Psychiatric nurse practitioners have the opportunity to work in a variety of subspecialties including the addiction, forensics, geriatrics and pediatrics. One of the lesser known but incredibly exciting fields is psychosomatic medicine.
Psychosomatic medicine, also called consultation-liaison psychiatry, focuses on the interface between physical and mental illness. The word psychosomatic arises from the Greek terms psyche (soul) and soma (body). Practitioners of psychosomatic medicine are known as “med-psych detectives,” and they are charged with investigating some of the most complex patient cases. I remember learning about this specialty in nurse practitioner school and thinking, “You had me at “detective!” Ever heard of the TV show House? Well, it’s sort of like that, but with less Hollywood and more paperwork. I originally wrote this article for Health eCareers. Read the article on their blog, and check out the latest nurse practitioner jobs and salary information on their website. Usually, large hospital systems employ a handful of psychosomatic specialists who are consulted across different medical units to solve bewildering patient presentations. Anytime a clinician encounters an uncertain diagnosis, peculiar symptom or confounding psychiatric disorder, they call upon a psychosomatic nurse practitioner to investigate. I had the incredible opportunity to work on a team of psychosomatic specialists including physicians, physician assistants and other nurse practitioners. It was the experience of a lifetime, and I would recommend it to every psychiatric nurse practitioner. I worked Monday through Saturday from 8:00 am to 5:00 pm at a massive healthcare system with over 1,000 acute care beds and level I trauma center. Each day I saw three to five patients. Patient cases usually fell into one of the following categories:
I’d spend hours scrutinizing a case. I’d conduct comprehensive chart reviews, in-depth interviews and search recent scientific research for the latest case studies or treatment options. I communicated regularly with secondary sources such as police officers, case managers and family members. Sometimes a mere Google or Bing search would unveil extra information about the case in question. My patients were sometimes the center of news stories requiring moments of dodging the nosy journalists. Each patient encounter resulted in lengthy reports that summarized my analysis and recommendations. In an average week, I’d find myself anywhere from the emergency room, burn unit, ICU, PICU, NICU and SICU to the labor and delivery and dialysis unit. The week was never complete without complex delirium, postpartum depression, alcohol withdrawal or a suicide attempt. I made difficult decisions every day; I conducted suicide risk assessments and capacity evaluations. I was often faced with answering these questions:
As a psychosomatic medicine nurse practitioner, I saw a 47-year-old man who attempted suicide with a firearm to the head and a 6-year-old girl who attempted suicide by hanging herself from her bunk bed. I treated murderers and arsonists handcuffed to the hospital bed. I’ll never forget the man with a factitious disorder who was injecting himself with feces in order to gain compassion from medical providers. I originally wrote this article for Health eCareers. Read the article on their blog, and check out the latest nurse practitioner jobs and salary information on their website. I facilitated moments where a new mother’s child was taken away due to her methamphetamine addiction, and I supported moms who had stillborn children. I saw patients with psychogenic amnesia, Wernicke's encephalopathy, factitious disorder by proxy and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. I saw patients and treated conditions I’ll never forget. I was, undoubtedly, confronted with the most emotionally exhausting and traumatic moments of my life. I witnessed some of the darkest moments in people’s lives, but I know I came out a stronger, smarter, better NP. Working in psychosomatic medicine was the most exciting and challenging clinical position I ever held. Every day my team took on the toughest patients in the entire system. Learn more about psychosomatic medicine by reading some of my favorite books: You Might Also Enjoy
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In the United States, healthcare costs are growing at an unsustainable rate. In 1970, we spent $75 billion on healthcare. In 2010, we spent $2.6 trillion. By 2021, spending will reach $4.8 trillion, which is one-fifth of the U.S. economy.
