Duke Nursing Dean Ramos Testifies: FPA “is About Health Equity”

Duke Nursing Dean Ramos Testifies: FPA “is About Health Equity”

“For me, [FPA] is about health equity. I grew up in a community that was underserved,” Duke University School of Nursing Dean Vincent Guilamo-Ramos, PhD, MPH, LCSW, RN, ANP-BC, PMHNP-BC, FAAN told North Carolina legislators on March 29. “I care about access for all … and having all of us collectively move forward.”

”Three decades of evidence have shown that nurse practitioners with full practice authority play a vital role in improving health outcomes, especially in underserved communities, Ramos observed in his remarks. Focusing on the connections between FPA, access to care, and health outcomes, the Dean presented his case to the state’s Joint Legislative Committee on Access to Healthcare and Medicaid Expansion at the North Carolina General Assembly and urged them to pass the SAVE Act to grant full practice authority for NPs providing primary care. Ramos, who is also the vice-chancellor of nursing affairs for Duke, was among eight experts presenting varied views on full practice authority.

“Full practice authority isn’t new. This isn’t innovative. We have 30 years of evidence from 24 states, D.C., and several US territories about the benefit of granting full practice authority to NPs.”

In speaking to the joint committee presided over by Sen. Joyce Krawiec, Ramos addressed the role that nurse practitioners have in transforming health care access and outcomes in North Carolina, including the opportunity to expand care in rural areas that face health care shortages. The joint committee is hearing from experts as they consider passing the SAVE Act, which was first introduced in 2021 to expand full practice authority for primary care NPs in North Carolina. A similar version of the SAVE Act has been introduced in previous legislative sessions, but no action was taken on the legislation.

 Role of FPA in Access to Care and Health Outcomes
Duke Nursing Dean Vincent Guilamo-Ramos, PhD, MPH, LCSW, RN, ANP-BC, PMHNP-BC, FAAN.

“Nurse practitioners should be able to practice at the highest level of their competencies, education, and licensing,” Ramos said. “Full practice authority isn’t new. This isn’t innovative. We have 30 years of evidence from 24 states, D.C., and several US territories about the benefit of granting full practice authority to NPs. This improves health outcomes and expands health care to underserved populations and will benefit the people of North Carolina.”

Across the state, 97 of 100 counties face a health professional shortage.

Ramos reflected on his role as dean of the top school of nursing in the state and the second-ranked school in the U.S., and the intense pride he has seeing Duke graduates strengthen their career opportunities with the education they gain at Duke. “The nurse practitioner workforce growth is faster in states with full practice laws than in states with restricted practice,” said Ramos, who is interested in attracting NPs to practice in the state.

Ramos observed that the first states to authorize full NP practice authority began doing so in 1994 — nearly three decades ago — and that, once passed, full NP practice authority has never been repealed. “Full practice authority for primary care NPs improves care access, improves care outcomes, and improves workforce supply,” said Ramos, who also addressed a systematic review of 33 studies that showed no evidence for better NP care outcomes in states with more practice restrictions.

NPs with FPA Increase Efficacy of a State’s Health Workforce

In addressing the critical nursing workforce shortages across the U.S., Ramos notes that NP workforce growth is faster in states with full practice laws compared to states with restricted practice. Across the U.S., during the COVID-19 pandemic, states issued temporary waivers of NP practice restrictions. “This enabled more time-responsive NP practice and care provision as well as a streamlined process for NP orders in the absence of physician signature requirements and an increased capacity of the health care workforce to respond to COVID-19,” Ramos said.

Ramos observes that the reliance of nurses in this manner during a pandemic and health care crisis demonstrates the clinical, scientific, and relational expertise that support nurse influence in improving health outcomes, and it demonstrates the confidence that the health care systems and public have in nurses, who have been considered the most trusted and most ethical profession for more than 20 years.

In conclusion, Ramos pointed out to the committee that:

  • NP practice restrictions contribute to inadequate care access and primary care workforce shortages, particularly in rural areas.
  • NP practice restrictions can be a barrier to improving health outcomes and reducing health outcomes and reducing health-related economic costs.
  • NP practice restrictions requirements can lead to an unsafe and fragile care model, including risks such as the possibility of immediate NP loss of ability to care for patients if a physician can no longer provide supervision for any reason, including moving, retiring, and so on.
  • NP practice restrictions weaken health workforce responsiveness to emergencies.
  • Physician supervision agreements can contribute to unnecessary and excessive costs.

