Monday, September 12, 2011

National day of remembrance

Like so many Americans, it is hard for me to believe it has been 10 years since the day that so changed all our lives.

Every U.S. generation has “that moment”—the one that forever defines for members of that generation where they were when “it” happened. For some, it is the beginning or end of a war, for others the day President Kennedy was shot. For younger generations, it seems there are several moments: The day President Reagan was shot and the two times we lost a space shuttle certainly qualify, but the biggest one was the attacks of 9-11.

Where were you on September 11, 2001? What is your story? How has your life changed?

For me, I was sitting in my favorite chair, nursing my now 10-year-old and enjoying a rare solo visit from my father. My mom was in North Carolina, awaiting the arrival of my sister’s third child. We were living in Las Vegas and had turned on the TV to check the weather for our planned outing to Mt. Charleston, for a day of hiking and a picnic. At first, as the weather report filled most of the screen, a list of airport closings and shutdowns scrolled across the bottom. It didn’t make sense. When we changed channels and saw pictures of what was happening in New York, Washington, D.C. and Pennsylvania, the situation came into focus—at least as much as anything could come into focus that day. It took awhile for the shock and reality to sink in.

We called Mom and then pressed on with our plans to spend the day on Mt. Charleston. There was nothing we could do, and our need to escape and try to be as normal as possible was strong. But as we hiked, we were a little on edge, wondering if anything else was happening or what surprises awaited us when we returned to town and the constant media coverage.

Has life changed? Sure, especially when it comes to travel and security. As a military member, I have deployed in support of the global war on terror. My kids now live with the knowledge that our borders are not as safe and secure as we believed them to be when we were young. But our lives have also changed in positive ways. There seems to be more support of those who spend their days protecting America: policemen, firemen, soldiers, sailors and airmen. Ordinary citizens seem to better grasp the service-before-self concept that these people display every day they’re on duty. The stories of public servants entering the doomed twin towers, or the daily scenes played out at airports all over the country as military members deploy or return in support of the mission, remind Americans everywhere of those who serve.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. 

Tuesday, September 6, 2011

“The physician will ...”

People who know me well will not be surprised that I was recently pretty fired up by some otherwise benign statements. I tend to be a little sensitive when it comes to physician-centric verbiage. I have a healthy respect for my MD counterparts, and it frustrates me to be sidelined or to feel our role as NPs is not being supported. (I also tend to shudder at the terms “mid-level” or “physician extender.”)

So what set off my tirade a few days ago? I read the Accreditation Association for Ambulatory Health Care (AAAHC) standards for Patient Center Medical Home (PMCH). Have you read them? If you work in a PMCH or Family Health Initiative (FHI) clinic, you should. You might be surprised at what we NPs no longer need to do as, apparently, “the physician will” do everything!

A little background is needed, I suppose. All U.S. Air Force (USAF) facilities, as well as most other armed-services facilities, are in the process of changing their clinical operating model from one where the goal is to see your Primary Care Manager (PCM) to one where you are able to see only your PCM or his or her team partner (a team typically made up of an MD and a “mid-level” NP or PA). Under the new system, providers were rumored to have more control over their schedules, creative templating was encouraged and we were no longer restricted to the traditional, clinic-wide template of 20 or 30-minute appointments. A minimum number of per-week appointments was established, and we were given the flexibility needed to ensure that each of our populations was taken care of. We were allowed to do this as uniquely as we chose.

All USAF facilities are inspected by the AAAHC, and careers can be made or ended by inspection results. As an additional duty—yes, as in “in addition to doing all the patient-related care”—I review the inspection criteria and, through a series of self-inspections, make recommendations to the senior management team regarding our adherence to the standards on which we will be inspected.

So, on a rare day when no patients were scheduled—we were waiting for a planned base “incident” to happen, so we could prove our ability to care for a mass influx of “patients”—I took the opportunity to review the new PCMH standards from AAAHC. I was shocked to see how prejudiced the verbiage was and how it completely sidelined the role that NPs (and PAs, for that matter) play in today’s health care arena. The standards were completely based in physician-centric terms and gave the impression that physicians are the only deliverers of health care.

Get with the times, AAAHC! In some states, we can practice independently, hanging out a shingle and seeing patients without the oversight of a physician. If we seek accreditation in that instance, will we fail because there is no physician guiding the patient-care decisions?

It frustrates me that this national organization, one from which facilities seek accreditation, can be so close-minded about what is needed for health care to survive. Do we as NPs recognize the training and schooling that our MD counterparts must endure to practice? Yes! And we know our role in health care. and that most of us do not need a physician to direct that role. We are counterparts, members of a team, who work together to provide the services our patients need most. Does a team need a leader? Yes, sometimes it does, but in health care, that leader is often the most experienced member, not just the one with the MD behind his or her name.

I don’t know that this physician-centric rhetoric will ever change. A friend of mine (gasp–an MD even!) thinks that, as the “silverbacks” who currently head up these types of organizations move on and a generation that has trained alongside NPs comes to “power,” things will be different. I hope so. Only time will tell.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.