Chat Transcript: Nursing Opportunities with Physician Practices

What is the future of bedside nursing under health care reform if,  as experts predict, fewer hospital beds will be utilized?

What kind of nursing opportunities will exist within the expanded primary care system? And are these new roles — as case managers, wellness coaches, and patient navigators — right for you?

On July 12th, American Sentinel University and sponsored a live chat, to discuss nursing opportunities within physician practices. Here’s a transcript this lively Q&A. Today, I am proud to welcome Dr. Catherine Garner with American Sentinel University as my co-host for this chat. I am also excited to welcome Alice Masciarelli, who is a medical practice administrator and DNP student at American Sentinel, as a second co-host. She can give us real time/real life insight into this topic. Alice, I think it’s wonderful that you are currently enrolled in American Sentinel’s DNP program, and I think your current role in a medical practice will give us more insight about the opportunities available.

Dr. Garner: Thank you for this opportunity, Jenny. Alice is becoming our resident expert on accountable care organizations and how nursing is the core of success. Alice, tell them more about your background.

Alice: I have been a family practice office administrator for the last 15 years. In the past, I have also worked as a care coordinator in an outpatient clinic setting. It has been very rewarding to see patients improve their health over the years. member comment: I’m actually a nursing student and I’m hoping to gain as much insight as possible prior to starting my career.

Alice: You’re entering the health care industry at an exciting yet uncertain time with respect to where health care will be delivered. It seems that the onus will be on health in the community: doctors’ offices, community health settings, home health care. member comment: I agree that health care will be changing. I just hope it is for the better. Our senior citizens and future customers deserve that! I have been a nurse for 31 years, and this is the biggest push I have seen to change things in health care.

Dr. Garner: And we need nurses to speak up and take the lead in new models of care.

Alice: As nurses, we now have the opportunity to push for more recognition and to promote our roles and skills with the help of the IOM Future of Nursing Report.

Alice: There is room for new innovative roles both within the hospital setting as well as in the community. The new models of care delivery proposed by the ACA call for care coordination and care integration. Who is better equipped to do this than we nurses?

Dr. Garner: Alice, do you find it difficult working with a medical team? What skills do you use?

Alice: I currently work in a community health clinic with the under-served. There is such a big need for health education. It is challenging to work with different cultures and their perception of health and health care.

Dr. Garner: One of the roles that I loved best was working as a nurse at the community clinic in a low-income area of Tucson. It was a real eye opener to the needs of the underserved and to be on my own in a challenging area of education. Have others had experiences like this? member comment: I worked for 10 years at an underserved area clinic that also served the developmentally disabled community. It was fascinating. I worked as the nursing supervisor and the Assistant Director.

Dr. Garner: It is such a great opportunity to work in community health and out-patient clinics.  There are also many freestanding surgical centers, oncology centers, and women’s health groups that operate outside hospitals. They all need nurses.

Alice: The most essential skill is communication and a clear vision of what nursing can contribute to a patient’s health. Physicians always complain about how demanding patients are but do not realize that it’s often because their needs are not met.

Dr. Garner: I agree. They are not really trained to listen to the whole patient!

Alice: In addition, there are many non-profit groups that are trying to impact community health. Nurses can play a big role.

Dr. Garner: I have also found a great place to get experience teaching patients is through volunteering with the American Heart Association, the Lung Association, or any of the groups in the community. They often need nurses to run support groups. member comment: I think taking a front line role in the “medical home” is a great place for nursing to be involved. Physicians, of course, do not want them run by RN’s or NP’s.

Alice: Nurses in a physician or outpatient setting can play a big role in getting patients to feel understood and to have patients understand their health plan. The problems we have with high costs are due a lot to the fact that patients do not know what to do to take care of themselves. member comment: I disagree that patients don’t know how to take care of themselves, but they tend to dictate what their care should be and fail to follow through with the basic care.

