NEWS

Health reform has advanced practice nurses in spotlight

Holly Fletcher
hfletcher@tennessean.com
Nurse practitioner Jayme Gibson checks out patient James Harrison after he returned from surgery at Vanderbilt Medical Center in May.

There's less nodding and more questions from people sitting in hospitals and doctors' offices as consumerism takes root in health care.

Often the people answering the questions, at least in many clinical settings ranging from hospitals to retail clinics, are advanced practice nurses — which can be nurse anesthetists, nurse practitioners, nurse midwives and clinical nurse specialists.

Patients "are asking a lot more questions about their care and why. I think they are much more savvy and have more questions than in the past," said April Kapu, associate nursing officer, advanced practice for Vanderbilt University Medical Center.

"It's no secret that our health care is the most costly in the world and why is that: We need more cost-effective quality care. I think the average consumer is more cognizant that these are important issues."

Foot soldiers of reform

Advanced practice nurses talk to and treat patients. They help translate medical-speak to patients and families in hospitals. They, and the nurses on the floor, are the front line of pain management. The quality of nursing and how effectively it's coordinated are at the heart of several questions on quality surveys patients take after a hospital stay.

Advanced practice nurses are trained, and expected, to be important members of care teams and hospital units, but also they are the foot soldiers of reform that is sweeping health care.

They have been leaders in clinical settings for many years, said Chris Hulin, dean of Middle Tennessee School of Anesthesia in Madison, but their roles are coming to light as health reform prioritizes cost effective care.

"We have to be creative" about how to meet the goals, Hulin said. "The (Affordable Care Act) has really pushed that forward. It's not new but people are starting to care and see the cost effectiveness of advanced practice nurses."

In the about 10 years that Kapu has been a nurse practitioner, the job has evolved.

The number of nurse practitioners at Vanderbilt has shot up in the last decade. There were about 100 in 2003-04; now there are just under 750, Kapu said.

"I would say the two biggest changes is that advanced practice nurses are more aware of their outcomes. In the past I was coming to work, taking care of patients, going home and thinking about what was fulfilling: did I talk to the family, get my to-do list done," said Kapu. "More and more nurse practitioners are thinking about the bigger picture and their impact on the bigger picture."

Degree a path to leadership

More nurses are going back to school to be advanced practice nurses. There are currently about 10,000 such nurses in the state.

The nurse practitioner program is Tennessee State University's most popular nursing specialty, said Kathy Martin, executive director and associate dean of nursing at TSU.

Some hospitals are encouraging nurses to go back to school to get bachelor's or advanced degrees to meet higher levels of accreditation requirements, said Kim Estep, chancellor at Western Governors University in Tennessee, noting that some offer tuition reimbursement programs.

Other nurses see an advanced practice degree as a path to leadership on a hospital floor, in a management team or in a corporate setting.

As emphasis is placed on consumer choice as well as efficiency, nurses — who traditionally log many hours of patient face time — can make a difference.

Mindy Mullins, a doctor of nurse anesthesia practice graduate from MTSA in December, rethought how forearm blood pressure is monitored, particularly on obese patients before and after surgery in a hospital in Mississippi. Mullins reviewed medical studies and how devices fit — devices designed for upper arm measurements often do not fit around forearms properly — and made a recommendation about an instrument designed for forearm measurements.

"Nurses are, in general, more highly educated than ever before. They are increasingly analyzing medical research and applying it," said Estep. "It's more than just basic day-to-day care. More front-line care is moving from the hands of physicians into advanced practice nurses."

Reach Holly Fletcher at 615-259-8287 and on Twitter @hollyfletcher.

Nurse practitioner Lauren Oliver looks at an X-ray of patient Fred Birch at Vanderbilt Medical Center.