The SAVE Act (House Bill 277/Senate Bill 249) did not receive a committee hearing during the 2021 legislative long session. However, following the conclusion of the committee’s work later this spring, the bill could move forward when the legislature returns for the 2022 short session on May 18, 2022.

A Day in the Life of an FNP

A Day in the Life of an FNP

Being a family nurse practitioner (FNP) can be a rewarding path for just about anyone who dreams of making a difference as a nurse. An FNP allows you to become a trusted primary care provider in most states and opens the door to a range of ongoing opportunities for learning and professional growth. And, if you want to do it all… or at least as much as possible, an FNP degree will give you maximum career flexibility. It can position you to create your ideal tailor-made nursing career, whether you want to work in a hospital or clinic setting—or both—while running your own business or pursuing research projects if you wish!

The heart of being an FNP, though, is of course family care… and here’s an overview of what a day in the life of an FNP entails.

Diagnosing a variety of medical conditions for patients of all ages

A family nurse practitioner can care for a wide age range of patients. An FNP may treat everyone from infants to geriatric persons, and this is just one of the reasons the job is almost always lively and interesting.

Am FNP might arrive at the clinic in the morning with or without an idea of their patient caseload on any given day. However, one thing they can count on is variety. You may start your morning with an annual physical of a 35-year-old, then pivot to managing hypertension and diabetes medications for a 71-year-old, before quickly peeking at another patient’s rash, and looking in another patient’s throat. While this may seem intimidating at first, family nurse practitioner certification ensures that you have the necessary breadth of medical acumen and will be prepared to manage whatever comes your way.

Creating treatment plans

After taking a medical history and performing a physical exam, an FNP will formulate a diagnosis for any given condition. Each day, they may use a variety of tools to arrive at their diagnoses—including cultures, blood work, imaging tests, and other medical diagnostics. After reaching a suspected or confirmed diagnosis, an FNP will work with each patient to create a treatment plan, which may include a lifestyle modification, a new medicine, a referral, or another kind of treatment.

Providing a lifetime of primary care

When family nurse practitioners serve as primary care providers, they identify and treat problems, and follow up to ensure the best possible health outcome for each patient. One of the most valuable aspects of being a family nurse practitioner is being able to follow patients throughout their lifespan, anticipating and addressing conditions across decades, and providing patient education.

Preparing for the Next Day

At the end of the day, an FNP may spend time reviewing messages in their electronic medical record inbox, and return phone calls from patients or pharmacies. They will need to catch up on documentation in some patient charts from earlier in the day, communicate with staff members, and make sure everyone on that patient’s team is receiving the assessments and care that they need.

Learn more about family nurse practitioner jobs at our Career Center.

UTA Nursing Opens Rural Health Center

UTA Nursing Opens Rural Health Center

The College of Nursing and Health Innovation (CONHI) at The University of Texas at Arlington has launched a new center to enhance access to health care for Texas’ rural communities.

The Center for Rural Health and Nursing is funded by a $4 million legislative appropriation by the state of Texas. The funding will support the center’s efforts to improve rural nursing education and the health outcomes of rural populations.

“I am very thankful of the Legislature for its support of the University’s efforts to educate and train the next generation of rural health care providers,” said Teik C. Lim, UTA interim president. “Through this new center, we can significantly expand the reach of one of the nation’s top nursing programs to improve the health of rural Texans.”

Elizabeth Merwin, the center’s executive director and dean of CONHI, hopes the center will develop and foster a model for providing nursing education to rural residents aiming to become registered nurses and nurse practitioners. This model will support and educate those students while they reside in their home communities. It will also aim to reduce the shortage of nurses and other health providers in an effort to support access to health care for Texas’ rural populations.

“Thanks to generous funding by the state of Texas, CONHI will be able to form sustainable partnerships with rural communities that improve the quality of life for underserved populations in those areas,” Merwin said. “Our goal is to form close relationships with key organizations and stakeholders within rural communities in Texas to improve access to health care by enhancing the health professional workforce.”

In its first year, the center will develop partnerships in rural communities to perform educational needs assessments of registered nurses and nurse practitioners. Once needs have been identified, the center will provide training to support the communities’ current health care providers and educate new, incoming nurses and health professionals.

“UTA has a proven track record both in Texas and nationwide as a leading center of excellence for nursing education,” state Sen. Kelly Hancock said. “I have great confidence in the university’s ability, through its new Center for Rural Health and Nursing, to bring its nationally recognized nursing education and training programs to improve both nursing education and health outcomes in our state’s rural communities.”

