recruitment and medical practice utilization of advanced practitioners terri fowler, dnp, aprn, np-c...

Recruitment and Medical Practice Utilization of Advanced Practitioners

Terri Fowler, DNP, APRN, NP-CPaul F. Jacques, DHSc, PA-C

Interprofessional Practice

• Institute for Healthcare Improvement (IHI) Triple Aim– Improve patient experience– Improve health of populations– Reduce per capita cost

• Affordable Care Act– Expand number of primary care providers– New models of delivering care– Payment models

Patient-Centered Medical Home

• Agency for Healthcare Research and Quality (AHRQ)

• Five functions of a PCMH:– Comprehensive Care– Patient-centered– Coordinated Care– Accessible Services– Quality and Safety

What NP/PA bring to the medical team

• Quality care• Access• Safety• Patient Satisfaction• Care Coordination• Quality Improvement

NP Education

• Nurse Practitioner – Graduate degree (Masters or Doctoral)– Various programs/certifications– Length of program: Approx. 1.5 – 3 years– Clinical hours vary by program: Approx. 800-

1200 hours– National Certification (AANP, ANCC)

PA Education

• Physician Assistant– Graduate degree (Masters – over 100 credits)– Focus on general medicine– Length of program: 27 months – Clinical hours: Approx. 2000 hours– National Certification (NCCPA)

License, scope of practice, state laws

• Physician Assistant– Varies by state– Board of Medical Examiners – PA Practice Act– Assess, diagnose, treat, prescribe– Prescriptive authority (including Controlled Substance

II-V)– Supervising physician – Reimbursement

License, scope of practice, state laws

• Nurse Practitioner– Varies by state– Board of Nursing – Nurse Practice Act– Assess, diagnose, treat, prescribe– Prescriptive authority (including Controlled Substance

III-V)– Supervising physician – Reimbursement

Postgraduate education (Fellowships)

• Carolina Healthcare - Medical Critical Care, Surgical Critical Care, Hospitalist, Cardiology, Urology, Urgent Care, Pediatric Urgent Care, Internal Medicine, Family Medicine, Pediatrics

• Association of Postgraduate PA Program (APPAP) www.appap.org

• Nurse Practitioner Residency Programs (http://www.graduatenursingedu.org/nurse-practitioner-residency-programs)

Expectations:

• Contract; benefits packages• Integrate into team as provider • Job descriptions (clear on needs and

expectations)

Posting new jobs (how to reach out to NP/PA population)

• National – AAPA, AANP, ANCC• List serve – npcentral.net, PAjobsite.com• Journals – JAANP, ADVANCE, JAAPA• State – SC Academy of PA (SCAPA), SC

Nurses Association (SCNA) – APRN Chapter• Conferences (State and local chapters)

Posting new jobs

• Local (regional representatives of state chapter)

• MUSC College of Health Professions• MUSC College of Nursing

Retention (part of team)

• Involvement in shared governance• Discussion of innovations/changes impacting

the delivery of services• Seek best practices• Maximize the utilization of provider to the

extent of their expertise, experience and license• Support and engage in professional

development