It’s National Influenza Vaccination Week, and if you haven’t yet gotten a flu shot, you still have time. But why is it important to get the shot, especially if you’re not in any risk groups? And how can you encourage your patients and their family and friends to get it without being a nag? Jennifer Femino, FNP-BC, Family Nurse Practitioner/Director of Quality Improvement at North Shore Community Health and member of the American Association of Nurse Practitioners (AANP), explains why and how you can help your community prepare for flu season.
Why is it important for people to get vaccinated against the flu? Who is at the highest risk for having complications from it?
It is important for everyone 6 months and older to get vaccinated against the flu because it is a contagious respiratory illness, which can cause severe illness and even death in some people. Not only will receiving the flu vaccine help protect the individual, but it will also help prevent those they come in contact with from getting the flu, by helping to stop the spread of the virus. The best way to prevent the flu is to get the flu vaccine.
Those at highest risk for having complications from the flu include children under 5 years old, people 65 years and older, pregnant women, and people of any age with certain chronic medical conditions, such as asthma, diabetes, or heart disease.
How can nurses encourage their patients to get vaccinated? What should they say to those who have fears that the shot will give them the flu? What about those who believe that the vaccination will hurt them?
Nurse practitioners can encourage their patients to get vaccinated by addressing any specific concerns the patient has. They can also remind patients the flu can cause severe illness and death in some people, and the flu vaccine is a simple way to prevent this. Nurses can also get vaccinated themselves, and wear a badge advertising this; patients may feel reassured their trusted health care professional also gets vaccinated against the flu.
NPs also educate patients that the flu vaccine does not cause the flu. Flu vaccines are made with either inactivated flu or a weakened flu virus, neither of which can cause the flu. Some people may feel mild symptoms after receiving the flu vaccine, but nurses should emphasize that the symptoms are mild and brief, and are very different from the severity of symptoms of the flu.
Serious reactions to the flu vaccine are rare. People who have a severe allergy to the flu vaccine or any of its ingredients should not get the flu vaccine. Most people with egg allergies are able to get the flu vaccine. However, any patients with a history of an egg allergy or a history of Guillain-Barré Syndrome, should speak with their health care provider about options for flu vaccination.
What about families/friends of patients? How can nurses encourage them to get vaccinated? Suppose the patient has a compromised immune system? What can they say to get visitors to get vaccinated?
Nurses can talk with families and friends of patients about the importance of them getting the flu vaccine in order to help prevent the flu in their loved ones. NPs can also remind family members and friends it is not enough to simply avoid the patient if they are sick because they would likely be contagious with the flu even before they knew they were sick.
This is even more important for family members and friends of patients with a compromised immune system. It is imperative that they get the flu vaccine so that they do not spread the flu to the patient, who will likely not be able to fight it and is at serious risk for complications, including death.
Nurses can talk with patients and families about ways in which they can talk to their visitors about the importance of receiving the flu vaccine and can work with them to perhaps set limits or discourage visitors who have not been vaccinated.
Some people think that it’s fine to get the flu—it’s like getting a cold. It will go away. Explain why the flu is more serious and why vaccinations are crucial.
The flu is much more serious than a cold. The symptoms are much more severe and intense. The most important difference is that the flu can result in serious complications, including death. The flu vaccine is crucial, not only to prevent flu in an individual, but also to prevent the spread of flu to those who may be at higher risk of complications.
Are all health care providers required to get vaccinated?
Health care providers are strongly encouraged to get the flu vaccine. Policies regarding the flu vaccine vary from organization to organization. Many institutions have policies mandating the flu vaccine, and those who choose not to get the flu vaccine must wear a mask throughout the flu season.
What about those who say that they’ve gotten the flu shot in the past and still gotten the flu? How can vaccinations benefit them? How can you encourage them to get vaccinated?
Flu vaccines are not 100% effective, and sometimes the strain of flu circulating is not a perfect match for the flu strains in the flu vaccine. In some cases, people were exposed to the flu before their immune system had time to build a response to the flu vaccine.
There is evidence the flu can be milder and briefer in those who have been vaccinated against the flu. Although flu vaccines are not perfect, they are the best way to prevent getting the flu.
Anything else regarding the importance of vaccinations for influenza that you think is important for our readers to know?
The CDC is an excellent resource for information regarding the flu. They have a wealth of resources for nurses and patients on their website. They also are on Twitter (@CDCFlu).
Flu activity is starting to increase across the United States, so if you have not yet had your flu vaccine, now is the time!
According to Joyce Knestrick, PhD, C-FNP, APRN, FAANP, President of the American Association of Nurse Practitioners (AANP), Congress recently passed and President Trump signed “a comprehensive package of anti-opioid bills into law with a key provision permanently authorizing NPs to prescribe Medication-Assisted Treatments (MATs), further expanding patient access to these critical treatments.”
