Inserção dos profissionais de enfermagem na política partidária: análise da participação nas disputas eleitorais municipais / Inclusión de los profesionais de enfermería en política partidaria: análisis de su participación en los comicios municipales / Inclusion of nursing professionals in party politics: analysis of their participation in the municipal electoral disputes

Objetivo: analisar a participação dos profissionais do campo da enfermagem nos processos eleitorais para os cargos dos poderes legislativo e executivo municipais. Método: estudo descritivo, retrospectivo, realizado a partir dos dados do Tribunal Superior Eleitoral das últimas cinco eleições para vereadores, prefeitos e vice-prefeitos no Brasil entre 2004 e 2020, considerando sexo, estado, categoria profissional e êxito no pleito eleitoral. Resultados: os profissionais de enfermagem apresentaram aumento de candidaturas em todos os estados. Técnicos e auxiliares em enfermagem foram os que mais se candidataram. Os enfermeiros corresponderam ao maior número de eleitos, no entanto, os profissionais de enfermagem apresentaram as menores taxas de sucesso eleitoral, quando comparados com médicos, odontólogos e farmacêuticos. Conclusão: em relação às outras categorias, os profissionais de enfermagem apresentaram maior quantitativo de candidaturas, embora esse número, diante do contingente de trabalhadores, seja considerado pequeno.

Objetivo: to analyze the participation of professionals from the Nursing field in the electoral processes to hold offices in the Municipal Legislative and Executive powers. Método: a descriptive and retrospective study based on data from the Superior Electoral Court regarding the last five elections for city councilors, mayors and deputy mayors in Brazil between 2004 and 2020, considering gender, state, professional category and success in the election. Resultados: Nursing professionals presented an increase in the number of political candidacies in all the states. Nursing technicians and assistants were the professionals that most put themselves forward. Nurses represented the largest number of elected members; however, Nursing professionals had the lowest electoral success rates when compared to physicians, dentists and pharmacists. Conclusión: in relation to the other categories, Nursing professionals had a higher number of candidacies, although given the number of workers, this number is considered small.

Objective: analizar la participación de los profesionales del campo de la Enfermería en los procesos electorales para cargos de los poderes legislativo y executivo a nivel municipal. Method: estudio descriptivo y retrospectivo realizado a partir de los datos do Tribunal Superior Electoral de las últimas cinco elecciones para concejal, alcalde y vicealcalde en Brasil entre 2004 y 2020, considerando sexo, estado, categoría profesional y éxito en los comicios. Results: los profesionales de Enfermería presentaron un aumento en la cantidad de candidaturas en todos los estados. Los técnicos y auxiliares de Enfermería fueron los que más se postularon. Los enfermeros representaron la cantidad más elevada de candidatos electos; sin embargo, los profesionales de Enfermería presentaron índices de éxito electoral más bajos en comparación con médicos, odontólogos y farmacéuticos. Conclusion: en relación con las otras categorías, los profesionales de Enfermería tuvieron mayor cantidad de candidaturas, aunque dado el contingente de trabajadores, dicha cantidad se considera reducida.

Role and Growth of Independent Medicare-Billing Otolaryngologic Advanced Practice Providers.

OBJECTIVE: To evaluate the role and growth of independently billing otolaryngology (ORL) advanced practice providers (APPs) within a Medicare population. STUDY DESIGN: Retrospective cross-sectional study. SETTING: Medicare Provider Utilization and Payment Data: Physician and Other Supplier Data Files, 2012-2017. METHODS: This retrospective review included data and analysis of independent Medicare-billing ORL APPs. Total sums and medians were gathered for Medicare reimbursements, services performed, number of patients, and unique Current Procedural Terminology (CPT) codes used, along with geographic and sex distributions. RESULTS: There has been near-linear growth in number of ORL APPs (13.7% to 18.4% growth per year), with a 115.4% growth from 2012 to 2017. Similarly, total Medicare-allowed reimbursement (2012: $15,568,850; 2017: $35,548,446.8), total number of services performed (2012: 313,676; 2017: 693,693.7), and total number of Medicare fee-for-service (FFS) patients (2012: 108,667; 2017: 238,506) increased. Medians of per APP number of unique CPT codes used, Medicare-allowed reimbursement, number of services performed, and number of Medicare FFS patients have remained constant. There were consistently more female APPs than male APPs (female APP proportion range: 71.3%-76.7%). Compared to ORL physicians, there was a significantly greater proportion of APPs practicing in a rural setting as opposed to urban settings (2017: APP proportion 13.6% vs ORL proportion 8.4%; P < .001). CONCLUSION: Although their scope of practice has remained constant, independently billing ORL APPs are rapidly increasing in number, which has led to increased Medicare reimbursements, services, and patients. ORL APPs tend to be female and are used more heavily in regions with fewer ORL physicians.

