Bill Would Let Nurses Prescribe Medicine On Their Own, Without Consulting Physicians

Measure could help ease shortage of primary care doctors, limit impact of federal healthcare reform.

S-2354 is a bill that is currently working its way through the New Jersey state legislature that would allow Nurse Practitioners to prescribe medicine on their own without the joint protocol from a physician. Because of this, the bill makes it easier for NPs to establish their own private practice.

As of recent NPs have taken a much larger role in primary care and are assumed to have their role grown as a result of the Affordable Care Act. This is because more people are now available with medical coverage through Medicaid and at the same time a high volume of doctors do not see patients on Medicaid.

The objection holding back this bill is that physicians believe that NPs establishing their own health care practices will affect the quality of patient care even though NPs have the proper training and school to give proper healthcare.

Historically NPs are more conservative towards writing prescriptions. As such they help to lower malpractice rates. Studies have been conducted through New Jersey that state that the level of care that NPs provide is equal if not better than the care given by physicians across the state. In addition, the cost of providing care is 20 to 35 percent cheaper than a physician.

As the bill currently stands NPs with less than 24 months or 2,400 hours of practice will still need to have joint protocol with a physician.

The bill is not a perfect solution for the NP and physician paradigm but it is on the right track for giving NPs equal privilege to physicians in New Jersey.

For more information and the full article follow the link provided.

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Written by Brandon Kassof

More nurse practitioners visit home care patients

More and more Nurse Practitioners are providing home care for elderly or other patients with limited care access. Over time this type of care has shifted from physicians to NPs. As the population ages there is an increased need to care and NPs are now in a position to fill that role at the convenience of the patient.

Hospitals are even involving themselves in home care by sending out their NPs to local residences like the ones near Maimonides Medical Center, Brooklyn, New York.

The benefit of home care is understanding and analyzing the home environment of the patient and make corrections to better ensure that their sustainability and recovery are done in an environment that is indicative of a situation where health is at the forefront and proper care can be implemented in the most direct way.

NPs are the proper agents for this type of care because of their predisposition for warmth and understanding towards their patients. By being in the patients home an NP can custom tailor their treatment to fit the exact needs and surroundings that the patient lives in and thus engineer the perfect health care paradigm for the patient.

All of this allows anyone to receive the proper care they deserve even if they were in a situation where they normally would not be able to reside in a hospital or long term care facility.

There are still flaws in the system currently. While NPs can write prescriptions for patients  they cannot sign home care certifications, as this must be done by a physician. Other problems exist in the communication between home care and hospitals in terms of Medicare reimbursement, but as time goes on and more home care is needed NPs are positive that the needed change will occur.

For more information and the full article follow the link provided.

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Written by Brandon Kassof

Nurse Practitioners See Rise in Full-time Salary Rates

Since the beginning of the decade nurse practitioners have earned an increased salary every year. Experts say that the reasoning for this is that people are recognizing the value of nurse practitioners. Depending on their location and their skill NPs can earn as much reimbursement as a physician. Employers are understanding the value of nurse practitioners and are thus willing to pay them more. 

An online survey found out that NPs were earning $90,770 compared to $89,579 from two years ago. Nurse practitioners working in emergency situations made the most at $104,549. Nurse Practitioners working in cardiology earned the biggest change in income, 11.9 percent increase, from $90,195 to $100,881. Interestingly male NPs earned 12.8 percent more than females. 

In 2011 Indeed.com listed the average income of NPs at $90,000 and trending upwards.

Marsha Siegel, former president of the American College of Nurse Practitioners says that even though there is a significant pay increase, the responsibilities and requirements are much more advanced than an RN. She notes that the life of a NP is not for everyone but at the same time it is very rewarding.

For more information and the full article follow the link provided.

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Written by Brandon Kassof

Hospital Readmissions

Readmission rates have been dropping steadily, but links between rates and demographics could make it tough to make big strides

Two out of every ten New Jersey Medicare patients return to the hospital within a month of being discharged. This number is a significant reduction from over the past four years. Studies show that even though the number of readmissions is dropping, a significant change seems hard to achieve because of correlation between readmission rates and demographics.

Healthcare Quality Strategies Inc. released data that showed a drop in the rate of patients readmitted to hospitals in the state of New Jersey. The data was broken down by county and showed that 20 percent of patients return to the hospital within 30 days.

Last year nearly every hospital in New Jersey was penalized by Medicare for having too high readmissions.

