The Key Role Nurses Play in Patients’ Journeys with Chronic Diseases

The Key Role Nurses Play in Patients’ Journeys with Chronic Diseases

It’s an exciting time to be a nurse—our role in health care is as important as ever and we have access to technologies and innovations that allow us to provide better care for patients. Even with these advances, however, the importance of ensuring we are well prepared to be sources of support remains constant.

During the last seven years as a pulmonary nurse practitioner at Temple Lung Center, I’ve found that knowledge sharing amongst peers is key to advancing my clinical skills and providing better holistic care for my patients, especially those with chronic diseases that may be difficult to manage. So in the spirit of National Nurses Week, I wanted to share a few things I’ve learned, both from my experiences and from other amazing nurses I’ve worked with, that may be helpful to you.

  • Tailor recommendations and discussions to the individual. It’s important to set realistic expectations about what life will be like with a serious, chronic disease and what the disease trajectory might be, while also motivating patients to actively manage their condition. And while there is a standard of care for most disease states, it’s OK if some patients don’t agree with those recommendations.

Every patient is unique, so treatment plans should reflect individual needs. I partner with pulmonologists to tailor a plan for each patient that takes into account his or her lifestyle, goals, and the quality of life he or she is seeking.

Because information about diagnosis and treatment can be hard for patients to digest, and needs and personal goals change over time, my colleagues and I revisit this information over several appointments. We try to create an open and accessible environment by encouraging patients and their families to reach out to us and by providing clear instruction for how they can do so. I also try to gauge how much a patient is absorbing during an appointment and often proactively follow up if I feel he or she was  unsure about anything.

  • Think holistically about patient needs. I try to put myself in a patient’s or family member’s shoes, giving them the information I’d want about managing a disease and helping them find the emotional support that’s so important.

With patients I care for who have idiopathic pulmonary fibrosis (IPF), a progressive and irreversible lung disease, I review options such as FDA-approved therapies , supplemental oxygen, pulmonary rehabilitation, nutrition therapy, evaluation for a lung transplant, comorbidity and symptom management, as well as psychosocial support.

I also try to connect patients with sources of emotional support and up-to-date, reliable information such as psychologists, online or in-person support groups, and advocacy groups, like the Pulmonary Fibrosis Foundation.

Through the quarterly support groups I facilitate, I’ve seen first-hand how valuable it is for patients and caregivers to hear from others in similar situations. That environment also provides me the opportunity to offer additional guidance that I may not have time for in the clinic.

  • Enjoy that you will never be bored as a nurse—and take advantage of learning opportunities! With ongoing advances in treatment and the variety of conditions you may encounter, there is always more to learn. While it’s impossible to know everything, I try to understand as much as I can about all my patients’ conditions because it helps me better care for them.

I learn from pulmonologists I work with, who are very hands-on, and utilize an on-site pharmacist to help answer patients’ questions about their medicines. Up to half of patients with chronic illnesses do not take medications as prescribed, which may be due to not understanding the dosing instructions, side effects, or insurance and financial implications. If a pharmacist isn’t available to answer such questions, medicine manufacturers often have support programs, trained support nurses, or clinical coordinators who can provide helpful advice. I’ve found that support nurses for IPF medicines are very helpful and compassionate with patients. They take their time, either in-person or on the phone, to discuss the disease, its symptoms, the medicine, and how to address potential side effects.

I also attend relevant conferences and participate in research at Temple, as well as continuing medical education (CME), to learn about the latest evidence-based research. Lastly, I recommend sharing experiences, resources, new research, and advice with your peers. Doing so helps us better educate our patients and offer them the support they deserve.

The work we do as nurses is so valuable. During National Nurses Week, I hope you take a moment to recognize the impact you have in your patients’ lives and share any insights you think might help other members of our nursing community.

Nurse Practitioners Meeting High Demand for Chronic Disease Management

Nurse Practitioners Meeting High Demand for Chronic Disease Management

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.