One of the interesting stories to watch in the coming months in the states is the fight over “scope of practice.” That means: who gets to do what, and under whose supervision. It basically pits doctors against other health care providers – nurses, nurse practitioners, physician assistants, etc. They are sometimes called “extenders” or “non-physician providers.” (There are also big fights within dentistry.)
These fights would heat up even without the Affordable Care Act – you’ve all heard about the shortage (in some communities at least) of primary care physicians. And you know there is an aging population that is going to need access to primary care. Throw in the health care law – millions of newly insured people entering the system, as well as delivery system reforms and care innovations that encourage more primary care, care coordination and team-based medicine that invites a larger role from those “extenders.” (Can you tell I don’t like that word?)
But state law – some state laws – may limit what these health care workers can do or require so much supervision by a physician that it is tantamount to a limit. The nurses and physician assistants use the phrase “practice to the top of their license” to mean they want to be able to do everything they are trained and licensed to do. There also are questions about how insurance plans address these different kinds of providers, and what options/explanations/information patients are given about who they are going to see at any particular juncture in their care.
In my next Covering Health post, I will share two recent stories I liked a lot about the changing role of nursing (which isn’t the only scope-of-practice fight but it’s the one you hear most about). First I want to provide some resources and thoughts on how to cover this topic more broadly.
Keep in mind that there are national trends but it’s a state-based legal problem. Continue reading
Building off a state health department report showing that, as The Morning Call‘s Tim Darragh wrote, “Nurses at St. Luke’s Hospital three times in 2010 and 2011 improperly programmed patient-controlled pumps to deliver pain medication, causing patients to overdose themselves,” Darragh dug deep into each incident, uncovering patient details and adding perspective to the errors, which were severe enough that the feds decided the hospital’s patients were in “immediate jeopardy” until steps were taken.
In each of those cases and in three others, the nursing staff failed to document the errors properly, state investigators found.
Employees told the investigators that St. Luke’s did not require annual competency training on the pumps. Unnamed employees offered conflicting statements about when and whether all the staff had received retraining in 2010.
For their part, hospital officials say they have bought new patient-controlled pumps, developed a restricted dosage plan and retrained staff.
“When St. Luke’s nursing staff members identified the dosing pump programming issues, the events were promptly reported to all the appropriate individuals and regulatory agencies as outlined in our Network Patient Safety Plan,” said Carol Kuplen, chief nursing officer for St. Luke’s Hospital & Health Network.
“There was complete transparency in these events,” she said in an interview Thursday.
Jeffrey Shuren, director of the FDA’s Center for Devices and Radiological Health, appeared at a newsmaker briefing at Health Journalism 2010 to announce an FDA initiative to reduce risks associated with infusion pumps. Log in to the AHCJ website to see his presentation and listen to his announcement.
Patient navigators – “like the air traffic controllers in health care” – captured the attention of Pamela Fayerman of the Vancouver Sun.
Fayerman explains that patient navigators are specially trained health care providers who help patients get access to care and services they need, serve as liaisons between patients and doctors and generally ensure patients don’t fall through the cracks of a complex health care system.
Fayerman’s five-day, multiplatform series on patient navigators was published last week and is a comprehensive look at this relatively new practice being applied to Canadian patients. She explores the roots of patient navigation in Harlem and goes on to document the evolution in Canada over the past decade.
In a story about one patient, Fayerman shows how the role of a navigator in getting efficient treatment, follow up and having a point of contact got the patient into the hospital for triple bypass surgery before she had a heart attack and sustained damage to her heart.
Other stories look at how navigators bring a culturally sensitive approach to treating members of the aboriginal community, as well as the unwillingness of Canadians to pay out of pocket for navigators, but:
In the U.S., where people are used to paying for health care, navigators are becoming more and more common – in both insured and non-insured settings and at for-profit and non-profit hospitals.
Fayerman, who used a $20,000 grant from the Canadian Institutes of Health Research, visited five provinces and 12 cities over eight months, interviewing nurse and other navigators, their patients and health system leaders. She explains why the series is important and how patients can be their own navigators.
“Anatomy of Writing for Publication for Nurses,” written by AHCJ member Cynthia Saver, R.N., M.S., has been published by Sigma Theta Tau International. Saver is the president of CLS Development Inc., an editorial consulting firm.
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For those of you who have followed the ongoing investigation ProPublica’s Charles Ornstein and Tracy Weber have done into nurses and whether states are reporting disciplinary actions, you might have a chance to localize the story.
ProPublica has posted a guide, “Reporting Recipe: How You Can Investigate Your State’s Oversight of Its Nurses and Other Licensed Professionals,” to help reporters and the public check up on what’s happening in their states.
ProPublica editor-in-chief Paul Steiger and managing editor Stephen Engelberg, explain why they are providing the reporters’ techniques and insights:
We hope that others will use the techniques created by Ornstein and Weber to hold local officials accountable. Reporters who look into the local boards that oversee nurses or other health professionals will make new discoveries, some of which will undoubtedly go beyond what we have found. That, in turn, will help others push the story ahead. We hope statehouse reporters, beat reporters, general assignment reporters, bloggers, citizen journalists and others will use this road map.
Use the state-by-state guide prepared by Ornstein (also president of AHCJ’s board of directors) and Weber that shows what information is available to the public in each state and specific things to look for in the records.
They have used the data to identify some states that appear to be inconsistent in reporting disciplinary actions against medical professionals. If you are covering any of these states, you should probably be looking into the story yourself:
- New Jersey
- West Virginia