Hunterdon County, which has the highest median income and the second largest non-hispanic white population in New Jersey has the lowest readmission rate, below 17 percent. On the other hand, Hudson County which is much more diverse and economically challenged is the county with the highest readmission at 24 percent.

The data shows a trend where better communication is implemented in the hospital and post-acute care facilities with the patients, even the counties with the higher readmission rates can lower their numbers.

After digesting the data the New Jersey Hospital Association knows that it still has a long way to go to ensure that every county has lower readmission rates regardless of diversity or economic situation.

For more information and the full article follow the link provided.

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Written by Brandon Kassof

NP Associates Youtube Video Introduction

We recently created a video on YouTube explaining NP Associates and how we work. The NP featured in this video is Courtney Leach. The script writer is Shaina Sarna. The videographer and editor is Brandon Kassof. NP Associates will be creating more videos in the future. Please subscribe to our Youtube channel for future updates.

YouTube

MRSA Testing: Newer, Faster, Better

In Fight to Detect MRSA, New Tests and Techniques Challenge Labs

Methicillin is an antibiotic that was introduced to combat certain penicillin resistant bacteria such as Staphylococcus aureus. Shortly afterwards a methicillin resistant strain of Staphylococcus aureus developed named MRSA. This is normally found in a hospital environment where people with lowered immune systems can pick up different strains of bacteria. In addition in the 1990's a strain of MRSA developed in people who were not associated with hospitals at all. This strain is called community acquired MRSA or CA-MRSA. 

MRSA Facts: 

• 95,000 cases of invasive MRSA infections occur annually in the U.S.

• MRSA causes 19,000 deaths each year

• 86 percent of MRSA infections are healthcare associated

• 14 percent of MRSA infections are due to community-acquired MRSA

• In 2012 it cost $3.2 billion to $4.2 billion to treat hospitalized MRSA patients

All this information is what laboratorians and researchers use to answer questions as to how to treat MRSA and how to stop its growth.


Setting up a System: One of the difficulties of MRSA is determining how to detect it. Some hospitals check every single patient they admit while others only check patients who are the most likely to acquire MRSA. In addition, different hospitals treat MRSA differently as well. The problem is that there is no surefire way to detect or treat MRSA so no one way is more correct that any other. New forms of detection are being implemented every day.

Detection: Last year, a British hospital utilized whole genome sequencing to halt a MRSA outbreak. This is the first time that DNA sequencing has been used in such a capacity. As technology advances these kind of practices can become more cost effective. There are many different tests that are conducted across the country to combat MRSA, each which provide answers in a couple of hours. Speed is your friend when working with MRSA because as soon as you can come back with a MRSA negative result you can start working on the actual problem that is facing your patient. Experts say that with continued developments on combating MRSA, a future strategy could involve a vaccine.

For more information and the full article follow the link provided.

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Written by Brandon Kassof

Integrating Care for Populations and Communities

Helping Patients Plan Their Healthcare Future

Depending on the patient there are a variety of different ways to approach the appropriate care for them. Palliative care works at managing your patients pain and suffering while also managing their condition. Hospice care covers patients with a life expectancy of 6 or less months. It is covered by Medicare and does not manage their condition. The goal is to ease the patients remaining time and also cares for the patients loved ones that are left behind. Understanding which type of health care they wish to receive goes a long way to giving your patient the proper care and making their time in your health care facilities as comfortable as possible. An asset that patients can use to ease their time at your health care facility is the advance directive. An advance directive is a living will that states the desires of the patient in regards to their healthcare at the end of their life. Having an advance directive created is a great way to reduce stress for the patient and their loved ones. Another way to plan for end of life care is through the use of Practitioner Orders for Life-Sustaining Treatment or POLST. POLST treats your patients end of life desire as a medical order so that the proper care is maintained until death. Whatever type of end of life care your patient and their loved ones decide on, the important idea is to plan for this inevitable life conclusion and to not be caught surprised by it. By taking these steps with your patient and their loved ones you can ensure a more comfortable end of life care facilitation.

