Nurse Practitioners Bridging the Gap

The NP role has been ranked  the number one “best healthcare job” for 2022 by U.S. News. NPs are registered nurses who are licensed by the Board of Registered Nursing in the state where they may be practicing. With an expanded scope of practice, the NP’s role can vary from state to state depending on the Full Practice Authority laws in that state.

If it wasn’t for the great visionary Dr. Loretta Ford, the nurse practitioner role would not exist. Dr. Ford discovered that there was a need for healthcare providers in underprivileged communities. She then realized that nurses with expanded roles who gained specialized training to make clinical decisions on their own would be the perfect solution.

With the passage of the Medicare and Medicaid legislation in 1965, the need for NP’s increased. A major barrier to practice was direct reimbursement due to NP’s not being licensed. NP’s started advocate for themselves at the state level beginning in the late 1980’s and early 1990’s. 

Full Practice Authority

NP’s have been lobbying for FPA and advocating for the expansion for their role since 1994. According to the American Association of Nurse Practitioners, Full Practice Authority (FPA) authorizes nurse practitioners to evaluate patients, diagnose, interpret and order diagnostic labs, initiate and manage treatments. This includes prescribing medications exclusively under the licensure under the authority of the state board of nursing.

Current states with FPA include: Alaska, Arizona, Colorado, Connecticut, Delaware, District of Columbia, Guam, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts. Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Dakota, Northern Mariana Islands, Oregon, Rhode Island, South Dakota, Vermont, Washington. and Wyoming.

The Newcomers

The Golden State

Due to the serious shortage of primary care physicians in California, AB290 granting FPA to NP’s was signed into law on September 29, 2020 by Governor Gavin Newsom. The main focus of AB290 is to improve quality access to healthcare. California’s FPA will go into full effect in January 2023. AB290 requires the California Board of Registered Nursing to define the minimum standards for an NP to transition to independent practice. Once that has been met, the NP can prescribe specific functions which include “ordering and interpreting diagnostic procedures, certifying disability, prescribing, administering, dispensing and furnishing controlled substances.”

The Big Apple

New York is now the 25^th state to grant NP’s full practice authority. On April 9, 2022 Governor Kathy Hochul signed into the state budget of New York that NPs who have more than 3,600 hours of experience no longer are required to have a formal relationship with a medical doctor to practice. According to the AANP, NP’s in the state of New York can now evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage patient treatments as well as prescribe medications.

Prior to waiving this law, New York NP’s had a “reduced” practice authority. NP’s were required to have a ‘written practice agreement’ with a physician in their specialty area. This stated that the physician would review patient records, make referrals, be on hand for consultations. Furthermore, if there was a disagreement, the physician would have the final word. Stephen Ferrara, DNP FNP-BC, president-elect of the AANP stated: “NP’s in New York, often times were required to pay physicians in order to have this contract agreement which did not serve the healthcare system very well. New Yorkers now have a greater advantage to access healthcare for both their physical and mental well-being.

The Sunflower State

Kansas is experiencing a healthcare shortage in its rural areas. On April 22, 2022 Governor Laura Kelly signed Senate Substitute for House Bill 2279, a bipartisan bill, which expands the role of advanced practice registered nurses (APRN’s) removes barriers for them to practice independently. Governor Kelly stated that House Bill 2279 “will empower APRN’s to decrease local and reginal care gaps.” Under HB2279, APRN’s are required to comply with the Federal Drug Enforcement Administration requirements for safely prescribe controlled substances, as well as maintaining malpractice insurance and national certification for licensure as an APRN.

The First State

Governor John Carney signed HB141 and H21 into law on August 4, 2021, improving access to primary healthcare to the 1 million residents of Delaware. Bethany Hall is Delaware’s Lt Governor and a nurse. When both HB141 and H21 were approved by 20-1 votes, Lt. Governor Hall was present presiding over the state senate.