An immersive clinical experience to create sustainable clinical learning opportunities for nurse practitioner students.

ABSTRACT: A significant increase in nurse practitioner program enrollment has resulted in a critical need for committed preceptors willing to offer clinical learning opportunities for students. Academic practice partnerships have been proposed as a strategy to address the preceptorship crisis. This project evaluated the impact of a longitudinal immersive clinical experience designed for nurse practitioner students in collaboration with two federally qualified health centers and an underserved clinic within an academic health center. The study used a pre- and postsurvey method to determine the impact of an immersive clinical experience on preceptor perceptions of benefits and rewards, support, and commitment to the role. A statistically significant increase in preceptor perception of support was noted in three areas. Participants reported increased opportunity to share information with other preceptors, improved support from nursing faculty to help identify students' performance problems, and greater clarity in faculty responsibilities related to the preceptor role. Increases in perceptions of benefits and rewards and commitment to the preceptor role did not reach statistical significance. Immersive clinical experiences have the potential to improve the levels of preceptor support, commitment, and perceived opportunities for benefits and rewards, which may facilitate the development of high-quality, sustainable clinical learning opportunities for nurse practitioner students.

Role of Nurse Practitioners in Caring for Patients With Complex Health Needs.

OBJECTIVE: The objective of this study was to estimate trends in the percentage of Medicare beneficiaries cared for by nurse practitioners from 2012 to 2017, to characterize beneficiaries cared for by nurse practitioners in 2017, and to examine how the percentage of beneficiaries cared for by nurse practitioners varies by practice characteristics. DESIGN: An observational study of 2012-2017 Medicare fee-for-service beneficiaries' ambulatory visits. We computed the percentage of beneficiaries with 1 or more ambulatory visits from nurse practitioners and the percentage of beneficiaries receiving the plurality of their ambulatory visits from a nurse practitioner versus a physician (ie, predominant provider). We compared beneficiary demographics, clinical characteristics, and utilization by the predominant provider. We then characterized the predominant provider by practice characteristics. KEY RESULTS: In 2017, 28.9% of beneficiaries received any care from a nurse practitioner and 8.0% utilized nurse practitioners as their predominant provider-an increase from 4.4% in 2012. Among beneficiaries cared for by nurse practitioners in 2017, 25.9% had 3 or more chronic conditions compared with 20.8% of those cared for by physicians. Beneficiaries cared for in practices owned by health systems were more likely to have a nurse practitioner as their predominant provider compared with those attending practices that were independently owned (9.3% vs. 7.0%). CONCLUSIONS: Nurse practitioners are caring for Medicare beneficiaries with complex needs at rates that match or exceed their physician colleagues. The growing role of nurse practitioners, especially in health care systems, warrants attention as organizations embark on payment and delivery reform.

Nurse practitioners and barriers to diabetic foot treatment.