For more information follow the links provided

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Written by Brandon Kassof

Reducing Healthcare Associated Infections

Catheter-Associated Urinary Tract Infections (CAUTI)

Urinary Tract Infections cover any infection found in the urinary system be it in the urethra, bladder, ureters, or the kidneys. The urinary tract sees the most healthcare-assoicated infections at 30%. Of those urinary tract infections 80% are caused by the urinary catheter. Because 15 to 20% of patients that enter health care facilities receive a urinary catheter the chance for such infections is high. By limiting the amount of time that the patient is using the urinary catheter you can prevent a urinary tract infection of this kind. The Center for Medicare and Medicaid Services is looking at urinary catheters and the related urinary tract infection and developing an effective plan to combat the problem in New Jersey. By understanding the risks of using a urinary catheter and learning how to effectively reduce urinary tract infections, you can better care for your patients and to keep them healthy.

For more information follow the link provided

http://1.usa.gov/1036kbp

Written by Brandon Kassof

10 Common Time Management Mistakes

The NP Associates newsletter for January contains a very interesting article about proper time management and how to avoid several time management mistakes. The key to proper time management is to make sure you are taking the correct steps necessary to become effective. This article list ten mistakes and how to easily overcome them.

Mistake #1. Failing to Keep a To-Do List: To make sure that you stay on task when working on a project it is mandatory that you create and keep a to-do list. The secret to the to-do list is that it is not enough to just have it, you need to manage it. It is important to detail each part of the to-do list so that you understand what each task entails. It is also important to prioritize each aspect of the to-do list. This is very important overall in time management to make sure you are optimizing every single aspect of whatever time you have designated for the given project.

Mistake #2. Not Setting Personal Goals: It is important to always set goals so that you have something to work towards. With out proper goals the threat of slacking off is omnipresent. By setting and understanding your goals you decide what the priorities are for your projects and you can then effectively plot your time.

Mistake #3. Not Prioritizing: When presented with multiple problems and projects at once it is important that you prioritize them so that they get the correct amount of your time. A good tip is to create cretirea for all of the information that is presented to you. If it meets a certain criteria than it is labeled urgent and should be dealt with before other projects get worked on. Proper time management allows you to always have time for each project and problem if you make sure that each one get dealt with at the proper time.

Mistake #4. Failing to Manage Distractions: When working efficiently you get into a groove and you enter the prime state to finish projects. When you allow distractions into your mind it brings you out of the groove and your productivity is reduced. It is very hard to return to the groove once you lose it. All of these things negatively impact your time management. Different people get distracted from different levels of stimuli. Some people only need to log out of Facebook where as other people need to be in an isolated room. The key is to reduce whatever distracts you so that you can focus on your task at hand.

Mistake #5. Procrastination: Procrastination develops when you have a lack of desire to complete the task assigned to you. You keep holding off on working on the project because of your lack of motivation. If you break up each task of the project into bite sized portions then the uninteresting project seems more manageable.

Mistake #6. Taking on too Much: You should never take on more projects than you can handle. You also need to leave room for any problem or emergency that my develop spontaneously. You need to be able to focus the correct amount of time that each task requires to ensure that the highest level of effort is put into each project. You never want to spread yourself to thin.

Mistake #7. Thriving on "busy": It is never a good thing to be working to the last minute and racing deadlines. There are no time management tools and tricks available to you if you cram everything in at the end.

Mistake #8. Multitasking: While multitasking seems like a good idea, it is impossible to give each task the correct amount of time they need. When you split your concentration each task only gets a small percentage of the total concentration and effort that the project needs to be completed to the best of your ability. You need to give each task the proper amount of time and utilization of your time management skills.

Mistake #9. Not Taking Breaks: The secret to taking breaks is to give your mind some downtime so it can stretch and develop new ideas for the next task ahead. Your break should only be a couple of minutes and should always involve you steeping away from your work center to walk around for a bit and to contemplate the work that you have just performed to check for mistakes you might have missed while in the groove.

Mistake #10. Ineffectively Scheduling Tasks: There are times during the day when you are most productive and when you are less productive. You need to schedule your higher level work during the times of the day when you are most productive and the lower level and easier work turning the times of day when you are less productive.

By following and implementing these techniques into your time management skills you will produce more effective work while also not stressing out over time or energy.

For more information and the full article follow the link provided.
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Written by Brandon Kassof

Heart Failure Treatment Choices

The NP Associates newsletter for February contains an informative article on Heart Failure and on possible treatments for the condition. According to Jennifer Cervino, MHS, PA-C, the author of the article 5 million people in the United States have heart failure and 550,000 will be diagnosed with HF this year alone. HF accounts for 15 million office visits and 6.5 million hospital visits each year for patients 65 and over. Hypervolemia is the contributing factor to HF. This leads to high re-hospitalization rates and increased health care costs. Diuretic drugs are the normal component of treatment plans. While the diuretics work at controlling the congestive systems, adaptations and resistances to the drugs normally develop as the disease progresses. In light of this, new therapies are being developed to better treat HF patients. One just technique is mechanical ultrafiltration or UF.