Aspen Drude, the center’s manager, said the center aims to support existing providers and recruit young people from rural populations to become nurses in their communities.

“We want to make sure students who are in rural high schools and community colleges have paths into our programs,” Drude said. “We hope that our continuing education programs will meet the needs of current nurses and increase opportunities for rural residents, while meeting the workforce needs of the rural community.”

The center’s nursing education initiatives will be supported by Elanda Douglas, a clinical assistant professor and nurse practitioner with extensive experience as a family nurse practitioner.

“It’s really important for nursing students to understand that when they work in rural communities, they have to be well-rounded because they could be the only nurse in the clinic,” Douglas said. “Our rural health curriculum will prepare students with a broad set of skills to meet the day-to-day demands of rural care.”

According to the Centers for Disease Control and Prevention, rural Americans face numerous health disparities compared with their urban counterparts. They are more likely to die from heart disease, cancer, unintentional injury, respiratory disease and stroke. Factors that put them at greater risk include higher rates of smoking, lower physical activity and less access to health care and health insurance. Rural communities also face unique workforce challenges and, too often, shortages of health care providers.

Reshma Thomas is a first-year student in CONHI’s Master of Science in Nursing program who has joined the center as a student nursing assistant. As a family nurse practitioner in training, Thomas is passionate about serving vulnerable rural populations.

“Nearly 25% of Texas’ population lives in rural communities and suffers from harmful health disparities and lack of care,” Thomas said. “Providing preventive care and raising the health care standards in these communities is vital.”

More on the center and updates can be found at its new website https://ruralhealthcenter.uta.edu/.

HHS: Awards Bringing “Record Number” of HCPs to Rural and Underserved Areas

HHS: Awards Bringing “Record Number” of HCPs to Rural and Underserved Areas

The Department of Health and Human Services (HHS) has awarded the largest field strength in history for its health workforce loan repayment and scholarship programs thanks to a new $1.5 billion investment, including $1 billion in supplemental American Rescue Plan (ARP) funding and other mandatory and annual appropriations. More than 22,700 primary care clinicians now serve in the nation’s underserved tribal, rural and urban communities, including nearly 20,000 National Health Service Corps (NHSC) members, more than 2,500 Nurse Corps nurses, and approximately 250 awardees under a new program, the Substance Use Disorder Treatment and Recovery Loan Repayment Program. The U.S. Department of Health and Human Services’ (HHS) Health Resources and Services Administration (HRSA) oversees these critical programs.

“Thanks to the American Rescue Plan, we now have a record number of doctors, dentists, nurses and behavioral health providers treating more than 23.6 million patients in underserved communities,” said Health and Human Services Secretary Xavier Becerra. This demonstrates the Biden-Harris Administration’s commitment to advance health equity and ensure access to critical care across the country. We will continue to invest in our health workforce to make life-saving support within everyone’s reach.”

During the pandemic, thousands of NHSC and Nurse Corps health care providers have served in community health centers and hospitals across the country, caring for COVID-19 patients, supporting the mental health of their communities, administering COVID-19 tests and lifesaving treatments, and putting shots in arms.

Connecting Skilled Providers with Communities in Need

HRSA’s workforce programs directly improve the nation’s health equity by connecting skilled, committed providers with communities in need of care. National Health Service Corps, Nurse Corps, and Substance Use Disorder Treatment and Recovery Loan Repayment Program members work in disciplines urgently needed in underserved tribal, rural and urban communities.

“Today’s awards, which represent a more than 27 percent increase in scholarship and loan repayment awards, support current and future providers who are committed to working in vulnerable communities,” said HRSA Acting Administrator Diana Espinosa. “These awards also provide critical support for health care sites that need to recruit and retain clinicians to meet increasing demand.”

  • Today’s field strength includes more than 11,900 members working in behavioral health disciplines, including psychiatrists, substance use disorder (SUD) counselors and psychiatric nurse practitioners.
  • Nurses represent the largest proportion of the field strength, numbering more than 8,000 across all scholarship and loan repayment programs. National Health Service Corps nurse practitioners make up its largest discipline at approximately 5,400 and fill a critical need for primary care where shortages exist throughout the country.
  • Currently, one-third of HRSA’s health workforce serves in a rural community where health care access may be especially limited or require patients to travel long distances to receive treatment.
  • More than half of all National Health Service Corps members serve in a community health center where patients are seen regardless of their ability to pay.