BACKGROUND: Even with full practice authority, nurse practitioners (NPs) face limitations in care and treatment options. An example of this is current federal law prohibiting NPs from ordering diabetic shoes. PURPOSE: This study reviewed the background of this problem, potential impacts on patient health and NP practice, and viable solutions for consideration. METHODS: This was a descriptive study of NPs in a northwestern state with full practice authority. An anonymous online survey was used. There were 54 total NP respondents. RESULTS: The potential negative patient outcomes associated with restricted NP ability to prescribe diabetic footwear were supported through the literature review and the survey, including increased foot complications and acuity, translating to increased costs. Of the NPs queried, 80% felt inability to prescribe diabetic footwear was limiting to their practice, and 92% felt this affected patient outcomes. Federal legislative changes with support of bipartisan bills allowing NPs to prescribe diabetic footwear could facilitate timeliness and access to care while reducing costs. IMPLICATIONS FOR PRACTICE: Legislation affecting NP scope of practice is an important issue with implications related to patient outcomes. Nurse practitioners should continue to support legislation at the federal level to pass bills allowing for NPs to certify orders for diabetic shoes.

Nurse practitioners leading the way: An exploratory study on the added value of nurse practitioners in outpatient care in the Netherlands.

BACKGROUND: Many Dutch nurse practitioners (NPs) work together with physicians and specialized nurses (SNs) in outpatient clinics, although the latter have questioned the added value of NPs in the outpatient clinic. Clarification of the distinction between and the added value of both nursing professions in relation to each other could lead to optimal use of the unique competencies of each type of nurse. PURPOSE: To explore NPs' perspectives on their added value in relation to SNs in the outpatient clinic. METHODOLOGICAL ORIENTATION: Data were analyzed by Braun and Clarke's thematic analysis. The CanMEDS competences were used to identify the NPs' comments about their practice. SAMPLE: Twelve semi-structured interviews were conducted with NPs from two hospital settings. CONCLUSIONS: The added value of NPs was most evident in: nursing leadership, integrating care and cure and performing an expert level of nursing expertise, and competencies in science. To optimize their roles, NPs and SNs need to make all team members aware of their unique competences and promote role clarification. IMPLICATIONS FOR PRACTICE: This study provides barriers in barriers that influence optimal positioning of NPs within the interdisciplinary team, stresses the importance of discussion on the optimal skill mix within the interdisciplinary team, and describes the NPs' leadership role because this is the encompassing link between the main competencies of their practice. Addressing and overcoming these findings could improve the NPs' positioning and effective collaboration within (the outpatient clinic's) interprofessional teams.

Improving influenza immunization rates in the uninsured.

BACKGROUND AND PURPOSE: Infection from influenza virus causes tens of thousands of deaths annually in the United States, costing millions to manage hospital complications. Barriers exist for patients to choose the influenza vaccine, which is proven to effectively reduce incidence of infection and complications from influenza virus. A significant percent of uninsured patients are at high risk of these complications because of chronic illness. This article examines the literature for evidence of effective interventions to increase influenza uptake rate in the uninsured adult population. METHODS: Literature review of data sources including the Cumulative Index to Nursing and Allied Health Literature, PubMed, Scopus, and the Cochrane Database of Systematic Reviews. CONCLUSIONS: Effective interventions include free vaccines, mass communication efforts, implementing an influenza questionnaire, training health care workers, using a vaccine facilitator, implementing a standing orders policy and opt-out policy, scheduling year-round appointments, clinicians recommending the vaccine, clinician audit and feedback, tracking in an electronic medical record, and narrative communication techniques. IMPLICATIONS FOR PRACTICE: To reduce influenza-related costs, and improve health outcomes, it is imperative that nurse practitioners use evidence-based interventions in the practice setting to increase influenza uptake rates in the adult uninsured population.

Health care system changes supporting the development of the nurse practitioner role in Tanzania.

BACKGROUND AND PURPOSE: Accessibility to health care services remains a global challenge, and this has affected the quality of services delivered. This has affected the quality of health care services. Poor accessibility to health care services in Tanzania has hindered the achievements of health care system goals. The development of the nurse practitioner (NP) role has not yet received enough attention to resolve current existing and emerging problems facing the Tanzanian health care system. This study assessed the health care system changes that support the development of the NP role in Tanzania. METHODS: A descriptive, cross-sectional study design was used to collect quantitative data. Purposive and convenience sampling techniques were used to collect data from 237 health care providers using a semi-structured questionnaire. Data were entered into SPSS version 20 and analyzed using descriptive statistics and Chi-square test for independence (Pearson Chi-square, χ). CONCLUSIONS: Although the government of Tanzania has made some improvements in access to health care services, the rural health care facilities still suffer from an extreme shortage of skilled health care providers. This has forced the government to allow medical attendants to treat patients when they are not licensed to do so. The development of the NP role should be able to address the shortage of skilled health care providers in rural health care facilities. IMPLICATIONS FOR PRACTICE: The development of the NP role will improve the accessibility to health care services in rural primary health care facilities.

