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.
Vanderbilt University School of Nursing recently received a $1.43 million award from the US Health Resources and Services Administration (HRSA) to develop and implement a Sexual Assault Nurse Examiner (SANE) education program for emergency nurse practitioner (ENP) students. The program is expected to increase the number of SANE-trained advanced practice registered nurses practicing in emergency departments and rural or underserved communities across the country.
Mavis Schorn, PhD, FACNM, the grant’s principal investigator, tells Nursing.Vanderbilt.edu, “Currently, there are just over 800 sites in the country that provide SANE services, yet nationally, one in six women and one in 33 men will experience an attempted or completed rape in their lifetime. Sexual assault nurse examiners have specialized education to conduct forensic examinations that have been shown to provide better physical and mental health care for assault survivors, deliver better evidence collection and support higher prosecution rates. Most important, SANEs treat patients holistically with compassionate and comprehensive care that takes into account the patient’s current acute care needs and the possible long-term effects of sexual assault.”
ENPs are positioned in emergency departments and are often the first to discover a patient who has been sexually assaulted. Their education and experience allows them to provide primary, episodic, and critical care of males and females of all ages.
Vanderbilt will offer SANE education to students in the Emergency Nurse Practitioner Post-Master’s Certificate program. Students in the program are current family nurse practitioners who want to become ENPs, and they will complete SANE training and their ENP education simultaneously with an option to select adult/adolescent and/or pediatric/adolescent SANE training.
The initiative is supported by Vanderbilt University Medical Center, Our Kids, Nashville’s Sexual Assault Center, and EmCare. To learn more about Vanderbilt Nursing’s $1.43 million HRSA grant to develop sexual assault nurse examiner education, visit here.
Registered nurses looking to advance their practice have several career paths they can take. One option is to become a nurse practitioner. Nurse practitioners are advanced practice providers who differ from registered nurses in several ways.
First, RNs either have a diploma, associate’s degree, or bachelor’s degree. The degree level corresponds with the type and length of time that was spent in school. Nurse practitioners are advanced degree nurses with either a master’s or doctorate in nursing. These degrees translate to an additional two to three years beyond a bachelor’s degree.
Another significant difference between RNs and nurse practitioners is the scope of practice. NPs have a greater scope of practice to include conducting physical exams, ordering and interpreting diagnostic tests, and prescribing medications. The board of nursing in each state sets forth the specifics of the NP scope of practice, and some states are more restrictive than others.
The highest degree a nurse can obtain is a doctorate of nursing degree. The length of time it takes to earn a DNP depends on the RN’s starting point:
- RN to BSN takes around two years
- BSN to MSN takes around two years
- BSN to DNP takes about three to four years
- MSN to DNP takes about one to two years
Additionally, some students opt to attend part-time. If so, the length of time to earn a DNP can take a little longer.
Many prospective students may wonder what they will learn in a DNP program. The curriculum can vary between schools, but some of the concepts students can expect to learn include evidenced-based practice, theoretical concepts for advanced-practice nurses, planning, evaluation, and leadership. Additionally, depending on the DNP track the nurse chooses as well as their starting point, they may need to take courses in advanced pharmacology, physiology, and health assessment. These three courses are typically required for BSN students enrolled in a DNP program and following a nurse practitioner track. MSN-prepared students have likely already completed them unless they are changing specialties (i.e., a nurse educator earning a DNP to become a nurse practitioner).
In addition to the core courses and specialty track courses, DNP students are required to complete a final DNP project. The project is to demonstrate that the nurse can identify issues or concerns in health care and provide evidence-based solutions to enhance patient care and improve outcomes.
Aside from it being a commendable academic achievement, earning a DNP can enrich the nurse in many ways. For example, nurses can expand their knowledge base. A bedside BSN nurse can earn a DNP and become a certified registered nurse anesthetist. An adult primary care NP can earn a DNP and become an educator. A clinical nurse specialist can earn a DNP and become a nurse executive. There are so many possibilities available to nurses with a DNP degree—which means a wider scope of career mobility.
