21st century belongs to nurse practitioners, The

Nurse Practitioner, Apr 2000 by Sharp, Nancy

On January S, 2000, the 21st century opened with an inspired jolt of publicity for nurse practitioners (NPs). The publicity arose from an article in the Journal of the American Medical Association, "Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians,"' and an article on the Web site http://www.cnn.com, "Study: Nurse Practitioners Equal to Doctors in Some Cases."2 The ramifications from these articles will echo throughout the year as additional NP patient outcome data are released.

Nurse Practitioner 2000

Summit

An incredible spirit of optimism was voiced by the speakers at the American College of Nurse Practitioners' 2000 Summit, held from February 5 to 8 in Washington, D.C. The summit's keynote speaker, Barbara Safriet, JD, associate dean and lecturer at Yale Law School in New Haven, Conn., opened with this statement to the NP audience: "You are the model of what health care providers should be."

Safriet stated that there has been phenomenal progress made by NPs in the 6 years since she last spoke to the ACNP Even while NPs have worked "as if their hair is on fire" in both the legislative and regulatory arenas, this election year gives NPs a smidgen of calm. She said NPs should continue to look for more uniformity in the scopes of practice for each state and should not back away from examining these. The increased flow of information from studies like the AMA study plays to NPs' strengths. NPs should arm themselves with data from this and other studies when they work the state legislatures this year. Outcome information is critical.

Another speaker, Pamela Maraldo, RN, PhD, FAAN, spoke on "NPs and Managed Care: A Holy Alliance," and convincingly stated that NPs are the hope of the nursing profession, clearly poised as professionals on the "leading edge." Dr. Maraldo called for the audience to "believe in the passion of the original NP vision," stating that NPs make an incredible impact on peoples' lives and are learning how to use such information to think more strategically. Maraldo stated that the keys to an even more powerful future include NPs aligning themselves with e-health and consumers as information specialists.

National Nurses' Week 2000

In the continuing effort to project positive exposure for nurses, the American Nurses' Association prepared the following information for National Nurses' Week, which will be held May 6 to 12, 2000. Readers are encouraged to use the following points to discuss nursings' impact. Additional information is on-line at http://www.nursingworld.org.

* Of the 2.6 million registered nurses in the United States, 2.2 million are actively employed.

According to the Bureau of Labor Statistics, the demand for health care professionals is expected to grow 47% by the year 2005, with the greatest demand being for NPs and other advanced practice registered nurses.

* The United States is home to more than 160,000 advanced practice registered nurses (NPs, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse midwifes [CNMs]).

All 50 states and the District of Columbia allow advanced practice nurses some type of prescriptive authority.

* In 1995, almost 217,000 newborns were delivered in hospitals with a CNM in attendance; this is about 5.4% of all hospital births.

This national information can be used to the NP's advantage, but NPs should also gather similar data showing the impact of NPs in their town, county, or state. NPs should remember that "all politics are local."

The Reinvention of Health Care

Jeffrey Bauer and Marc Ringel, authors of Telemedicine and the Reinvention of Healthcare: The Seventh Revolution in Medicine, are friends of all advanced practice nurses. They state that telemedicine empowers consumers by giving them access to information and an informed choice in an increasingly competitive health care market. Telemedicine will ultimately break down geographic and product barriers just as it has already started to liberate the patient-practitioner relationship from traditional constraints of time and place.3

Telemedicine creates the possibility that the patient can be anywhere in the country. The mismatch between today's technology and state practice acts derives from the historical fact that states have always licensed health professionals. Currently, three different and promising solutions exist, in fairly advanced states of development, to deal with this problem:

* The creation of a multistate compact to authorize telenursing across state lines is being pursued by the National Council of State Boards of Nursing. Updates are available at http://www.ncsbn.org. An interstate (or multistate) compact has been adopted by six state legislatures as of January 2000. Bauer and Ringel state that compacts will not immediately create a national solution but are a big step in the right direction.

* A plan to allow interstate telemedicine based on a model state practice act limited to telemedicine is being developed by the Federation of State Medical Boards (http://www fsmb.org).