Graceful Health: Nurse Practitioners - Providing personalized care, improving accessibility

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National Nurse Practitioner Week, Nov. 12 through 18, is a good time to highlight the unique role that Nurse Practitioners have played in the evolution of today's health care system, helping to focus the system on self-care and prevention as well as on treating disease.

Nurse Practitioners have been providing primary care for over 50 years. Back in the 1940s and '50s, Loretta Ford, founder of the Nurse Practitioner profession, was working as a public health nurse in rural Colorado. After WWII, as socio-economic imbalances grew, the demand for health services and the resources needed to provide them outstripped accessibility and affordability throughout the US. Because there were so many underserved patients in inner city or rural areas, public health nurses were often the only ones providing medical care. They traveled town to town, setting up temporary clinics in churches, schools, and wherever they could find space, bringing healthcare directly to the people through wellness exams, childcare education, immunizations, and medication management.

These experiences fueled Ford's vision to create more specialized training so that these nurses could independently assess, diagnose, treat and evaluate their patients.

"We were the Lone Rangers; we had to make decisions," Ford said.

In 1965, in conjunction with pediatrician Dr. Henry Silver, Ford established the first Pediatric Nurse Practitioner training program at the University of Colorado. In 1972, she founded the Nurse Practitioner program at the University of Rochester, N.Y., directing it for many years.

The NP profession grew rapidly in the 1980s, with new programs established across the country. Today, there are more than 234,000 licensed NPs in the U.S., with approximately 23,000 new graduates each year. The workforce has nearly doubled since 2007.

The education of a Nurse Practitioner starts with a Bachelor of Science in nursing and Registered Nurse certification. NPs must have at least a master's degree, and up to 860 hours of clinical training, before they can sit for NP certification. Like physicians, they have yearly continuing education and pharmacology requirements in order to re-credential their certification and advance their skills.

During a visit with NP students at the University of Wyoming in 2013, Ford emphasized that the NP profession did not evolve because of a shortage of physicians. Rather, she said the NP role was developed to improve the health of children and families, and the physician shortage created a unique opportunity to implement this new role.

Today's rapid, turbulent, and extensive financial changes within the healthcare system are creating additional opportunities for Nurse Practitioners to be change agents. People are still dealing with physical, psycho-social, and financial problems, and NPs are adapting to meet these community's needs. NPs are capable, facile and committed, first to addressing individual patient needs, and to creating positive solutions that improve healthcare and increase its availability.

NPs provide primary, acute and specialty care for over one billion patient visits each year. In addition to diagnosis and treatment, they provide education and counseling, with an emphasis on teaching self-care skills. This has always been their focus, from Ford's early days as a public health nurse, to the present time, in whatever specialty field an NP chooses. Ford told a CNN reporter in 2011 that the goal of this emphasis on educating patients is "to empower the patient or the family, to advance self-care."

NPs now practice in a range of specialties. Advanced certifications are available in acute care, pediatrics, adult care, family practice, gerontology, psychiatric mental health, women's health, oncology, forensics and genetics. Most NPs (89 percent) are certified in some area of primary care. Some NPs have multiple certifications (mine are adult primary care, acute care, and family medicine). NPs can also undertake advanced training to serve additional roles such as educator, mentor, researcher, political advocate and/or administrator.

Grace Cottage is so fortunate to have has four other talented, interesting, and board-certified NPs in addition to me: Jorda Daigneault (family medicine), Devan Lucier (gerontology), Ben Wright (psychiatric mental health), and Andrew Semegram (family and emergency medicine). Like NPs elsewhere, these medical providers are skilled at caring for patients with acute or chronic conditions. They provide a full range of services, from diagnosis and treatment; to ordering, overseeing and interpreting lab tests; to prescribing and managing medications; to referrals to specialists and other therapies; thus managing overall patient care. If you've never been treated by a Nurse Practitioner, try it, it's a treat.

NP advanced training has led to full independent practice authority in 22 states including Vermont, plus the District of Columbia, meaning that NPs do not need to consult with a physician before directing a patient's care. Yet no one works in isolation, and communication with everyone in the organization as well as outside peers is critical for ongoing patient success.

Ford was a trend-setter back in 1965, when she established the first NP program. Today, at age 96, she is a vibrant visionary believing that an understanding of genomics is essential for future health care knowledge.

This knowledge will allow health care providers to guide patients in utilizing their own genetic make-up to prevent disease and maximize health. "The human genome project has afforded us a wonderful opportunity to improve health," noted Ford. "NPs need to embrace genomics and help patients navigate their personal genetic make-up."

"Nurse practitioners continue to be one of the solutions to America's health care," said American Association of Nurse Practitioners CEO David Hebert. "As health care reform moves forward, nurse practitioners will be front and center. The increasing number of individuals choosing to be a nurse practitioner is an affirmation of this outstanding profession."

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