This is a problem, to say the least. This issue is multi-faceted, encompassing rising hospital costs, medical technology, fraud and waste, an aging population, and unhealthy lifestyles. One particularly interesting facet is the direct impact that healthcare providers have on this problem. Healthcare providers in the United States charge patients significantly higher prices than providers in Europe. In fact, a 2011 study conducted by the National Institute for Healthcare Management found that the second greatest contributor to rising costs was the increase in physician costs. These costs accounted for 18 percent of the total growth in healthcare expenditure. I originally wrote this article for Health eCareers. Read the article on their blog, and check out the latest nurse practitioner jobs and salary information on their website. An Obvious Solution Nurse practitioners offer a cost-saving solution for this growing problem. Nurse practitioners are healthcare providers who assess, diagnose, and treat medical conditions. They prescribe medication, order and interpret diagnostic tests, and perform medical procedures. Their philosophy of care is holistic and emphasizes disease prevention and health promotion. Nurse practitioners specialize and subspecialize in various areas of medicine including family practice, acute care, pediatrics, geriatrics, psychiatry, and women’s health. They can be found working all across the healthcare system, from clinics to hospitals, to homeless shelters, to prisons. Importantly, these innovative clinicians save their employers and the country lots of money. Compensation Savings Compared with physicians, nurse practitioners cost less from the beginning, because they are paid less. Studies have found that nurse practitioners are paid one-third to one-half the rate of a physician while providing the same services to patients. For example, in 2010, the median total compensation for primary care physicians ranged from $208,658 to $219,500. Likewise, at that time, primary care nurse practitioners earned $97,345. This drastic difference in compensation has remained unchanged for 30 years. Better Patient Outcomes Lower Costs Another method to save the healthcare system money is to improve cost-related outcomes such as length of stay, emergency visits and hospitalizations. A 2011 systematic review of 37 studies found that nurse practitioners provided care equivalent to physicians in all these measures. Using this information, the Perryman Group analyzed the potential economic impact of using more nurse practitioners to provide medical care. Their study estimated a $16.1 billion in immediate savings, which would continue to increase over time. I originally wrote this article for Health eCareers. Read the article on their blog, and check out the latest nurse practitioner jobs and salary information on their website. Savings Across Practice Settings In their report titled Nurse Practitioner Cost-Effectiveness, the American Association of Nurse Practitioners describes the impact of nurse practitioners on managed care organizations. For example, nurse practitioners in Tennessee's managed care organization provided care at 23 percent lower costs than physicians, resulting in a 21 percent reduction in hospitalization rates. Nurse practitioner care results in lower costs in acute care settings as well. A 2009 study published in Nursing Economics found that nurse practitioner provided care was associated with lower overall drug costs for patients. Furthermore, a 2006 study compared nurse practitioner and physician management of hypercholesterolemia following revascularization. This study demonstrated that patients who were treated by nurse practitioners had lower drug costs and were more likely to achieve their goals and comply with their prescribed regimen. To learn more about the cost-effectiveness of nurse practitioner care, check out these resources:
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Let me guess. You’re a nurse practitioner (NP) with years of experience and a master’s degree. You’ve heard the hype about this new degree, the Doctor of Nursing Practice (DNP), but you already provide excellent patient care, so why do you need more education? Research even backs you up; for decades, master's-prepared NPs have provided high-quality, safe, and effective care, as demonstrated by a systematic review published in Nursing Economics.
So, after all these years, should you get a DNP? What about new registered nurses (RNs) who want to become an NP? Should they be required to earn a DNP rather than the traditional master’s degree? The purpose of this article is to offer you enough information to answer these questions for yourself. I originally wrote this article for The Barton Blog, which is full of other amazing content too! Check out their interesting articles on nurse practitioners, and puruse their job openings while you're at it! Is the DNP a Valuable Degree? When NPs ask me this question, I usually smile and respond, “Depends on how you define value.” Is value money, knowledge, impact, esteem, or something else? For starters, let me quickly answer some common questions before diving deeper into the history and purpose of the DNP.
