Agents Of Change: How Nurse Practitioners Can Be The Difference

Dawn Pascale

The Role of On-Site Physicians in Today's Healthcare Landscape

The end of open enrollment in 2014 saw 15 million Americans who were previously uninsured obtain coverage thanks to the ACA.  While commendable, these numbers bring another issue to the forefront: a shortage of primary care physicians.

There simply aren’t enough doctors to go around, particularly in rural areas.  This precise concern is what led to grants now provided by the Patient Protection and Affordable Care Act for the development of nurse-managed health centers.  Such centers have been sparse in the past, but the overwhelming numbers of newly insured Americans and increasing lack of physicians demands their presence along with advanced practice nurses who are capable of leading them.

For forward-thinking nurse practitioners who are ready to seize new opportunities provided to them by health care reform, programs designed to prepare them for such leadership roles offer unprecedented opportunity.  The Duke-Johnson & Johnson Nurse Leadership Program is one such option. It affords nurse practitioners or NPs and other advanced practice nurses or APNs the opportunity to expand proficiency from that of “medical technician” to “leader,” as someone who makes a positive and quantifiable impact on the community.

Now in its second year, the one-year certificate program is the only one in the nation selected by Johnson & Johnson for the joint program.  Funded by a grant, it places special emphasis on maximizing opportunities for APNs who practice in community-based clinical settings for underserved populations.

Just like their peers at hospitals or large healthcare systems, these APNs have an opportunity to shape the future of their profession. While continuing their work “at home,” they’re propelled by successful completion of the program, having attended retreats on Duke’s campus and utilized distance-based learning technologies.

Applications recently closed for the next 2015 – 2016 cycle. They originated from 30 states versus 18 for the inaugural round, says program director Anh N. Tran, PhD, MPH at Duke School of Medicine. “Candidates applied from more rural populations and the overall quality of applicants far exceeded our hopes,” she says.

Successful applicants are already leaders and managers within their practices and within their community health systems, she says, and they come to the program at different professional levels and with different needs. For that reason, Tran and colleagues organized the curriculum into four categories: effective leadership, business acumen, financial management and healthcare operations.

ACA Expands Practice Scope

Advanced practice nurses can realize greater opportunities under the Affordable Care Act, especially due to the acknowledged gap in primary care services in more remote, underserved areas. Depending upon legislation—since policies vary from state to state—many APNs may be able to operate their own practices and manage clinics, to see patients independently and to prescribe medical treatment.

“Not all are able to bill independently of a supervising physician, but some have the opportunity to bill independently for services without oversight of the provider,” she says. “Some come into this program already owning and operating their practices. They’re seeking guidance on how to do this better, especially when they may be the only healthcare source in a community for 60 to 100 miles.”

In a video on the program’s website, Carolyn Zaumeyer, MSN, ADNP of Ft. Lauderdale, Fla., says she’s a believer. “When I graduated from my first nurse program, my favorite nursing instructor looked me straight in the eye and said, ‘Be an advocate for change.’ This program is a chance to do change, whether it’s in an independent practice or a larger institution.”

Tran says the application process for the 2016 – 2017 program opens in October, so check the program’s website for current information.