February, March, April 2012

Nevada RNformation Page 13

Future of Nursing
Nurses Should Practice to the Full Extent of Their Education and Training
Regulatory Barriers
Debra Scott, RN, MSN,
When taken on its face, it seems that there would be no argument against implementation of the first key message of the IOMs Future of Nursing Initiative, that nurses should practice to the full extent of their education and training. In truth, barriers do exist which limit nurses scope of practice, impair transition from education to practice, decrease mobility, and undermine the financial rewards of professional practice. The IOM Report speaks to all levels of nursing, from advanced practice registered nurses, to licensed professional nurses, to licensed practical nurses. Endogenous and exogenous barriers serve to limit the potential for nurses to be instrumental in leading innovative strategies to improve state, national, and international health care systems. First, we as nurses limit our own potential as leaders in health care. Our education prepares us to identify a problem, in other words to make a nursing diagnosis, and then fix it. As long as the nursing profession sees itself as primarily in acute care settings, we limit our role in what healthcare is becomingfocused on delivery of healthcare in the community rather than in hospitals. Nursing attitudes must broaden to include utilization of community resources and collaboration among the health care team of providers that manage an individuals overall health care plan. We are seeing truly future minded nurses making strides in health care wellness and prevention, defining nursings role in health maintenance rather than limiting our role to disease or symptom management. We need to their outdated policies to allow reimbursement for services offered by the appropriate provider. Interdisciplinary challenges to scope of practice, without an examination of the rigor of education nor the evaluation of competency, pose barriers to nurses professional practice. The complexity of healthcare delivery environments have created a gap between education and practice which has resulted in barriers to professional development of the nursing workforce. Transition to practice opportunities provide a setting where new nurses can acquire the knowledge and skill to practice to the full extent of their education. Integration of experiential learning provides new nurses with the courage and skill to be instrumental in moving our profession forward. Finally, and most importantly, we, as nurses, must be at the forefront of moving our profession toward overcoming the barriers to our practicing to the full extent of our education and training. Lets use this groundbreaking report to do what we know must be done to transform the role of nursing to provide greater access and higher quality health care to the citizens we serve.
References Institute of Medicine, The Future of Nursing, Leading Change, Advancing Health, Washington, D.C.; The National Academies Press; 2011. Spector, N. & Echternacht, M. (2010).A regulatory model for transitioning newly licensed nurses to practice. Journal of Nursing Regulation, 1(2), p18-25.

reconceptualize nursings role by identifying health access gaps and bridging those gaps with what nurses have always been able to offera focus on patient centered health care. Barriers must be identified, defined, analyzed, and removed. Regulation may limit scope of practice for nurses. The diversity among states in regulating advanced practice registered nurses (APRNs) impedes mobility and leads to confusion in scope of practice. Issues arise from the diversity in the level of supervision/collaboration that is required for APRN practice. In addition, the authority to prescribe dangerous drugs, and to a greater degree, controlled substances varies among statesanother barrier to consistent standards of practice. Reimbursement discrepancies may render an APRN unable to receive financial compensation for healthcare services which are comparable to services offered by other compensated providers. Insurance companies must assess and revise

Nursing Leadership & Innovation in Nevada

The Nevada Tobacco Users Helpline
Elizabeth Fildes, EdD, RN, CNE, CARN-AP
As one of the Centers for Disease Control and Prevention (CDC) Best Practices for Comprehensive Tobacco Control Programs, telephone-based tobacco cessation counseling has been identified in research as an effective and evidence-based approach to tobacco cessation. Founded by a nurse in 1997, the Nevada Tobacco Users Helpline (Helpline) has been the State of Nevadas free tobacco quitline that provides comprehensive, statewide nicotine dependence treatment for all forms of tobacco (smoked and smokeless), and education available to all Nevada residents 18 years and older. The program is medically driven, research & evidence-based, follows CDCs Best Practices guidelines, follows Agency for Healthcare Research and Quality Guidelines (AHRQ), uses FDA approved medications in the Helpline Medication Assistance Program (MAP) and hires professional counselors for treatment delivery. Although quitline services vary across states, the Helpline offers a longer, more intensive proactive counseling protocol than any other state quitline, with many users receiving proactive counseling sessions for a year or more before discharge. Program evaluation results based on over 40,000 clients served, support meta-analytic reviews that have established that telephone counseling is an effective intervention for tobacco use cessation.

Nevada NPs Make a Difference in the High-risk Senior Citizen Population

With offices in Northwest and Southeast Las Vegas (LV), Caremore Nurse Practitioners (NPs) are part of an innovative system that began in the late 90s and expanded to LV, in early 2010, from Southern California. Caremores program uses an innovative collaborative model where the local NPs at the Caremore Care Center clinic work with seniors who have the diagnoses of HTN, COPD, CHF, Tobacco Dependency, DM, CKD, Fall Risk, and Anticoagulation needs. Currently staffed with two full time NPs, a part-time NP, and a locum tenum NP, the Medicare Advantage patients go to the clinic sometimes multiple times in a week. This innovative prevention model actually decreases cost by reducing patient hospitalizations. A day in the life of a Caremore NP includes seeing a patient whose warfarin level is not in balance and prescribing dosages to stabilize the patients drug levels. The NP will see a new patient for an hour long appointment to welcome them into the program. Managing phone calls for patients whose home monitors link to the telephone and alert the NP if the patients blood pressure is increasing, or the congestive heart failure (CHF) patients weight on the Caremore provided scale has changed more than 3 pounds overnight is another NP responsibility. The NP may then see a COPD patient and make adjustments to their home medications based on the GOLD standard. Later in the day, the NP may help a patient stop smoking
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February, March, April 2012

