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.”
The holiday season has almost started and there are less than two months left in 2018. This is the time of year when we can get reflective because it’s always surprising how quickly time passes. It seems like only yesterday when we were all formulating our New Year’s Resolutions.
Are you gobsmacked by how many items still remain on your 2018 to-do list?
Nurses are go-getters. They know how to get things done at work. But sometimes they aren’t as diligent about attacking their own personal goals and dreams. There’s no need to despair if you’re not where you want to be with your resolutions, personal to-do’s, or life “bucket list” items. It’s only common sense that nurses have the option of approaching these final weeks in a couple of ways.
One: you can drive on cruise control for the final days of 2018, resigned to the fact that you probably won’t be getting much accomplished after all. You may even be in a holiday mental fog, simply looking forward to enjoying time off from work, as health care environments generally slow down during this season.
Two: you can put the pedal to the metal and accelerate to reach your goals in the final stretch of this year. And if you’ve already reached your targets (good on you!), then you will try to get a jump-start on the coming year.
That’s not much time, but it can be plenty of time to reach many goals. From buying a new winter scarf to applying for an advanced nursing degree, there’s still an opportunity to take action during November and December.
Still, the temptation is there to take it easy and not push yourself during what is already the most hectic and stressful season, with family gatherings and all the emotional drama that entails for many people.
Another common mistake? Looking to the future and dreaming about how wonderful it’s bound to be—without actually doing what’s necessary now to make it happen.
There is no easy way out, though. As motivational speaker Jim Rohn says, “We must all suffer from one of two pains: the pain of discipline or the pain of regret. The difference is discipline weighs ounces while regret weighs tons.”
So, take a load off of your shoulders.
Right now, pick up your calendar, a notebook, and a pen. Make a list of what you’re aiming to accomplish. Research proves that lists have power. It can help make you more organized and productive when you “think it and ink it.” Perhaps it’s because writing activates so many different parts of the brain so it’s easier to remember what you want to get done.
Some items on your list are bound to be meaningful while others will be mundane. The biggies on most people’s lists regard daily living (“conquer procrastination”), dream jobs (or how not to go bonkers at work), romantic relationships, health and wellness, family and friends, and the pursuit of happiness.
Some goals are a bit of both—for instance “drink only hot water with lemon or cold water with cucumber slices” could make a major impact on your health if it replaces sugary sodas.
In any case, you’ll feel awesome come January 1st when you’re able to cross off (check off?) your action items, and get a head start on some others for next year. That’s so much better than starting 2019 from a dead stop after six weeks of holiday frenzy or winter hibernation.
See you tomorrow.
Hartwick College recently celebrated the 75th anniversary of their nursing program with a day-long symposium on the future of nursing. Several seminars and sessions were offered, covering holistic caring, pediatric mental health, innovation, and the future of healthcare.
One of the highlights of the symposium was a panel discussion on “Nurses’ Role in the Future of Healthcare.” Moderated by Hartwick College President Margaret L. Drugovich, three top hospital executives discussed the role of Chief Nursing Officer (CNO), nurse leadership in hospital administration, and academic advancement for nurses.
Betsy Tanner Wright, president of the University of Pittsburgh Medical Center Chautauqua WCA Healthcare, was encouraging of nurse leadership, noting that there has been a “tremendous grown in leadership opportunities for nurses.” She shared with the panel and audience: “I see a very bright future for nurse leadership not only at the executive level, but also at the bedside level.”
Jeff Joyner, president of A.O. Fox Memorial Hospital, and Mark Webster, president and CEO of Cortland Regional Medical Center also discussed the importance of the personal connection with patients and working together as a team in hospital administration. All three hospital executives agreed that nurses are vital to hospitals functioning properly, and used the CNO role as an example of how the nursing profession has expanded and evolved for the modern age.
“I think we are seeing progress in the industry,” Tanner Wright shared with the crowd. “We are seeing more nurses as hospital presidents.”
Hartwick College was one of several colleges across the United States that began their nursing program in order to train students for the US Cadet Nurse Corps. The Cadet Nurse Corps was founded in 1943 as a federal government program, to increase the number of nurses available both stateside and abroad, to treat military members fighting in World War II. Since then, over 1,500 students have become nurses, and nursing is presently the most popular field of study at Hartwick College.
For more information about Hartwick College’s nursing department, click here.