Providing Treatment and Care to Patients with Substance Use Disorders

Through dedicated funding for substance use disorder (SUD) professionals, HRSA is now supporting more than 4,500 providers treating opioid and other substance use disorder (SUD) issues in hard-hit communities. The Substance Use Disorder Treatment and Recovery Loan Repayment Program was launched in FY 2021 to create loan repayment opportunities for several new disciplines that support HHS’ comprehensive response to the opioid crisis, including clinical support staff and allied health professionals. In addition, this year’s NHSC awards include 1,500 substance use disorder (SUD) clinicians at approved treatment sites through the NHSC’s Substance Use Disorder and Rural Community loan repayment programs.

Investing in the Future Health Workforce

Through scholarship programs, HRSA is investing in the next generation of providers committed to working in communities most in need. The American Rescue Plan supplemental funding announced today allowed HRSA to award almost 1,200 scholarships — a four-fold increase — in the National Health Service Corps and nearly doubled the number of Nurse Corps scholarship awards to 544. In addition, new awards to 136 nurse faculty are supporting training for the future nursing workforce. This year’s scholarship recipients join 2,500 current National Health Service Corps medical, dental, and health professions students and residents and approximately 900 current Nurse Corps scholars preparing to serve in high-need communities across the country.

HRSA also recently awarded approximately $28.4 million in ARP funding to create new accredited teaching health center primary care residency programs in rural and underserved communities. To further support the expansion of primary care, the Administration plans to continue awarding the full $330 million in ARP funding for Teaching Health Center Graduate Medical Education in the coming months.  This additional funding will support the expansion of the primary care physician and dental workforce in underserved communities through community-based primary care residency programs in family medicine, internal medicine, pediatrics, internal medicine-pediatrics, psychiatry, obstetrics and gynecology, general dentistry, pediatric dentistry, or geriatrics. They are based in the communities they serve, with 80 percent located in community-based health centers, such as Health Center Program-funded health centers, Health Center Program look-alikes, rural health clinics, community mental health centers and tribal health centers.

Opportunities Now Open for Loan Repayment Programs

American Rescue Plan funding has made it possible for the National Health Service Corps to make a historic number of awards to all eligible applicants. Additional American Rescue Plan-funded awards are planned, with the next application cycles for the National Health Service Corps and Nurse Corpsloan repayment programs now accepting applications.

The National Health Service Corps helps medical, dental, and behavioral health clinicians pay off their student loan debt through scholarship and loan repayment programs in exchange for working in a Health Professional Shortage Area (HPSA). Nurse Corps participants commit to providing care in facilities with a critical shortage of nurses or as nurse faculty and help reduce the nursing shortage issues experienced across the nation. The Substance Use Disorder Treatment and Recovery Loan Repayment Program makes awards to clinicians, allied health professionals, and support staff who provide substance use disorder (SUD) treatment and recovery services to patients at treatment facilities located in a Mental Health Professional Shortage Area or in a county (or a municipality, if not contained within any county) with a threshold drug overdose death rate defined in statute.

Today’s funding announcement is directly responsive to the recommendations in the final report – PDFof the Presidential COVID-19 Health Equity Task Force.

More information on clinician, program, location and site attributes can be found on HRSA’s Bureau of Health Workforce Clinician Dashboards.

New Legislation Could be Game Changer for CRNAs in Rural States

New Legislation Could be Game Changer for CRNAs in Rural States

The COVID-19 pandemic has brought rural healthcare systems to the brink. In 2020, at least 20 rural hospitals closed —a new annual record since 2005.

Even before the pandemic, rural healthcare systems have been fighting for their lives. A recent report from the U.S. Government Accountability Office (GAO) found that 101 rural hospitals closed from January 2013 through February 2020. The report found people in the closed hospitals’ service areas would have to travel substantially farther to access certain healthcare services—the median distance to access some of the more common healthcare services increased about 20 miles from 2012 to 2018.

In addition to putting patients at risk of losing access to healthcare, hospital closures strike at the heart of a community. Hospitals are major employers and communities lose jobs, businesses, tax revenue—and people. Doctors, nurses, pharmacists, and other staff employed by the hospital often have to leave the area. GAO found that the availability of healthcare providers in counties with rural hospital closures generally was lower and declined over time.