Nevada NPs Make a Difference

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Professional Nursing Practice

Palliative Care Nursing
Leslie Hunter-Johnson, MSN, RN-BC, CCRN, CNRN, CHPN Palliative Care Coordinator, Sunrise Hospital and Medical Center
Palliative care nursing is a new specialty that is directed at identifying and treating pain and other symptoms for patients in acute care settings who are experiencing life-threatening and/or chronic illnesses. The goal is to improve the quality of life while concurrently providing curative treatment. There have been misconceptions that palliative care equates to an anticipated death. The results of a public opinion survey conducted by the Center to Advance Palliative Care (CAPC), confirmed that physicians equated palliative care with hospice care and were reluctant to order referrals to those facilities offering palliative care services. On September 1, 2011, The Joint Commission released certification standards on Advanced Certification for Palliative Care. This information should help promote consumer awareness of the availability of palliative care in acute care settings. The services are provided by specially trained teams that include physicians, nurses, and other team members that work together toward the patients goals. Along with treatment of pain and symptom management, the patient is treated as a whole and not a defined disease process. This process has a positive impact on the patient and family and promotes stress reduction in an otherwise stressful situation. As a palliative care nurse, I am very passionate about the patients and families to whom I provide care. The members of the team take the time to listen to those involved without constraints of limited time. We look at the patient and their symptoms as a whole forest, and not just a single tree. Recently, Nevada was upgraded from a D to a B on the provision of palliative care services due to the continuing efforts of palliative care providers. For more information on palliative care or to view the Public Opinion Survey on Palliative Care, visit the Center to Advance Palliative Care website at www.capc.org

with Caremores tobacco cessation program. Then the NP will manage risk factors for patients with chronic kidney disease. An important part of the NPs job is to manage patients with diabetes, including assisting the patient with a glucose monitor that can be downloaded during clinic visits, and free lancets and monitoring strips, plus teaching how to use both long and short acting insulins and providing wound care. In addition to all the care provided by the NPs the Caremore senior can go to the clinic to visit with the extensivist, a physician director that also visits the patient in the hospital, and sees the patient in the clinic after the hospitalization. There are also visits at the clinic with a pulmonologist, a podiatrist, and a psychiatrist, plus multiple disease focused nutrition classes led by a dietician, all centrally scheduled on the Caremore electronic health record (EHR). To add to the value, the clinic includes a senior friendly gym called Nifty after 50 that guides the patients in how to lose weight and increase strength and balance to help prevent falls; they can also see a physical therapist at the gym. The social aspects of the gym also help seniors who may have slight depression due to isolation or pain. An RN Case Manager, medical assistants, and a Licensed Clinical Social Worker round out the staff in the clinics. Caremore also employs two additional NPs in its Touch program. NPs go out to assisted living facilities to help patients, providing quality healthcare with the convenience of not having to leave home. A few not so common perks the seniors receive are toenail trimming offered in the clinic and drivers to assist them with getting to appointments or picking up prescriptions. To learn more about Caremore please see their website at: http://www.caremore.com Model described by Diane McGinnis, DNP, APNFNP, NP-C, the AANP NV State Representative 2010-2012. To contact Diane, please email: mcginnisFNP@gmail.com

Research Highlights
Wallace J. Henkelman, Ed.D, MSN, RN Assistant Professor, Touro University Nevada

New Treatment for Head Lice

Head lice are a persistent problem, particularly in persons living in crowded situations such as classrooms. Traditional, nonpharmacological treatments such as applying petroleum jelly and combing are very time-consuming and tedious. Unfortunately, lice have also been developing resistance to commonly used pharmacological agents such as Nix (permethrin) making treatment more difficult. The FDA recently approved a new treatment for head lice, spinosad (Natroba Topical Suspension) for use on children age four and older. It is more expensive, but clinical trials have shown it to more effective than Nix (86% vs. 44% louse-free after 14 days). It has been shown to be effective after just one treatment without the combing for nits. The nits appear to be unable to hatch after the treatment.
References Binns, C. (2011). No more nit-picking? New FDA approved treatment promises easier way to defeat lice. TODAY Health@ TODAY.com. U.S. Department of Health and Human Services. (2011). FDA approves head lice treatment for children and adults. Retrieved from http://www.fda.gov/NewsEvents/ Newsroom?PressAnnouncements/ucm240302.htm

Olive Oil and Stroke Risk

A recent study conducted in three cities in France (Samieri et al., 2011) compared persons of ages 65 and older with no history of stroke looking at, among other things, dietary habits. Two specific items studied were self-reported intake of olive oil and plasma oleic acid levels (an indirect indicator of olive oil intake). There were 7,625 individuals in the first group and 1,245 in the second. After adjustment for demographic, other dietary variables, body mass index, and other risk factors for stroke, it was found that intensive users of olive oil had a 41% lower incidence of stroke than those who did not use olive oil. Intensive use was defined as using olive oil for both cooking and dressings. The participants with high oleic acid levels were 73% less likely to have strokes than those with lower oleic acid levels. Oleic acid can, however, be increased by dietary factors other than olive oil consumption. Perhaps in discussing diet with our clients, we need to suggest the use of olive oil, particularly in clients with risk factors for stroke.
Reference: Samieri, C., Feart, C., Proust-Lima, C., Peuchant, E., Tzourio, C., Stapf, C., Barberger-Gateau, P. (2011). Olive oil consumption, plasma oleic acid, and stroke incidence. Neurology 77(5), 418-425. doi: 10.1212/ WNL.0b013e318220abeb

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