopy, a high-tech X-ray, without physician supervision.
  • In 2011, North Dakota scrapped a requirement that NPs work in collaboration with physicians.

But these changes are not without their controversy. Some feel that it goes too far, that the supervision of a physician should be maintained. According to this editorial in the Times-Herald Record, “though well intentioned, such proposals underestimate the clinical importance of physicians’ expertise and overestimate the cost-effectiveness of nurse practitioners.”

Other areas of healthcare pose the same challenge. In Minnesota, a state law allows dental therapists to work under the supervision of dentists and perform many of the tasks they do, something that has been opposed nationally and in most other states.

But the field of NPs is also changing. First created in 1965 to meet the growing demand for basic pediatric care, by 2015 all new NPs will need to be trained at the doctorate level as a Doctor of Nursing Practice, and 104 new DNP programs are in development, according to a new infographic from Maryville University Master of Science in Nursing Online.

Infographic: Healthcare’s Demand for Nurses

December 25th, 2013 by Jackie Lyons

Some 55 percent of nurses ages 50 and older expressed their intention to retire by 2020, according to a new infographic from Brown Mackie College based on a 2010 survey. The Bureau of Labor Statistics estimates 711,900 new job openings by 2020.

This infographic also identifies where nurses are most needed, required nursing skills, popular nursing jobs and more.

Healthcare's Demand for NursesData collected and visualized by Brown Mackie.

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You may also be interested in this related resource: Health Care System Transformation for Nursing and Health Care Leaders: Implementing a Culture of Caring.

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Infographic: Mobile Device Use by Nursing Faculty

January 18th, 2013 by Patricia Donovan

Among nurse educators holding advanced degrees, 71 percent own a smartphone, 47 percent own a tablet computer, and 39 percent own an eBook reader. These were some of the results from a Springer Publishing Company survey illustrated in its new infographic, which reveals key findings on the use of technologies among nursing professors.

The annual survey polled 1,281 nurses on their ownership and usage of mobile devices, their preferences for nursing and medical apps and eBooks, and their social media use.

nurse mobile devices

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Lower Readmissions for Hospitals with Good Nursing Work Environment

January 14th, 2013 by Cheryl Miller

No one could argue that nurses do more than their fair share of work. But now a new study is documenting that work environments that are beneficial for nurses are also beneficial for hospitals in terms of readmissions rates.

Researchers at the University of Pennsylvania School of Nursing found that Medicare patients treated in hospitals with a good work environment for nurses had up to 10 percent lower odds of readmission than those treated in hospitals with a poor work environment.

Researchers suggest that improving nurses’ work environment and reducing their workloads are organization-wide reforms that could result in fewer readmissions. All hospitalized patients are exposed to bedside nursing throughout their stay and combining targeted transitional care, the coordination of healthcare during the transition from hospital to home, with high-quality inpatient nursing care will produce more positive outcomes for all patients, and help reduce overall healthcare costs. Preventable hospital readmissions cost the United States more than $15 billion annually, and Medicare is now penalizing hospitals with excessive rates of readmissions.

This study parallels another recent news story documenting nurses/case managers’ role in reducing readmissions by dispensing phone calls within 48 hours of discharge to high risk patients. The study, from Cigna, followed nearly 4,000 high-risk gastrointestinal, heart and lower respiratory patients and found that prioritized, telephonic outreach by health plan case managers after hospital discharge reduced future readmissions by 22 percent. This subject is currently a hot topic on our new LinkedIn forum, CaseTalk – a Forum for Care Coordinators. You can join in the discussion group here.

How to find the right nurse/case manager? Robert Fortini, vice president and chief clinical officer of Bon Secours Health System, tells us that they should posess both creativity and critical thinking skills, in our story excerpted from our new book, Profiting from Population Health Management: Applying Analytics in Accountable Care. Bon Secours’ nurse navigator program was so successful that they were planning on doubling their budget for them within 18 months.

And in other news, the increased use of EMRs and other related tools have failed to fulfill the financial promise of HIT, according to a new RAND Corporation analysis. One of the major reasons is that systems deployed are neither interconnected nor easy to use. Some changes to reverse this are documented in our story.

And don’t forget to take our new survey on Medication Adherence.