Ultrafiltration and Diuretics: Mechanical ultrafiltration has been used for more than 50 years in patients with end-stage renal disease requiring hemodialysis. Only within the last 25 years has UF been used and considered for HF patients who are diuretic resistant. During ultrafiltration, often called aquapheresis, blood is withdrawn from a patient with volume overload and then passed through semipermeable membrane (a hemofilter). The filter removes all the excess salt and water and then returns the blood back to the patient. UF can remove as much as 500 mL of fluid per hour. Because the extracellular fluid being removed is isotonic with the blood, serum electrolyte balance is maintained as sodium is removed.

Diuretics: Benefits, Limitations: Despite this data, the American College of Cardiology and the American Heart Association still use diuretics as the diagnosis of choice for HF patients. Diuretics are the cheaper and more readily available form of treatment for HF. There are obvious downsides to diuretics as well. Their use can actually do more harm than good if the proper care to replace key nutrients such as potassium to the body is not noted. Patients can see an increase of fluid retention which would complicated their HF problems. This problems seemed tied to  worsening renal function, prolonged length of hospital stay and increased long-term morbidity and mortality in addition to the other problems associated with HF and the use of diuretics.

Ultrafiltration: An Alternative?: The Acute Decompensated Heart Failure National Registry performed a study that looked at patients that have been hospitalized for HF and discovered that their treatments of diuretics was not solving the problem. Following that study, trials for UF have been performed. The RAPID-CHF trial showed that after 24 hours significant advances had been made to patients with decompensated HF and diuretic resistance. They had better results at a shorter interval then their normally prescribed diuretic therapy. The UNLOAD trial also concluded with results that reflected a safe and more effective way of fighting HF with the use of UF.

Questions Remain: As the use of UF is still relatively new in the field of HF and diuretic resistance patients there are still parts of UF therapy that is unknown. In addition the knowledge and understanding of UF is still not part of the main stream HF solution. One of the major inhibitors is the economic factors associated with using UF to treat HF.

For more information and the full article follow the link provided.
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Written by Brandon Kassof

Nutrition and Congestive Heart Failure

The NP Associates Newsletter for March contains an informative article about Congestive Heart Failure and how proper nutrition can stave off any possible effects of heart problems. According to Gail C. Frank, DrPH, RD, CHES, author of the article, ten percent of the United States population suffers from congestive heart failure. As people age this percentage increases within their age group. Obviously our job as NPs includes reducing the cardiac workload and swelling and improving heart functions. The article poses some easy management strategies to help your CHF patients.

Reduce Sodium: As you know, too much sodium can raise blood pressure. CHF patients should only consume .5 to 1.5 grams of sodium a day. .5 grams is all that is needed per day for normal body functions. An easy way to ween CHFs off of a high sodium diet is by slowing going in stages. As the normal American average is between 7 and 10 grams a day, you can slowly cut their sodium intake in half. Go from 10 grams to 5 grams, from 5 grams to 3 grams and from 3 grams to 1.5 grams. Encourage your CHFs to actively seek out low sodium alternatives.

Reduce Alcohol: Alcohol increases hypertension by up 10% in males. By staying away from alcohol a previous drinker can have his blood pressure reduced to that of a non drinker. Alcohol is absorbed through the gastrointestinal track and is then feed to all body tissues and organs. High fat foods and proteins can slow the absorption of alcohol while the carbon dioxide in champagne, sparkling wines, beer and carbonated mixed drinks accelerate the absorption of alcohol. The truth is that your CHF should not be consuming alcohol. It contains empty calories which hold no nutritional value, ethyl alcohol which is toxic, and stresses out the liver.

Adjust Calories: Obesity is no friend to a CHF. It is important that your CHF is eating the correct amount of calories for their body type. 

Exercise: According to the National Heart, Lung, and Blood institute, exercising 3 times a week for at least 20 minutes is necessary for a healthy living. As a NP you should confirm that your CHFs are getting the correct amount of exercise each week to keep them in a healthy state.

For more information and the full article follow the link provided.

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Written By: Brandon Kassof