By the year 2030, it is estimated that one in five Americans will be over the age of 65, and approximately 60% of this population will need treatment for at least one chronic condition. As the U.S. health care system faces the aging of the baby boomer population and the rise of chronic disease, nurse practitioners (NPs) are leading the way by demonstrating positive results in managing care for older patients and the complexity of chronic conditions. This includes innovative practice solutions, research and training, and policy advances at the state and federal level to strengthen access to NP-provided health care.
Demand for nurse practitioners is at an all-time high, and NPs are now the fourth most sought after health care profession, as well as one of the fastest growing. Last year, primary care nurse practitioner graduates outnumbered primary care medical school graduates by more than three times. It’s no surprise U.S. News & World Report ranked the NP second on its list of the 100 best jobs – naming formidable salaries, job security, and increased practice rights as enticements for students considering health care professions. Factor in the Bureau of Labor Statistics’ projection of 31% job growth between now and 2024 (five times the national average for all professions) and the need for more than 50,000 new positions, and we have the right incentives to recruit the next generation of nurse practitioners who can continue strengthening our health care workforce.
But the rising tide of chronic disease is not the only factor revolutionizing the role of the nurse practitioner. Growing recognition of nurse practitioners as key players in the health care delivery system is driving legislative change. Today, 22 states plus the District of Columbia, have made the historic shift to grant NPs full practice authority, providing examples for similar legislation in statehouses across the country. Massachusetts, North Carolina, Pennsylvania and other states are considering comparable legislation, foreshadowing a time when all 50 states provide patients with full and direct access to NP care.
The abilities of NPs to lower costs, improve patient outcomes, and increase patient access have been noted in national studies. In 2017, more than 89% of NPs were trained in primary care, as compared to 14.5% of their physician counterparts. In addition to providing care in traditional settings within hospitals and rehab centers, many are now opening their own practices, working on the community front lines where they deliver comprehensive care, including managing chronic diseases from diabetes to COPD.
With the demand for quality, accessible health care growing, the supply of providers must keep pace. Nurse practitioner graduate education programs are expanding to accommodate increases in qualified applicants, and nurse practitioners are graduating at higher rates. Today, there are roughly 350 colleges and universities with nurse practitioner programs in the United States. In 2016 alone, more than 23,000 nurse practitioner graduates entered the workforce, with the majority prepared in primary care.
With the confluence of aging baby boomers, the rise of chronic disease, health care reform, and focus on prevention and patient-centered care, the next generation of nurse practitioners and the skills they bring to patients are poised to thrive. We are just a few years away from the historic shift when, for the first time in human history, the number of people over 65 will outnumber children under five, and by 2050, this gap will widen to a 2:1 ratio. With this shift comes tremendous opportunity and responsibility for nurse practitioners to practice at the top of their license, serving patients in innovative and rewarding ways. For the 234,000 nurse practitioners and counting, there’s never been a better time to be an NP.
Developmental care is a philosophy utilized by the entire interdisciplinary team to coordinate medical, nursing, and parental interventions based on the developmental needs for a particular patient. This philosophy of care is to support the infant and their families with a focus on environmental influences affecting neurologic development. Developmental care encourages frequent assessment and responses to a baby’s needs. These responses are meant to decrease the stress of the preterm neonates in the neonatal intensive care unit (NICU), according to the Northern Neonatal Network’s guideline for family-centered developmental care.
Why use developmental care?
Neonatal medicine is an ever-expanding field. Babies born at progressively earlier gestational ages are able to survive due to advancements in modern medicine. Mortality rates have declined with the fast-paced achievements of neonatal medicine. However, evidence exists to suggest increased morbidity for neonates born prematurely or acutely unwell. Long-term studies have identified more subtle problems including neurosensory impairments such as cognitive delays and behavioral difficulties. “These can have a significant influence on a child and their families’ way of life.” Developmental guidelines for interventions, handling, inclusion of family and nursing protocols help to optimize neurodevelopmental outcomes for NICU infants and their families.
