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The Nurse Practitioner and Primary Care Nurse: Differentiating the Roles in Primary Care

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Katie de Leon-Demare RN (EP), MN, FNP. Rebecca Neto RN, BN ... Preceptorship of NP students. A typical day in the clinic. Collaborative Practice Model ... – PowerPoint PPT presentation

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Title: The Nurse Practitioner and Primary Care Nurse: Differentiating the Roles in Primary Care


1
The Nurse Practitioner and Primary Care Nurse
Differentiating the Roles in Primary Care
  • Katie de Leon-Demare RN (EP), MN, FNP
  • Rebecca Neto RN, BN
  • River Avenue Community Health Centre, WRHA

2
River Avenue Community Health Centre
3
What is a Nurse Practitioner ?
  • RN with advanced education
  • (Master of Nursing - NP Stream)
  • additional licensure RN (EP)
  • Canadian NP Examination
  • American Nurses Credentialing Centre Exam
  • authority to treat, prescribe refer
  • Extended Practice Regulations
  • Shadow Billing using MB Tariff Codes

4
The Nurse Practitioner Diversity of Practice
Settings
  • Primary care
  • Ambulatory care
  • Acute care
  • Neonatal ICU
  • Pediatric ICU
  • Emergency
  • Chronic care
  • Home care
  • Long-term care
  • Personal Care Homes

5
Research on the NP role in Primary Health Care
6
Research on the NP role in Primary Health Care
  • Conclusions
  • 1. Patient outcomes were equivalent. (Brown SA
    Grimes DE Nurs Res 1995 Mundinger et al. JAMA
    2000 Spitzer WO et al. NEJM1974)
  • 2. NPs can provide a major increase in total
    quantity of clinical service, without a reduction
    in quality.at a net cost that is still less than
    that of conventional approaches. ( Spitzer WO et
    al. NEJM 1974290251-256)

7
The Strong Model of Advanced Practice
Direct comprehensive care
Support of systems
Collaboration
Scholarship
Patient
Publication and professional leadership
Education
Empowerment
Research
Novice
Expert
8
A typical day in the clinic
  • Chronic disease diagnosis management
  • Transitional care to long-term care
  • Case management
  • Preceptorship of NP students
  • Periodic health examinations
  • Health promotion health counseling
  • Diagnosis treatment of minor episodic
    illnesses
  • Prenatal care

9
Collaborative Practice Model
  • Primary Care Nurse
  • Nurse Practitioner
  • Physicians
  • Shared Care Counselor
  • Shared Care Psychiatrist
  • Community MH Worker
  • Public Health Nurses
  • Dietitian

10
The Nurse Practitioner in Home Care
  • Goals of Nurse Practitioner in Home Care
  • Improve access to primary care services for home
    bound clients
  • Promote continuity of care between hospital, the
    primary care provider and the home
  • Reduce hospital readmission
  • Provide additional health resource for home care
    staff, clients/families

11
Research Geriatric Nurse Practitioners in Home
Care
  • Outcomes
  • Decreased hospital nursing home admission
  • Decreased outpatient visits
  • Disability and nursing home admission delayed in
    treatment groups
  • Higher caregiver satisfaction
  • Less readmissions (37 control vs 20
    intervention)
  • Hospital stay days (4 days control vs 1.5
    intervention)
  • Zimmer (1985)
  • N 167 homebound, disabled, unable to access
    outpatient clinic
  • Stuck (1995) Alessi (1997)
  • Cho (1998) Bula (1999)
  • Naylor (1999)
  • N 363 adults
  • 30 without social support

12
The Nurse Practitioner in Home Care
  • Improved and timely access to primary care
    services
  • Timely response to acute exacerbation and
    episodic illnesses
  • Continuity of care between acute care and home
    care

13
The Nurse Practitioner in Home Care
  • Timely and appropriate referral to health
    services
  • House calls and on-going primary care for the
    frail elderly
  • Family and patient education and support

14
Collaborative Practice Team in Home Care
  • Nurse Practitioner
  • Physicians/Specialist
  • Case Coordinators
  • Visiting nurses
  • Occupational/ Physiotherapist
  • Clinical Nurse Specialist
  • Nutritionist
  • Primary care nurse

15
Outreach Satellite Wellness Clinic
  • Fred Tipping Place
  • Winnipeg Housing Authority
  • 200 Apartments for 55
  • Wellness Wednesdays

16
Research Publication
  • Utilization of research and evidence in practice
  • Research on NP practice and outcomes
  • Presentations publications

17
Do you need an nurse practitioner in your primary
care team ?
  • What are the needs of the population and
    community served by the clinic? Are there gaps in
    services?
  • Is there a match between these needs and the
    skill set of the NP?
  • Are support systems in place?

18
Tips to successful integration of a nurse
practitioner to your team
  • Informed health team members clients
  • Supportive work environment
  • space, scheduling
  • time for non-clinical aspects of role
  • continuing competency
  • Enabling policies
  • Minimizing liability issues
  • Managing role overlaps

19
What is a Primary Care Nurse?
  • Baccalaureate in Nursing
  • Education/certification in primary care clinical
    areas (diabetes asthma)
  • Community experience

20
Role of the Primary Care Nurse
  • Health promotion education
  • Case management within primary care team
  • Clinical care within scope of practice of nursing
  • Chronic disease management

21
The Primary Care NurseA typical day in the
clinic
  • Telephone triage
  • Management of incoming lab reports
  • Nursing appointments
  • Initial assessment of minor episodic illnesses
  • Nursing procedures
  • Clinic support management
  • Intake appointments
  • Special projects

22
Conclusion
  • Maximize the potential contributions of both
    nursing roles
  • Appropriate use of human resources
  • Improving timely access to care
  • Promote client satisfaction
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