HB141 allows NP’s and APRN’s to practice to the full extent of their training removing the prior oversight contract previously needed between a physician and an NP. Some employers in Delaware may still require a physician NP practice contract. HB 21 allows for a ‘multistate” licensure entering the APRN interstate licensing compact. North Dakota and Delaware are the only 2 states to pass legislation even though 37 states are members of the Nurse Licensure Compact for both Registered Nurses and Licensed Vocational Nurses. AARP recently conducted a study in Delaware and found that 86 percent of the senior residents of Delaware stated that having greater access to healthcare was important to them.

States on the FPA Horizon

The Great Lakes State

Michigan introduced SB680, a bill allowing FPA to NP’s on October 5, 2021. The bill is sponsored by Senator Rick Otman and co-sponsored by Senator Jeff Irwin, Senator Sylvia Santana, Senator Jim Runestad, and Senator Tom Barett. The bill will amend Public Act 368 0f 1978, inserting and changing language which states “The administrator may issue a controlled substances license to an individual licensed as a registered nurse under part 172 if the individual has been granted a specialty certification as a nurse practitioner by the Michigan board of nursing under section 17210.”

Improving Access to Healthcare Through FPA

The U.S. is facing a significant healthcare crisis with physician shortages in primary care and psychiatry. Currently, there are more than 355,000 licensed NP’s in the U.S. who provide healthcare in communities of various sizes and demographics nationwide. NP’s are known to provide a high level of service and care to over 1 billion patients a year. Research shows that states who adopt FPA have a better advantage to improve access to healthcare, address healthcare disparities as well as increase their workforce.

MedCare Staffing Providing the Highest Quality of Healthcare Providers

MedCare Staffing provides a hands-on professional leadership team. Whether you are a healthcare provider looking to work locum tenens or you are looking to hire healthcare coverage, MedCare Staffing offers dedicated professional support through the entire tenure. With 70 years of combined recruiter experience, we have a reputation for success. To speak to a recruiter today click here.

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History of correctional healthcare

Correctional healthcare did not exist until 1770 and was invented in England by a wealthy philanthropic healthcare former by the name of John Howard and physician John Fothergill. Louise Rene-Villerme a physician and pioneering hygienist published a study titled Des Prisons in 1820, further overhauling the public health concerns in prisons.

According to the CDC the most common healthcare problems reported by prison inmates include:

Infectious disease

• Hepatitis
• HIV/ Aids
• MRSA
• Sexually Transmitted Diseases
• Tuberculosis

Chronic Diseases

• Arthritis
• Asthma
• Cancer
• Heart Disease

Learning disabilities and mental health

The most common impaired functioning that jail inmates report is a learning impairment such as dyslexia or attention deficit disorder. Many inmates also report having been enrolled in special education classes during their youth. Approximately 8 percent of inmates state they suffered from mental health condition that kept them from fully participating in school, work, or other activities.

Pregnancy in incarcerated women

Approximately 3 to 5 percent of incarcerated women are reported to be pregnant when they go into a correctional system. Pregnancies of incarcerated women are usually high risk due to poor nutrition, limited accesses to prenatal care, domestic violence, mental illness, drug and alcohol addiction.

Transgender healthcare

During incarceration, transgender people may face a multitude of problems that may endanger their health and wellbeing. Correctional healthcare professionals must pay special attention to evaluation, screening, referral, and management of mental healthcare needs. Particular attention must be given to hormonal treatments for gender dysphoria and should follow accepted guidelines developed by professionals with specialized in transgender health.

Special attention must be paid to transgender youth who enter into the corrections system. Mental health professionals experienced in working with transgender adolescents  must review the youths current clinical stability, mental health functioning , and possible need for added mental health therapy and intervention.

Overall decreased life expectancy

For every year a person spends in the correctional system, 2 years is taken off of their lives.  With 1.8 million people locked up, mass incarceration has lowered the life expectancy of a significant portion of the human population in the United States.

Healthcare staff within the correctional system:

Physicians: a physicians role in corrections is primary care that can reach highly intensive levels. Physicians medical practice roles include internal medicine, preventative care, urgent care, emergency care, routine patient care, basic orthopedics, dermatology, minor office procedures, chronic care and end of life care. Some patient may need to be transported off site for tests, medical procedures and consultations.