What is the goal of developmental care?
As caregivers, we want to protect the infant’s brain and create an environment suitable for neurobehavioral development of the infant. According to the Network, the outside environment now needs to mimic the inside environment, which is crucial for normal brain development. The inside environment provides containment and allows for the baby to maintain a supported flexed posture with limited noise and light exposure, as well as, protected sleep cycles with no separation from the baby’s mother. The goal is to support more positive experiences for the baby and thus achieve more positive outcomes for even the littlest of our patients.
How do we implement developmental care?
In the NICU, we use developmental care to support the infant and their families with individualized care which focuses on the environmental influences including handling, positioning, light, and sounds. The amniotic fluid serves as tactile sensory stimulus for the infant while in utero. When the infant is in the NICU, they are exposed to various touch stimuli versus constant tactile stimulus. Studies suggest that even routine handling during procedures can have adverse effects on the infant such as bradycardia, hypoxia, sleep disruptions, increased intracranial pressure and behavioral agitation.
One way to overcome this overwhelming tactile stimuli is to swaddle the infant. A systemic review published in Pediatrics found that swaddled infants have improvement in physiological and behavioral states such as lower heart rate, alleviates pain, prevents hypothermia and calms the infant. It also induces and prolongs sleep with fewer startles. The Network’s guideline suggests that these same benefits can also be achieved by the practice of developmental positioning utilizing positioning aids. Developmental positioning also provides the musculoskeletal support of flexed & midline postures, encourages self soothing behaviors and helps to conserve the baby’s body temperature and energy thus growth and weight are promoted.
Gentle human massage and touch is another intervention that can help decrease stress levels of premature babies. A Research in Nursing & Health study found that gentle human touch increases respiratory regularity, improves sleep cycles, motor activity and behavioral distress during periods of gentle touch. Gentle massages have been reported to help improve weight gain, improved pain alleviation, reduced postnatal complications, improved physiological and behavioral states, shorter hospital stay and improved performance in developmental scores.
The NICU is quite often an overstimulating environment. Behaviors, which should be modeled by staff and taught to the parents can ease the constant stream of auditory and visual stimulation. The NICU staff can control the lights and sounds of the outside environment. A 2013 study published in Indian Pediatrics recommends that we keep the infant on a schedule to allow for uninterrupted rest and decrease stress by using non-nutritive sucking, kangaroo care with parents, swaddling, and containment.
In summary, developmental care should be utilized for all preterm infants during their adaption to extrauterine life. Creating a positive environment and protecting neurobehavioral development is crucial to an infant’s long term outcomes. Implementing developmental care practices such as positioning, swaddling, nonnutritive sucking, gentle human touch and massage can help alleviate pain and provide better outcomes for the premature babies and their families.
Mary Zerlan, DNP, CRNA, at Washington University School of Medicine in St. Louis, MO was recently named to the Nursing Board of the American Health Council. She was selected for her vast knowledge and expertise in anesthesia from three decades of experience in the healthcare industry.
The Department of Anesthesiology at Washington University’s School of Medicine emphasizes innovative education and comprehensive, personalized clinical training. Fostering an academic culture that integrates clinical care, research, and education, services provided include patient care in pre-operative evaluation, intraoperative anesthesia, post-operative critical care, and pain management.
In her role as a Certified Registered Nurse Anesthetist (CRNA) at the Washington University School of Medicine, Zerlan functions as an anesthesia provider at a Level I trauma center. Her scope of practice includes preoperative, intraoperative, and post-operative anesthesia care. After beginning her career as an ICU nurse, Zerlan began serving as an anesthesia provider upon completion of her master’s degree with a sub-specialty in anesthesia. Zerlan’s education background also includes a Doctor of Nursing Practice (DNP) degree from Loyola University Medical College in 2012.
Zerlan credits her success to a strong worth ethic, perseverance, and passion. To learn more about Mary Zerlan and her position on the Nursing Board for the American Health Council, visit here.