Rethinking the cost of care: Nurse practitioners as stewards of clinical and patient resources.

Clinicians are the building blocks of value-based care, yet the cumulative human and financial cost of daily care decisions are mostly hidden from them. As essential primary care providers, nurse practitioners play a role in driving efficiency and resourcefulness in care. The growth and expanded capabilities of the specialty give nurse practitioners a powerful voice in setting standards for clinical stewardship. Yet to be successful in this effort, nurse practitioners must have a better understanding of cost containment and cost reduction to make better decisions. This means synthesizing cost and risk data, efficacy, and patient advocacy to propagate value-based decision making and standardized quality care across our organizations. Clinicians need to understand that caring about patients means being good stewards while caring for patients.

Does State-Level Nurse Practitioner Scope-of-Practice Policy Affect Access to Care?

There is heated debate surrounding policy reform granting full state-level nurse practitioner (NP) scope of practice (SOP) in all U.S. states. NP SOP policy is argued to impact access to care; however, a synthesis of empirical studies assessing this relationship has yet to be performed. Our study fills this critical gap by systematically reviewing studies that examine this relationship. We apply Aday and Andersen's Access Framework to operationalize access to care. We also use this framework to map components of access to care that may relate to NP SOP through concepts identified in this review. Our findings suggest that full state-level NP SOP policy is associated with increases in various components of access to care, but additional work is needed to evaluate causality and underlying mechanisms behind this policy's effect on access. This work is necessary to align research, practice, and policy efforts surrounding NP SOP with healthcare accessibility.

Systematic review addressing nurse practitioner reimbursement policy: Part one of a four-part series on critical topics identified by the 2015 nurse practitioner research agenda.

BACKGROUND AND PURPOSE: The growth and sustainability of nurse practitioners (NPs) requires transparent, fair and equitable reimbursement policies. Complicating this issue is variation in reimbursement policy within and across federal, state, and other payers. Even with explicit regulations, there remain questions on how reimbursement policies are covertly operationalized in practice. This systematic review aims to identify knowledge gaps related to reimbursement policy issues and outlines recommendations for further research. METHODS: Eight major databases were searched using terms including "nurse practitioner," "reimbursement," "policy," and "research," limited to the United States and inclusive of December 2006-September 2017. Articles meeting the inclusion criteria were analyzed for themes and gaps. CONCLUSION: The final review includes 17 articles identifying themes including state-determined Medicaid reimbursement and scope of practice legislation shapes NP clinical practice; NPs as identified primary care providers: credentialing and contracting; reimbursement parity; and "incident to" billing. Moreover, there is evidence of discriminatory policies that disadvantage NPs and limit their access to patients, direct billing, and direct reimbursement. IMPLICATIONS FOR PRACTICE: Future research needs to focus on outcomes of discriminatory, as well as supportive, reimbursement policies in organizations, and their influence on patient access and quality care.

California Nurse Practitioners Are Positioned To Fill The Primary Care Gap, But They Face Barriers To Practice.

Nurse practitioners are well prepared to help fill care gaps arising from shortages of primary care physicians in California. This article reports findings from a survey of California nurse practitioners that examined their employment and practice barriers. The number of nurse practitioners per capita varies across California counties and is positively correlated with the number of physicians per capita. Hispanic and Filipino nurse practitioners are more likely to live in underserved areas. Nurse practitioners and their education programs are concentrated in the same counties that have high physician-to-population ratios. In these counties, recently graduated nurse practitioners are more likely to report that they plan to relocate to another state in the next five years. Expanding education programs in underserved areas, increasing the diversity of the nurse practitioner workforce, and ensuring that nurse practitioners feel empowered to fully use their skills are necessary to meet both current and future primary care needs.