According to the American College of Correctional Physicians, a physician working in corrections must be aware of and balance interests of; good solid medical practice, medical supervision, implementation of process, medical board rules, the safety and security of the facility, the individuals in the facility, and the community. A few examples of medical-custody coordination are:

• Timely access to medical
• Timely treatments and
• Medical training and supervision

Nurse Practitioners: can provide care to adolescent patients to geriatric patients within the correctional healthcare system. Nurse practitioners practice within their scope and can perform physical exams, health screenings, medication management, sick calls and pregnancy and post-partum care. Correctional NP’s are positive advocates for patients and provide education to correctional administrators, judges, caseworkers and correctional staff.

Nurses: provide direct patient care to inmates in jails and prisons. Nurses treat patients in the correctional system for a variety of ailments including emergency medical conditions, acute illness, as well as chronic medical conditions.

Correctional healthcare staff may also be involved in hunger strikes, isolation, sexual abuse, transgender, elderly release pleas, compassionate release pleas and long term involuntary psychotropic medications. All incarcerated people within the correctional system must be treated with fairness and receive comprehensive healthcare. It is the responsibility of correctional healthcare team to advocate for the healthcare needs of these individuals.

Curious about a career in Corrections Health? Try out a Locum Tenens assignment with Medcare Staffing

Medcare staffing has a variety of locum tenen assignments in corrections for physicians, nurse practitioners and nurses in a variety of different states. Click here to find out more information and speak to a recruiter today.

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Is going back to the bedside as an RN a wise decision?

Personally, I’ve volleyed back and forth from the NP role to the RN role in various different positions. That’s the beauty of nursing, you have lots of opportunities. Each time I went back to the RN role, I learned something valuable that I would not have learned in the NP role. At the time, I chose to make these shifts in my career, I was looking for a break from being an NP. Sometimes, I was looking for greater compensation and a better work life balance.

One of the biggest problems with rebounding your career is your ego. Your career should not define who you are. Instead, a healthy work life balance should dictate how you maneuver your life.

COVID-19 pandemic brought many opportunities.

Nurse Practitioners took advantage of the COVID-19 pandemic crisis opportunity to go back to the RN role on the frontlines. One NP reported “It was a nice break. It felt good getting overtime pay again.” Another NP stated, “I’m thankful for the opportunity to go back to bedside nursing as an RN during this COVID crisis. Although, I would not want to leave my NP hospitalist position to be an RN full time again.”

The CARES Act signed into law a 2 trillion-dollar economic relief and public healthcare package which also increased the need for more nurses at the bedside. Hospitals and staffing companies recruited nurses to work on the frontlines paired with robust salaries and accommodations. Petitions were even being circulated so that AANP (American Academy Of Nurse Practitioners) should strengthen the bedside numbers by having Nurse Practitioner’s act as bedside nurses during this crisis. Hospitals are now offering higher pay to recruit nurses due to overproduction of NP’s and RN’s leaving the bedside to pursue an NP degree.

Transitions Can Be Difficult

The transition from the RN role to the NP role can be a difficult one.  Responsibilities are greater in the Nurse Practitioner role. In some cases, you may be the main provider in your practice setting.

Changes in schedule, going from 12-hour shifts, 3 days a week to 8 hours 5 days a week may also cause conflict. Charting at home, working longer than 40 hours and not getting paid overtime are common complaints from new Nurse Practitioners. One NP in a Facebook group stated she had to take out several loans to pay for her college tuition and NP program. She further stated she felt the pay from NP to RN was the same in her state of residence. She was also having difficulty finding a job as an NP and regrated leaving the bedside.

Carpe Diem (Seize The Day)

COVID-19 brought with it a flurry of new RN positions. Some of these may include PCR testing, vaccine administration, and public health educator. The demand for ICU nurses is increasing day by day. If you find yourself furloughed, out of an NP job, or just wanting to take a break from the NP role, it’s best to call a locum Tenens recruiter and see what options are available for you.