Where Did the DNP Come From? In 2001, the Institute of Medicine (IOM) published its groundbreaking report, Crossing the Quality Chasm. Here, the IOM famously identified the immense gap between the healthcare we have and the healthcare we could have. To close this chasm, the IOM recommended changing the way we educate healthcare providers. Much to everyone's surprise, the IOM did not suggest more clinical or residency hours; instead, they implored physicians and nurse practitioners alike to focus on translational research, teamwork, and technology. Without delay, the nursing discipline took action and responded to the call by creating the DNP. They designed this new degree to align directly with the IOM’s education reform, and the American Association of College of Nursing (AACN) developed The Essentials of Doctoral Education for Advanced Nursing Practice. To emphasize their dedication to the IOM’s recommendations, the AACN designated the DNP as the terminal degree for nurse practitioners. Today, there are more than 125 accredited DNP programs across the United States, and they are available in 48 states plus the District of Columbia. I originally wrote this article for The Barton Blog, which is full of other amazing content too! Check out their interesting articles on nurse practitioners, and puruse their job openings while you're at it! Is the DNP Required for Nurse Practitioners? In principle, the answer is yes; however, state boards do not yet require NPs to receive their DNP in order to be licensed. In its Position Statement on the Practice Doctorate in Nursing, the AACN voted to move the level of preparation for nurse practitioners from an MSN to a DNP beginning in 2015. Some nurse leaders disagree with this requirement, though, so the DNP remains optional. RAND Health investigated the institutional, political, and professional issues related to requiring the DNP degree. Its findings were published in a detailed report titled The DNP by 2015. Through this research, RAND Health decided that the AACN needed to conduct outcomes studies on the effects of DNP patient care before making the degree a requirement. What’s the Difference Between a DNP and a PhD? Both a PhD and a DNP are rigorous, challenging doctoral degrees. A PhD is considered a research doctorate, which focuses on generating new knowledge. Nurse practitioners in PhD programs usually conduct original research and pursue a variety of programs including nursing, economics, epidemiology, ethics, health policy, and human-computer interaction. These graduates usually work in academia, research, administration, or industry. A DNP, on the other hand, is a practice doctorate, which focuses on translating research into practice. A physician, for example, has a professional doctorate in medicine or osteopathy (MD or DO). These graduates usually work in clinical practice or administration. I originally wrote this article for The Barton Blog, which is full of other amazing content too! Check out their interesting articles on nurse practitioners, and puruse their job openings while you're at it! What Do DNPs Learn That NPs Don’t Already Know? As the IOM noted, modern medicine has progressed to a level of sophistication that no one person could ever comprehend or master. Over the past 100 years, clinicians have become specialized and then subspecialized just to compensate for the sheer magnitude of scientific knowledge. Today, the amount of medical knowledge that a healthcare provider must know doubles every three years. In 2020, it will double every 73 days. Efforts have been made to more efficiently move research from dark labs and ivory towers into hospitals and clinics, but it still takes 17 years for the latest research to be implemented into clinical practice. Did you catch that? Seventeen years! This is why the IOM emphasized research, teamwork, and technology. Memorization and additional clinical hours don’t change outcomes; understanding where to find the right information, how to work together, and when to implement technology do. Doctors of Nursing Practice undergo extra education in these three areas. They study healthcare from a systems perspective. They graduate with a comprehensive understanding of this system, from policy and ethics to finances and informatics. They learn how to improve not just one patient’s life, but the lives of entire populations. These doctors are truly primed to be tomorrow's change agents and leaders in healthcare. Do DNPs Conduct Research? All DNP programs require the completion of a final research project that demonstrates clinical scholarship. This DNP project can take many forms, and students work on it throughout their entire program. The project must focus on a change that affects healthcare outcomes for a particular patient population. Specific guidelines for appropriate projects can be found in the AACN’s report, The Doctor of Nursing Practice: Current Issues and Clarifying Recommendations. Examples of previous students projects can be found on the National DNP Organization website. Where Can I Learn More? Consider reading the AANP’s DNP discussion paper. Dreher and Glasgow offer a fiercely honest and interesting text on the DNP titled Role Development for Doctoral Advanced Nursing Practice. Dr. Lisa Chism also offers a unique perspective on the DNP in her book, The Doctor of Nursing Practice: A Guidebook for Role Development and Professional Issues. I originally wrote this article for The Barton Blog, which is full of other amazing content too! Check out their interesting articles on nurse practitioners, and puruse their job openings while you're at it! You might also enjoy:
Patients, friends, academics, politicians, and everyone in between deserve to know the answer to an infamous question: do nurse practitioners provide care equal to that of physicians. There seems to be more than enough misinformation out there to lead to generations of confusion. The purpose of the article is to give you the right research to settle the debate once and for all.