Another way a DNP can improve a nurse’s career is that DNP nurses are trained to identify important issues in health care and have the knowledge, and sometimes power, to create change in their work environment. From the time one becomes a nurse, patient care remains the top priority. Nurses serve as advocates for patients on so many different levels, from the new grad bedside nurse to the executive-level DNP nurse. With each academic step, the nurse’s reach becomes longer, sometimes affording the ability to motivate and facilitate change within the highest level of an organization.
DNP nurses also have more of a critical thinking and holistic view of health care. Not only are they considered clinical experts, but they are also experts in leadership, management, and business. Being able to influence decision-making from a business standpoint with a patient-centered point of view is something unique and extremely valuable in health care. This exclusive approach allows patients to have a voice in health care, yet keep an organization sustainable.
In some organizations, DNP-prepared nurses have an edge when it comes to hiring. There is a push for the DNP becoming required for nurses looking to enter advanced practice, so those who earn one may currently have an advantage. Some employers offer higher compensation for DNP nurses as well. Nurses may want to consider earning either a PhD or DNP to become doctorate-level practitioners.
Each nurse has his or her own career and academic goals. One is not “better” than the other. However, for those looking to advance their practice and become clinical experts, the doctor of nursing practice is a great choice.
The Arizona State University (ASU) College of Nursing and Health Innovation has announced that it will be offering a new advanced practice nursing degree this coming fall with a focus on acute care for children. The Acute Care Pediatric Nurse Practitioner speciality program is an addition to ASU’s Doctor of Nursing Practice (DNP) program which aims to meet the needs of students and community partners.
Daniel Crawford, associate director of the DNP program and clinical assistant professor, believes the pediatric nursing program will prepare advanced practice nurses in the acute-care setting. He tells ASUNow.ASU.edu, “Those settings may include pediatric emergency rooms, pediatric intensive-care units, pediatric inpatient-care units and some pediatric specialties.”
Students who join the program can expect a hybrid format that requires in-person classes and online classes. The courses will focus on the development of a framework for developmentally supportive, family-centered, culturally appropriate advanced-practice nursing for infants and children with unstable chronic, complex acute, and life-threatening illnesses.
ASU’s Acute Care Pediatric Nurse Practitioner program is one of few in the country and will help prepare advanced practice nurses to treat a vulnerable population in need of specialized care. To learn more about ASU’s new pediatric nursing program, visit here.
Primary care is in short supply across the US, and nurse practitioners are increasingly stepping in to provide this much needed care. Studies show that NPs provide high-quality primary care, which improves access to care in underserved areas and reduces costs of care.
University of Pennsylvania researchers have called for modernization of the way Medicare pays for training nurses. A recent study highlighted a successful new model of cost-effectively training more advanced practice nurses to practice community-based primary care.
The findings come from a five-state demonstration of an innovative model of graduate nurse education (GNE) authorized by the Affordable Care Act. Each GNE site, managed by one teaching hospital hub, combined the training capacity of entire communities across health systems, hospitals, private medical practices, clinics, long-term care facilities, and universities.
The University of Pennsylvania School of Nursing’sCenter for Health Outcomes and Policy Research (CHOPR) and the Hospital of the University of Pennsylvania (HUP) led the largest demonstration site, which included nine universities, multiple health systems, and more than 600 community health care providers in the region.
Penn Nursing is calling for Medicare to adopt and fund the nurse training model nationally, shifting Medicare funding from diploma nursing programs that produce entry-level RNs to permanent, national funding of training for advanced practice registered nurses (APRNs).
To learn more about Penn Nursing’s call to action for Medicare to adopt a national nurse training model to help alleviate the national shortage of primary care providers, visit here.
I am privileged. I have been to the other side and experienced that the grass is greener. The majority of my career as a Neonatal Nurse Practitioner (NNP) has been in a Level 3 NICU with all the bells and whistles of high acuity, ECMO, high-risk deliveries, transport, and high patient volume. However, I then gained the privilege to also work as a NNP in a Level 2 Special Care Nursery (SCN). What a difference! But also, how similar!