Nurse practitioners' time on nonbillable activities.

BACKGROUND AND PURPOSE: During the provision of patient care delivery, all providers, including nurse practitioners (NPs), spend some time in activities that are not reimbursable. Understanding these nonbillable activities is crucial to the economic viability and success of existing and projected practice models. This study explored and compared seven nonbillable activities occurring in the practices of NPs in various settings. METHODS: Using a nonexperimental, descriptive design, 509 NPs were surveyed about nonbillable activities encountered in daily practice. Binomial regression analyses and incidence rate ratios were used to interpret relationships between each variable and nonbillable time. CONCLUSIONS: Although not every variable had significance, there were significant differences found in the amount of time spent in certain nonbillable activities depending on workplace setting, number of support staff, and primary care provider role. IMPLICATIONS FOR PRACTICE: The uncertainty of health care reform, including reimbursement, provider shortage, and the expanding roles of NPs, requires a closer look at both billable and nonbillable care activities. Understanding how nonbillable time affects work efficiency, costs, and the value of NPs will allow NPs to influence future health care reimbursement policies and delivery care models.

Nurse practitioners' recommendations for pharmacotherapy in the management of adolescent concussion.

BACKGROUND AND PURPOSE: Nurse practitioners (NPs) frequently treat acute conditions presenting in children and adolescents in the outpatient setting. No evidence-based guidance exists pertaining to the treatment of concussion with medications. The purpose of this study was to examine recommendations by NPs for pharmacotherapy of acute symptoms for adolescent concussion. METHODS: This is a secondary analysis of data from a web-based census survey of all licensed NPs in Oregon and Washington State, where they practice as independent providers with prescriptive authority. Based on a standardized adolescent patient scenario video, NPs were asked to indicate prescription or nonprescription medication recommendations for concussion symptoms. Open-ended descriptions of medication recommendations were coded, summarized, and described. CONCLUSIONS: In narrative text, 78.4% of the 991 respondents recommended at least one type of prescription or nonprescription medication. Prescription medications (recommended by 17.2%) included antiemetics and antimigraine medications; nonprescription medications (recommended by 75.5%) included nonsteroidal anti-inflammatory drugs, over-the-counter pain relievers, and herbal medications. Pharmacotherapy recommendations varied by NP practice setting and rurality. IMPLICATIONS FOR PRACTICE: Nurse practitioners have full prescriptive authority in many states. No guidelines inform medication use in managing acute concussion symptoms, yet many providers recommend their use.

Trends and Scope of Dermatology Procedures Billed by Advanced Practice Professionals From 2012 Through 2015.

Importance: Advanced practice professionals (APPs) such as nurse practitioners and physician assistants independently perform a large number and variety of dermatologic procedures, but little is known about how the number and scope of these procedures have changed over time. Objective: To examine the trends in scope and volume of dermatology procedures billed by APPs over time. Design, Setting, and Participants: A longitudinal study was conducted using the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File from 2012 through 2015. The data encompass nearly all outpatient procedures paid by Medicare Part B in the United States and include the type of clinician under which procedures were billed. Main Outcomes and Measures: For each type of dermatology procedure, the total number performed by APPs and the total number performed by dermatologists each year. Results: The total number (and percentage) of all dermatologic procedures performed by APPs increased from 2.69 million of 30.7 million (8.8%) in 2012 to 4.54 million of 33.9 million (13.4%) in 2015. The most common procedures performed by APPs in 2015 were destructions of benign neoplasms (3.6 million), biopsies (788 834), and destructions of malignant neoplasms (48 982). The numbers of patch tests, removals of benign and malignant neoplasms, intermediate and complex repairs, flaps, and surgical pathologic specimen examinations by APPs also increased each year from 2012 through 2015. Conclusions and Relevance: The number and scope of dermatologic procedures performed by APPs appear to be increasing over time. These procedures can be difficult and invasive. This study suggests that further studies are needed to determine what association these procedures have with patient outcomes and the potential need for more formal training.