What is a physician? The title physician encompasses a variety of disciplines, but for this article, we will only include doctors of medicine (MD) and doctors of osteopathy (DO). These are the people you typically think of when you “go to the doctor.” They are expert clinicians educated to assess, diagnose and treat medical conditions. They can prescribe medication, refer you to physical therapy, and determine your disability status. They typically earn a bachelor's degree in a general science prior to attending medical school. During medical school, they undergo extensive education in pathophysiology, microbiology, epidemiology, and pharmacology while completing patient simulations and rigorous clinical rotations. These physicians specialize and subspecialize in a variety of fields from pediatrics to psychiatry to gerontology. After medical school, physicians usually complete a paid residency in their area of specialty. I originally wrote this article for Health eCareers. Read the article on their blog, and check out the latest nurse practitioner jobs and salary information on their website. What is a nurse practitioner? Nurse practitioners are expert clinicians who are educated to assess, diagnose, and treat medical conditions. They can prescribe medication, refer you to physical therapy, and determine your disability status. Their philosophy of care is holistic and emphasizes disease prevention and health promotion. Nurse practitioners typically earn a bachelor’s degree in nursing prior to attending nurse practitioner school. During nurse practitioner school, they undergo extensive education in pathophysiology, microbiology, epidemiology, and pharmacology while completing patient simulations and rigorous clinical rotations. Nurse practitioners specialize and subspecialize in a variety of fields from pediatrics to psychiatry to gerontology. After nurse practitioner school, they sometimes complete a paid residency in their area of specialty; however, this is not a requirement. What do you mean by “equal care?” Equal care means that regardless of who provides the care, the patient received the same diagnosis and treatment, experiences the same or similar health outcomes, and feels satisfied with the care provided. With the emergence of the nurse practitioner role, physicians felt the pressure of market competition. They raised concerns about safety, effectiveness, and patient satisfaction. And rightfully so. Patients have the right to the best care at all time. These questions arose:
To address these very important questions, researchers began comparing the care provided by physicians with the care provided by nurse practitioners. They compared the health outcomes of the patients seen by physicians with the health outcomes of the patients seen by nurse practitioners. The question they sought to answer: do nurse practitioners provide patient care equal to that of physicians? I originally wrote this article for Health eCareers. Read the article on their blog, and check out the latest nurse practitioner jobs and salary information on their website. What does the research say? Research examining nurse practitioner effectiveness began in 1986 when the United States Office of Technology Assessment compared the practice patterns of nurse practitioners with physicians. This study concluded that nurse practitioners performed as well as physicians in all areas of primary care delivery and patient outcomes. Since this groundbreaking research, study after study has reached similar conclusions. A 2011 systematic review of all nurse practitioner effectiveness research found that nurse practitioners provide effective, high-quality care with outcomes similar or superior to physicians. This quantitative study synthesized the findings of all research conducted on this topic for 18 years. The authors of the study included both nurse practitioners and physicians. Furthermore, additional research has demonstrated that nurse practitioners actually lower healthcare costs, increase patient satisfaction, and offer a solution to the current and ever-worsening shortage of qualified primary care providers. For a complete annotated bibliography of all research comparing the care provided by physicians with the care provided by nurse practitioners please see the American Association of Nurse Practitioners’ paper titled Quality of Nurse Practitioner Practice. Who supports nurse practitioners? The Institute of Medicine and the Robert Wood Johnson Foundation are long-time supporters of nurse practitioners. They advocate that nurse practitioners provide patient care equal to the care provided by their physician colleagues. In their 2010 report, The Future of Nursing, Leading Change, Advancing Health, the Institute of Medicine asserted that states across the country should remove legal barriers, often imposed by physicians, that nurse practitioners from practicing to the full extent of their education. Shortly thereafter, the Robert Wood Johnson Foundation founded the Campaign for Action, which advocates for nurse practitioner independent practice in the United States. More recently, the United States Federal Trade Commission (FTC) published their perspective on the nurse practitioner and physician debate. In their paper titled Competition and the Regulation of Advanced Practice Nurses, the FTC stated that when physicians attempt to control nurse practitioner’s ability to practice, they are actually impeding quality competition, raising healthcare prices for patients, and diminishing access to care. Why does confusion persist? I’ve met my fair share of registered nurses who disavow the research and insist that physicians provide better patient care than nurse practitioners. If nurses remain confused, I can only imagine how confusing the topic must be to patients and the public. I think some of the confusion arises from how few people understand who nurse practitioners are and what they do. Many patients “go to the doctor” never realizing that a nurse practitioner assessed their symptoms, diagnosed their condition, and prescribed their treatment. Often, patients assume this person in a white lab coat is a physician. Even other clinicians do not understand nurse practitioners. Physical therapists who often need a “doctor’s referral” to provide treatment to their patients commonly do not understand that this referral is actually coming from a nurse practitioner. For all the nurse practitioners reading this article, you must ensure your patients and your colleagues know who you are; otherwise, how will they tell the world how awesome you are? The good news is, the confusion is dissipating. Nurse practitioners are showing up on the news, TV shows, and movies. It’s becoming a highly sought after career. Legislation is passing across the country that enables nurse practitioners to practice freely. Progress is being made, slowly but surely. I originally wrote this article for Health eCareers. Read the article on their blog, and check out the latest nurse practitioner jobs and salary information on their website. You might also enjoy: |
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