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“A significant percentage of physicians are over retirement age and new physicians are not keeping up with the need,” said Wood. “Of course, we can increase funding for medical residencies and loan repayment programs, and I have always supported those, but the reality is it’s not only an expensive solution but the number of residency programs will never be enough to meet the current and future need in California.”

A majority of physicians practice a specialty where incomes are usually higher. Nurse Practitioners are often found working in underprivileged rural areas. “Quality of Primary Care by Advanced Practice Nurses: A Systematic Review,” have concluded that nurse practitioners provide care of comparable quality as physicians, even when practicing without physician oversight.

On February 19, 2019 a final report was released by the California Future Health Workforce Commission which addressed the states shortages of primary care and behavioral health providers. The expansion of the Nurse Practitioner role was on the top 10 list. More than 80 organizations supported AB 890, including individual physicians.

The History Of The Nurse Practitioner Profession

Currently, there are more than 290,000 licensed nurse practitioners in the United States. Back in 1965, the United States expanded their Medicare coverage to include low income women, children and the elderly. At this time the US was experiencing a physician shortage particularly in urban areas servicing children.

Loretta Ford, EdD, PNP, FAAN and Henry Silver MD were called to action and founded the first NP program in 1965 at the University of Colorado. It became a master’s degree program in the early 1970’s. The U.S. federal government contributed money to NP education in 1987 and spent $100 million.

Although the NP profession continued to grow, Nurse Practitioners did not have full provider status in the eyes of the federal government and were not eligible for reimbursement. NP’s continued to fight to legitimize their profession. The role of the Nurse Practitioner has become important as more patients are covered by The Affordable Care Act and more states grant NP’s full practice authority. Today, 82.9% of full-time NPs are accepting Medicare patients and 80.2% are accepting Medicaid patients.

The term “Full Practice” means state practice and licensure law provides for all Nurse Practitioners to evaluate patients, perform diagnostic tests, initiate and manage treatments, including prescribing medications under the exclusive licensure authority of the state. Full practice authority varies in every state and due to tireless legislative advocacy, the state practice environments are constantly evolving.

What Nurse Practitioners Offer

Along with increased access to care, the AANP also lists these additional benefits to having full practice authority NPs: 

• Streamlined care. Allowing FPA removes the delay in care that can occur when an NP must consult or work with a physician to deliver necessary care. 
• Cost savings. NPs are more cost-effective in general, but FPA also avoids unnecessary service duplication. 
• Upholds patient autonomy. Some patients prefer to work directly with NPs and may even feel more comfortable sharing health care concerns with primary care NPs. 

California is the 23rd state in the U.S. to offer full practice authority to its Nurse Practitioners when it goes into effect in January 2023. AB290 requires the California Board Of Registered Nurses to define the minimum standards for an NP to transition to independent practice and once that has been met the NP can perform specific functions “ordering and performing and interpreting diagnostic procedures certifying disability and prescribing, administering, dispensing and furnishing controlled substances.” Full practice authority details vary from state to state. It’s best to contact the local boards of nursing to find out more regarding practice, prescriptive licensure, Practice acts and other details.

Who are we? MedCare Staffing is a small, veteran-owned, family-oriented team. We start every day with gratitude because we LOVE what we do! We are a team on a mission to make a positive difference in the lives of our clients and providers.

What we do: We place Physicians, Dentists & Advanced Practitioners in Locum Tenens, Contract Positions and Permanent Jobs

To contact MedCare Staffing, call 888.474.3380 or visit or website by clicking here

References

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If you’re a “Newbie” in the locum tenens game, you’re first day on the job can feel like that awkward first day in middle school. You don’t know anyone, you don’t know what to expect, and you probably forgot your lunch! The locums landscape of forever changing assignments can sometimes skyrocket your anxiety through the roof.

You may be working in a new city, embarking on a new commute, entering into an unfamiliar office space with new coworkers and administrative staff. Science says people are “hard-wired” to feel anxious in pretty much any new situation. However, moderate levels of anxiety can facilitate and drive performance. The stress of wanting to make a good impression on your first day of your new Locum Assignment can also add to your anxiety. 