This passage is extremely important to those fighting opioid addictions as well as those health care workers who are treating them. “Recognizing the ongoing impact of the opioid crisis, Congress and the President moved quickly to get this critical legislation across the finish line. We applaud their actions, which acknowledge the vital role nurse practitioners play in treating patients with opioid use disorder with Medication Assisted Treatments (MATs),” says Knestrick.
What does this mean for the health care community? Knestrick answered questions to explain.
Why is this important—both for NPs and for opioid addicts?
First and foremost, for the millions of American families struggling with addiction today, passage of this legislation ensures patients continuity of care, knowing that their NPs can continue to provide their loved ones access to MAT treatment.
Second, knowing that NPs are now permanently authorized to prescribe MAT, we anticipate significant growth in the number of America’s NPs who will become waivered to prescribe MATs—which will help turn the tide of opioid addiction in communities nationwide.
How will this help more opioid addicts?
As primary care professionals, NPs really are on the front lines of combating the opioid epidemic. Tragically, eighty percent of patients addicted to opioids don’t receive the treatment they need, due in part to health care access challenges, stigma, cost, and other factors. Thanks to advances in Medication-Assisted Treatment—which combines medications that temper cravings with counseling and therapy—and this new law granting NPs permanent authority to prescribe MATs, the opportunities to reach and treat patients struggling with addiction are better than ever before.
In addition to helping addicts, will this make the process more cost-effective? If not, how else will it be beneficial to health care facilities and/or treatment centers?
We do know that treating people with addiction to opioids and other substances is costly—in part because of the need for in-patient treatment and more frequent hospitalizations. Yet, most people in need of treatment simply don’t receive it. As a nation, we are facing significant shortages of specialty treatment facilities for addiction, and this makes it all the more important to ensure that NPs and other primary care providers have the tools to meet the patient need for MATs
AANP has formed a collaborative with the American Society of Addiction Medicine and the American Association of Physician Assistants to provide the 24-hour waiver training for NPs and physician assistants. We invite NPs to visit AANP’s CE Center at https://www.aanp.org/education for more information.
In the past few decades, so much has changed about HIV—for many, it’s no longer a death sentence. Jeffrey Kwong, DNP, MPH, ANP-BC, ACRN, AAHIVS, FAANP, a Professor and Associate Dean for the Division of Advanced Nursing Practice at Rutgers School of Nursing as well as the President of the Association of Nurses in AIDS Care (ANAC), began working with people living with HIV in 1986—initially as a volunteer for a local community organization. In honor of World AIDS Day, he took time to answer our questions about working as a nurse with people with HIV, how it’s changed over the years, and the challenges and rewards he’s experienced.
What made you interested in becoming involved with patients living with HIV?
In 1986, I was a “buddy” who provided basic companionship for people who were diagnosed and often alienated or abandoned by their families/partners/friends because they had HIV. It was a very different time. Professionally, I initially worked as a public health administrator overseeing a Ryan White Program for Alameda County in the San Francisco Bay Area, then I went back to nursing school. I began working as an HIV clinical trials nurse in 1996 and then as a Primary Care Nurse Practitioner in 1997, and I have been in this role ever since. Although I have an academic appointment, I still maintain a clinical practice and take care of patients living with HIV, as well as those at risk of HIV infection.
What initially sparked my interest in HIV was wanting to do something for my community—to help those who were alienated, ostracized, and stigmatized because of their HIV status.
What are some of the biggest surprises you’ve found with working with patients with HIV? What would other nurses be surprised by?
There have been many surprises over the years. However, I think what still strikes me is the resilience; many of my patients have to be able to overcome so many challenges and life “obstacles” and to survive and thrive. One of the great things about being a primary care provider is getting to see patients over time—and some of my patients I have followed for years. As part of that process, they share their life journeys with me, and for some people, it’s amazing to hear all of the things that they have experienced: from battling substance abuse, to overcoming stigma, to being able to go back to school and change careers, to starting families and being successful and happy and living!
I think other nurses would be surprised at how rewarding it is to share the journey of being with a patient who is newly diagnosed and who is in tears because they think that HIV is a “death sentence”—and teaching them, caring for them, getting them on treatment, and watching them regain their hope and do well on HIV treatment and move on with their lives. And now we are watching them age into older adulthood!
What are some of the biggest challenges that you’ve experienced working with this patient population?
I think the biggest challenges have been dealing with stigma. Even today there is still so much stigma around HIV that many people are afraid to talk about it. They don’t want to get tested because they think “it can’t happen to them” (even though the CDC has recommended universal opt-out testing for all individuals 13 to 64 years of age regardless of risk, and the USPSTF also recommends universal testing for ages 15 to 65). The other challenge is that people think “HIV is over” and that because there are highly effective treatments, HIV isn’t a “big deal.” It still is an issue and people still need to know their status, get tested regularly, and take preventive measures.