The job tasks are identical … morning signout, collection of data from the medical record, physical exams, and writing notes. I touch base with the bedside nurse, case management, social worker as needed, and any ancillary staff. Consults are typically by phone. Sporadically, we may physically see an ophthalmologist, ENT, or cardiologist; but these occasions are not usual and customary. In addition, I can stand in one spot with full visual assess to all patients; as long as the census does not exceed 7 in the ‘main unit.’ The unit has evolved from a one room unit with one light switch, where either all lights were on, dimmed, or off equally. The SCN now is a state of the art unit of 7 individualized spaces to offer developmentally appropriate care, more patient privacy, and family-centered care. It is phenomenal!
Now, one may be thinking what a piece of cake. Well before we slice the cake, the grass really is not always greener. You see, regardless of the nursery level, the families are all experiencing a crisis. Acuity and level of nursery does not matter! The hopes, dreams, and vision these families had for their pregnancy, birth, and hospital experience are all shattered in the blink of an eye. The level of medical acuity has no direct correlation to the level of crisis for families. Due to lower medical acuity and lower patient volume, I am afforded the privilege of being able to take more time with families. I have the pleasure of sitting next to them, listening with my ears and eyes, to be in the moment with them. I can truly experience what the crisis or fears are. I feel a great sense of connection with the families. Regardless of the nursery level, these families become our family during their infant’s hospitalization. The communication, both active and passive, are vital for these families to emotionally survive this experience.
I have never experienced cross-trained nurses prior to working in a Level 2. This certainly is another privilege! This has positively enhanced my perceptions of the significance of the staff nurse presence in the delivery room, nursery, and postpartum area. In a Level 2, there is a staff of one NNP per 24-hour shift with attending back-up. The attending does rounds and meets with us daily, is present for all high-risk deliveries, and is always just a phone call away. This was a change coming to a Level 2. I realized how much I depend on my colleagues by just randomly shouting out to a fellow practitioner … ”What do you think?” Here, there is no one to just ‘bounce’ something off. However, it does afford me the opportunity to strengthen my knowledge by needing to know the answer ‘why’ and utilizing resources to confirm, learn, or discover answers. Because of the lack of colleague presence, the cross-trained nurses are a life-saver. They have a different level of competency, assessment, and confidence. It was awkward at first coming from a staff of 20 nurses per shift to having only 1 or 2 nurses. It truly reinforces the impact of communication and establishing rapport with others. Since there are fewer nurses, you work with people more infrequently, so communication, planning, and evaluating are essential—especially when those emergent situations do occur.
I still have the privilege of experiencing transport in a Level 2. The exception is that instead of going to receive the infant, I am sending them out. What an eye opener! This is where experience, confidence, and collaboration are vital. I remember my first meconium that clinically decompensated and overhearing, ‘I can’t remember a baby being this sick here.’ What a powerful lesson! This has afforded me another privilege of truly understanding the significant impact on providers and staff in managing these infants in an environment where resources may be more limited or staff may not be routinely used to managing these infants. I feel I have gained a level of inner strength, confidence, and resilience in handling distress in the clinical setting. It also reinforces the magic of nursing. Just like a Level 3, in a Level 2 the level of teamwork is there with everyone pulling together to do what is needed. Though a sick patient who requires transport is not usual and customary, the nurses are able to stabilize and do what is needed to optimize patient outcome. As a NNP, it is a humbling experience. Typically, as I stated previously, on transport I would pick up these infants to ‘give them what they needed.’ Recognizing you can’t fix this and need help is a character builder and essential professional trait.
In summary, I am privileged to experience the green grass on both sides of my world. I am so appreciative for my Level 2 experience because I am more proficient in looking outside of the box. I am not only a better practitioner, but a better listener, communicator, and mentor as well. I certainly have gained more than I can ever give back. And with that …I will go slice that piece of cake!