The crisis in rural healthcare has many causes and the solutions are far from simple. Luckily, our nation’s leaders are starting to take action through various legislative and regulatory approaches. For example, the American Rescue Plan Act of 2021 provides $8.5 billion to reimburse rural healthcare providers for healthcare-related expenses and lost revenues attributable to the COVID-19 pandemic.

Notably, a bipartisan group of Senators has introduced the Save Rural Hospitals Act of 2021, which would help curb the trend of hospital closures in rural communities by making sure hospitals are fairly reimbursed for their services by the federal government. The House has also introduced the Rural Hospital Support Act, bipartisan legislation that would extend and modernize critical federal programs that rural hospitals rely on to properly serve their communities. If passed, these acts would help these community lifelines keep their doors open as we continue to face the lasting repercussions of the pandemic.

Another important solution gaining momentum among policymakers: allowing advanced practice nurses such as Certified Registered Nurse Anesthetists (CRNAs) and other nonphysician providers to practice to the full scope of their education and expertise.

CRNAs are in the thick of responding to this crisis as the sole anesthesia providers in the vast majority of rural hospitals, enabling these facilities to offer surgical, obstetrical, trauma stabilization, interventional diagnostic, and pain management services. Numerous studies have demonstrated that CRNAs provide safecost-effectiveanesthesia care.

Importantly, President Biden’s proposed Fiscal Year 2022 budget calls for added funding for the U.S. Department of Health and Human Services (HHS) to protect rural healthcare access and expand the pipeline of rural providers like CRNAs, noting, “The discretionary request also funds efforts to increase the number of individuals from rural areas going to medical school or other training programs, and returning or staying in rural communities to provide care, with a focus on primary care physicians, nurses, nurse practitioners, nurse anesthetists, and other in-demand providers.”

Additionally, in March 2020, the Centers for Medicare & Medicaid Services (CMS) temporarily removed physician supervision of physician assistants and advanced practice nurses to increase the capacity of the U.S. healthcare delivery system during the COVID-19 Public Health Emergency. This allowed CRNAs to step forward as indispensable providers responding to this unprecedented crisis. The waiver was extended by 90 days in April 2021 and HHS has indicated it is likely to remain through the year.

We can help address the rural healthcare crisis by applying the lessons learned during this tragic, unprecedented year. We need to move forward using all of the resources available and make the commonsense measures taken during the pandemic permanent. As these underserved areas need all of the help and resources that CRNAs and other nonphysician providers can give, the barriers that were temporarily waived last year must stay down.

The COVID-19 pandemic has laid bare fundamental, systemic problems within the U.S. healthcare system that will not go away when the pandemic goes away. Clearly, the nation cannot continue down the same path and do what we have always done.

Vermont is 35th State to Join Nurse Licensure Compact

Vermont is 35th State to Join Nurse Licensure Compact

A new link has been added to the Nurse Licensure Compact . In February 2022, Vermont will become the 35th state to allow nurses from other states to practice and treat patients without re-licensure. State legislators are also seeking other ways to reduce Vermont’s nursing shortage, and other measures under consideration include nursing school loan forgiveness and allowing nursing students to perform more clinical duties.

Vermont nurses are not universally applauding the law’s passage. The Vermont Federation of Nurses and Health Professionals expressed concern that the Licensure Compact will increase the flow of nurses departing from Vermont to seek higher-paying positions in states with a lower cost of living. However, this is a universal issue in states with substantial rural areas, and states like Oregon and Montana have been setting the pace with retention programs offering NPs and other healthcare providers tax credits and insurance incentives as well as school loan repayment and forgiveness, and Vermont appears to be pursuing a similar game plan.

Vermont Secretary of State Jim Condos praised the new law, commenting that the Nurse Licensure Compact bill “will ensure that qualified nurses from other states in the compact do not have to jump through hoops to practice in Vermont. COVID-19 showed how important it is to be able to quickly and efficiently license those qualified to care for Vermont patients in times of need.”

Office of Professional Regulation Director Lauren Hibbert chimed in, saying, that the bill “ensures quality care for Vermonters while providing mobility to Vermont nurses and nurses across the nation who wish to practice in the Green Mountain State. Our mission at the Office of Professional Regulation is to ensure the public’s safety and protect Vermonters from professional misconduct while making sure that qualified professionals who want to practice in Vermont do not face burdensome barriers to licensure.”

Other state legislatures considering the compact include Washington, Oregon, California, and Ohio.