For those who are doing well on treatment, we still have to educate and remind them of the importance of taking their medications regularly, having regular follow-up with their providers, and doing all of the preventive health interventions that will help them age successfully into older adulthood.
What have been some of your biggest rewards?
One of my favorite moments involves a woman I first met in the late 1990s when she was newly diagnosed with advanced HIV disease. I was her primary care NP for many years, and she shared with me when we first met that her dream was to live long enough to see her daughter graduate from high school. Well, not only did she get to see her daughter graduate from high school, but nearly 20 years later she is now a proud grandmother! And she said to me that all of this was “thanks to me”—but it really wasn’t me. I might have helped “steer the ship” by getting her on treatment and managing her over these years, but it’s moments like that when I’m grateful for the work that I get to do as an HIV provider.
With the progression of the treatments for HIV, I’m sure that the nursing field with these patients has changed as well. How has it? Please explain.
The biggest change and the challenge that I see as a provider is that our patients are aging. Nearly 70% of those living with HIV will be 50 years or older by 2030. Nurses, nurse practitioners, and other providers will need to know how to care for this population. When I think of the field of HIV, many of us initially only did infectious disease or hospice or oncology work. Then as patients started to do well, we had to learn primary care (how to deal with diabetes and hypertension, etc.). Now as patients are aging, we’ll need to learn how to be geriatric specialists. (Remember, geriatrics is its own specialty.) Similarly, geriatric providers will need to learn more about HIV to better care for this population.
Also with the availability of PrEP (HIV pre-exposure prophylaxis), many primary care providers need to be familiar with this intervention to help prevent people from becoming infected with HIV. The CDC estimates that over a million people would benefit from PrEP, but only a fraction of those individuals receive it—in part due to providers who are not willing or unfamiliar with how to prescribe it or manage patients who are on PrEP. This is where general primary care NPs can really make a difference in curbing the epidemic. We now have the tools to end the HIV epidemic. We just have to get providers (nurses, nurse practitioners, physicians, PAs, mental health providers, pharmacists, and the entire health care team) to work together to prevent and manage HIV, and together we can one day see the end of this epidemic.
If nurses want to start working primarily with patients with HIV, what should they do? Any particular training or certification they should get?
For those interested in HIV, I would recommend the Association of Nurses in AIDS Care (ANAC). We’re a professional organization for nurses and other health professionals who are interested in caring for persons living with HIV and those at risk for HIV. The American Academy of HIV Medicine (AAHIVM) is also great. Additionally, there are regional AIDS Education and Training Centers (AETC) across the U.S. that provide education and resources for clinicians wanting to learn more about HIV treatment and prevention.
As for certification, there are a couple of options. The HIV/AIDS Nursing Certification Board (HANCB) offers two types of certifications: the AIDS Certified Registered Nurse (ACRN) certification and the Advanced AIDS Certified Registered Nurse (AACRN) certification. The American Academy of HIV Medicine also offers a certification as an HIV Specialist (AAHIVS).
Is there anything else that you think is important for readers to know?
Nurses and nurse practitioners play a critical role in all aspects of care for persons living with HIV and those at risk for HIV—not only at the direct care level, but also at the public policy and advocacy level. I would encourage nurses from all disciplines and specialties to think about how HIV impacts their jobs, their lives, or their patients’ lives. As one of my mentors said, “Every nurse is an HIV nurse.”
Patty Piasecki, NP, is an orthopaedic oncology nurse at Midwest Orthopaedics at Rush. In the past, she worked as an orthopaedic trauma nurse. In that position, she says, “trauma” made it sound like she worked in the TV show ER, but in reality, it means longer hospitalizations for the patients, stays in rehab, follow-up appointments, numerous radiographic tests, and decisions about patients returning to work.
When she moved to orthopaedic oncology, though, Piasecki says that her previous experience had prepared her for more complex patients. In ortho, she admits, patients “can have multiple fractures in multiple sites as well as other injuries such as head and abdomen. It is challenging to triage the injuries. The volume of patients that need to be in ICU is huge too, so you have to always be on alert for new problems.”
As for what was the most difficult thing about working as an ortho trauma nurse, “Needing to tell a patient that they need an amputation after they fought for two years to keep the limb,” admits Piasecki.
The biggest challenge of the job was when her patients were never able to return to work. There were many rewards, though. Piasecki says that the greatest rewards were when patients were able to completely heal and get on with their lives and do things like get married, have children, or even ride their motorcycles again.
If you’re thinking about becoming an ortho trauma nurse, Piasecki suggests that you get a certification in orthopaedic nursing and working in a hospital with an orthopaedic trauma surgeon, an emergency department, or an ICU or surgical unit.