The Marian University Leighton School of Nursing is set to begin offering a Doctor of Nursing Practice (DNP) degree program starting in May 2017. The DNP program will offer two tracks: Family Nurse Practitioner (FNP) and Certified Registered Nurse Anesthetist (CRNA).
Marian’s DNP programs are open to registered nurses (RNs) who want to be educated to the highest level for advanced clinical practice and leadership roles. The DNP curriculum uses hybrid methods of on-campus and web-based instruction with courses in systems leadership, evidence-based practice, quality improvement, policy and advocacy, informatics, and other courses to improve patient and organizational outcomes.
The new CRNA curriculum will be the first program of its kind to be offered in Indiana. Students in the state who wanted to train to become nurse anesthetists previously had to complete programs in Cincinnati, Chicago, and other out-of-state nursing programs. The new DNP program tracks are intended to help meet local, regional, and national employment demand for advanced practice registered nurses (APRNs). Graduates of the Marian University DNP program will be fully prepared to provide primary care in hospitals and clinical settings, work in research facilities, and teach at the university level.
To learn more about Marian University’s new DNP program, visit here.
With a mental health professional shortage occurring in Northeast Florida and across the country, six Jacksonville health care systems have joined together to collectively donate $900,000 to the University of North Florida (UNF). The funding will help alleviate the mental health crisis by funding UNF’s Mental Health Graduate Nursing Program which educates mental health nurse practitioners who hold doctorate degrees in nursing practice.
Northeast Florida is experiencing higher suicide rates across all age sectors compared to the rest of the state, according to 2014 statistics from the Jacksonville Community Council Inc. Studies estimate that 270,000 of the 1.1 million adults in Northeast Florida are living with mental illness, with 4 percent of those adults living with severe mental illness.
Part of the health systems funding will go toward establishing a non-endowed professorship in Mental Health Graduate Nursing for a five-year period, paying the salary of an outstanding faculty member in the field of psychiatric/mental health nursing. UNF will take over funding for this position once the donated funding stream has ended.
UNF’s Brooks College of Health (BCH) already offers a Master of Science in Clinical Mental Health Counseling which prepares mental health counselors to provide direct counseling services to individuals, groups, and families. Combined with the new Mental Health Graduate Nursing Program, BCH will prepare mental health professionals who will significantly impact Northeast Florida. BCH also hopes for improved mental health care, and decreased social issues like homelessness and addiction.
To learn more about UNF’s mental health graduate nursing programs and the new health care systems funding, visit here.
The Clemson University School of Nursing recently received a $5,000 scholarship from the CVS Health Foundation to assist students in their studies to become family nurse practitioners. CVS’s grant is part of the new Advance Practice Nurse and Physician Assistant Scholarship program which launched this year.
The program is aimed at reducing the nationwide shortage of family nurse practitioners and physician assistants by supporting these promising future health care professionals. Scholarships will be provided to accredited academic institutions around the nation to be distributed to family nurse practitioner and physician assistant students for covering costs of tuition, books, and other academic fees.
Clemson is thankful for the scholarship funds which will go towards helping deserving students become excellent family nurse practitioners. Eileen Howard Boone, president of the CVS Health Foundation, credits the scholarship as one of many steps that the foundation is taking to increase the number of qualified healthcare professionals in South Carolina and around the nation. Boone tells The Newsstand at Clemson.edu,
“We know how important having a strong pipeline of family nurse practitioners and physician assistants is to making high-quality, convenient and affordable health care services more accessible. We’re proud to support schools like the Clemson University School of Nursing who are providing quality education to students pursuing a career as a family nurse practitioner.”
The scholarship will be awarded to students in good academic standing who are pursuing advanced practice nursing master’s degrees, doctorate family nurse practitioner degrees, or master’s degrees as a physician’s assistant. Scholarship recipients are also required to intern or volunteer with an organization supporting underserved populations, and at least 25 percent of the scholarship funds will be awarded to bilingual students.