Health care professionals with higher levels of anxiety and frustration were more than twice as likely to report workplace burnout, compared with those with lower levels of anxiety and frustration, according to a study of primary care professionals published in the Journal of the American Board of Family Medicine. Moreover, primary care physicians reported burnout at double the rate of other health care professionals in their practice settings.

Fear not newbie! All is not lost, and your anxiety can be controlled with these 5 tips:

1. Be Aware Of Your Stress Level And Anxiety Triggers

            Caffeine, skipping meals, bills and taxes can all be triggers too anxiety. Try and limit         these as best as possible before your first assignment. Perhaps pay your bills or write         out checks and be confident that they will be taken care of to decrease your anxiety. Prescriptions like birth control pills and OTC cough and congestion medications may            create sensations that become anxiety triggers for you. 

• Be Confident And Smile

            If you have too much anxiety it can derail your performance. Confidence in your clinical skills is key to success. Trusting your own judgement and abilities along with valuing   yourself worth can curb your anxiety. Body language can help boost confidence. Practice an open body posture. Don’t put your hands of your hips or slouch. Smiling and         practicing open communication will project an energy of confidence.

• Get Informed

            Before your assignment, try and get informed about what is expected from you as           much as possible. Does the clinic you are going to work at require you to have a health      physical, urine drug screen, TB, and COVID test? Having these done before starting your           first day on your locum assignment will create less stress. Ask your recruiter as many           questions as possible in order to get informed on what to expect. For example, what             type of charting will you be doing? Paper or electronic? Do you have the option to work      telehealth? Where will you be parking and is it secure? Who is the person you will be             reporting to at the clinic?  How many patients will you be seeing? The more you know,    the better.

• Brush Up On Your Skills

Brushing up on your skills before starting your first day in clinic can help boost your confidence level and decrease your anxiety. Classes for skills like CPR, PALS, ACLS, suturing techniques, and several others can be obtained online easily. You may even want to check out YouTube for videos that will help you refresh your skills like adult physical exams, pediatric physicals, new baby exams, sports physicals, and pap exams.

• Network And Connect With Your Support Staff

            Getting to know the clinic staff and communicating your needs can help minimize your    anxiety. Introduce yourself, smile and be cordiale. Find out if you will be working with       the same medical assistants on a daily basis or if you will have a new person with you.          Ask them what the standard routine is of the clinic and how they usually work with         healthcare practitioners. Communicate what your needs are and don’t be afraid to let       them know your weaknesses.

Following these tips will help to decrease your “Newbie” Locum Tenen jitters and quantum leap you forward to success. The more confident you feel with yourself, the better your assignment will be. Anxiety can be overcome ensuring you a happy and productive assignment.

“Experience is not what happens to a man, it is what a man does with what happens to him.”- Aldous Huxley

Who are we? MedCare Staffing is a small, veteran-owned, family-oriented team. We start every day with gratitude because we LOVE what we do! We are a team on a mission to make a positive difference in the lives of our clients and providers.

What we do: We place Physicians, Dentists & Advanced Practitioners in Locum Tenens, Contract Positions and Permanent Jobs

To contact MedCare Staffing, call 888.474.3380 or visit or website by clicking here!

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The experience of working at a Community Health Center usually starts on the streets before you enter the clinic. You drive by acres of rural farmlands that offer the sweet scent of manure as migrant workers pick their crops. You may pass many make-shift tents that serve as housing for the homeless population in an inner city. You may walk by street vendors making savory tacos that make your mouth water while small children walk hand in hand with their parents. As they see you, they may start screaming “Doctora, Doctora” and offer a sweet smile and a kind waive with their hands because they remember who you are. This scenic landscape before entering through the community health center’s doors begins to tell a story of what terrain your patient’s may have conquered before presenting themselves to you in your exam room.

“I usually have diarrhea from my mouth, but today it’s coming from my butt!” A quirky 5-year-old Latino American girl sits on my exam table and blurts out the phrase trying to stifle a laugh with her hands pulled immediately to her face. Her mother just rolls her eyes and smiles while her ‘abuela,’ sits back in her chair, eyes bulging, looking mortified. I laughed and ask, “Are you trying to be Sarah Silverman?” “Who’s that?”  she squeals as she proceeds to giggle and spew off several more jokes as I try and examine her. This family of 3 had to take several buses through an overcrowded urban city to show up at the clinic as a walk in. It also saved them a visit to the Emergency Room.

Community health centers are unique and special places. And yes, on many days they can resemble comedy shows which adds to the fun of working at them! One of their main purposes is to serve underprivileged communities, increasing access to timely care and to avoid costly Emergency Department (ED) admissions.

When you are working at a Community Health Center, it’s not just about the patient you are seeing, but about the whole family structure. It’s not uncommon for a mother, father, siblings, grandparents and even great grandparents to be present at a newborn’s first well check. This offers a great opportunity for assessment and teaching on so many levels as a practitioner.

Originally, community health centers were started in 1965. They were launched as a small demonstration program in conjunction with President Johnson’s ‘Office Of Economic Opportunity’ with a main focus on medically underserved communities. Today, clinics can be found in inner suburban cities servicing the homeless population to rural locations servicing migrant farmworkers.

Approximately 1400 community health centers provide healthcare to 28 million people throughout the United States. The main source of funding for these clinics is Medicaid along with other sources of funding which include Federal Community Health Center Program 330 Grants, Ryan White Funding, Title X Funding, and local county funds. The Affordable Care Act also offers additional funding.

Many clinics deliver a broad area of services which include mental health, dental, podiatry, maternal child health, pediatrics, HIV services, and Transgender services. They specialize in diagnosis and management of chronic illnesses such as diabetes, asthma, heart and lung disease, depression, cancer and HIV/AIDS. One of the main goals is to reduce mortality, health disparities and risk of low birth weight with the care they deliver. Services such as transportation, translation, case management, and health education are offered to ensure continuity of care.

Working with a lower socioeconomic population can offer challenges as well as a variety of learning opportunities which may include language barriers, poverty, and compliance to healthcare regimens. Community Health Clinics offer healthcare providers an opportunity to flex their creativity, employ a sense of humor and have an open mind in order to better meet a patient’s needs.

Community health clinics are great places for Physician’s, Nurse Practitioners, Nurses, Dentists, and Psychologists to practice. They offer an abundance of experience that can only be acquired at the rural clinic level and inner city. It’s a rich cultural exposure that can be incredibly humbling. You don’t necessarily have to be a comedian to work at one, but it doesn’t hurt.

Ersilia Pompilio RN, MSN, PNP

References

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You Get To Choose When and Where

With the demand for locums skyrocketing, the control is yours. Assignments vary from a few shifts a week, to a few a month with short and long term assignment as well. With MedCare Staffing, we will partner with you while doing our best to find the perfect match.

It’s A Great Way To Make Extra Income

Are you a new graduate with student debt? According to an article posted in December 2018, the class of 2018 medical school students graduated with $196,520 in student loans. Also, according to the Association of American Medical Colleges, seventy-five percent of medical school students in the class of 2018 graduated with student debt. Consider picking up locum tenens assignments and begin chipping away at this financial debt.

Unexpected Benefits of Locum Tenens

Working locum tenens can add to your repertoire of skills and experiences. When a medical provider travels outside of the network that they work in, they suddenly become exposed to various methods of doing things and unique nuances of different practices. And not to mention the cultural differences if one travels a long distance for locum tenens work.

As you can see, there are a few reasons to consider locums even with a full-time position. MedCare Staffing would love the opportunity to share more so feel free to contact us us at 888-474-3380 and let’s begin the conversation!

Who are we? MedCare Staffing is a small, Veteran-owned, family-oriented team; we start every day with gratitude because we LOVE what we do! We are a team on a mission to make a positive difference in the lives of our clients and providers.
What we do. We place Physicians & Advanced Practitioners in Locum Tenens, Contract Positions and Permanent Jobs.

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