Alice: What I meant is that they are overwhelmed by the complexity of the health care system and do not always understand their health care needs. member comment: I work with pediatric cancer patients. I’m wondering if any jobs are available out there for outpatient services.

Dr. Garner: Check with the oncologist and see how you might fit into their practice as a coordinator, educator, and navigator for families.

Alice: As a nurse, your value will be in having families understand the care needs of their child, appeasing their concerns, and responding to questions so that physicians’ time is more free.

Dr. Garner: I got my first job as an infertility nurse by asking the doctors to consider what I might do for their practice. They invited me to develop a job description, which I did and ended up two years later coordinating an in vitro fertilization program. These are exciting times in the nursing profession. I see a huge movement developing.

Dr. Garner: Many hospitals and health plans are now hiring “nurse navigators” for families with extensive health needs. member comment: Dr. Garner, what type of advanced degree would be appropriate for these nurse navigators?

Dr. Garner: A nurse navigator should ideally have a BSN or preferably an MSN. We have an MSN in Case Management that prepares nurses for this role.

Alice: I would hope that the nurse navigators had skills in care management, great communication skills, and family intervention skills.

Dr. Garner: Health plans, insurance companies, and disease management companies are all looking for care coordinators – with the increasing elderly and disabled population, this is the degree of the future.

Alice: Nurses are invaluable in health care and in helping reduce health care costs.

Dr. Garner: Nurse navigators seem to be popping up in oncology where families literally need  help navigating the system through labs, chemo, radiation, rehab, diet, etc. The other area where I see it is as private contractors to families with elders to help them navigate through the myriad of issues and choices.

Alice: Even in hospitals, nurses can play a bigger role in patient education. As nurses, we need to pressure the hospital administrators to understand that the role of nurse case manager needs to involve more time for patient and family education so that there is more time to evaluate the patient’s needs once he or she goes home and manage the care episode better. member comment: With nursing being the largest health care profession, it is often frustrating that we are not heard. It is important to move ahead into the DNP role, but I also think we need more nurses involved in the health care policy role. Dr. G, in the example you just mentioned about in vitro, were you just a BSN grad at that point or did you already have your MSN?

Dr. Garner: Yes, I was just a BSN grad and that job helped pay for me to get my MSN. member comment: I have worked in the case management field. It is very rewarding, but dealing with the insurance companies is difficult.

Dr. Garner: We work as a partner with Kindred Health, which has 222 long-term acute and rehab hospitals that have some 300 openings for nurse care managers! They have scholarships for service. I apologize if this question sounds elementary, but for medical practices, are you saying that nurses should follow the path towards case management? Or would that be NP’s?

Dr. Garner: It depends on what you want your role to be. If you want to be a direct care provider, the NP role is great. If you choose to instead navigate patients and their families through the system, the case management role is good. member comment: I see nurse navigators for the geriatric population helping manage care and appointments.

Alice: As Dr. Garner points out, with the aging population, another skill is knowledge of gerontology. Care for the elderly does have some unique attributes because the elderly do not react to illness like the younger population does. Population health of the aging segment is also going to be important. I hope that nurse navigators will be more than “navigators,” but health facilitators.

Dr. Garner: There was a new article this week in the nurse practitioner monthly newsletter about nurses training to be “wellness coaches.” There were also lots of businesses hiring nurses to hold on-site wellness screenings and do disease management and education. Check with employers in your area about opportunities. member comment: I love the name “wellness coaches!” member comment: We are hoping to open a “wellness center” at the college I work for. The nursing students seem to have the highest stress levels of all our students. Well, let me ask another question. What happens to bedside nursing? At hospitals? What does the future hold?

Alice: Health economists predict that there will be fewer hospitals and hospital beds. member comment: Wow! That is really amazing. Big changes are coming!

Dr. Garner: Hospitals will always need nurses, but the push in the community for Medical Homes, Accountable Care, and Primary Care Centers will see a rising demand in this area. Initially, this change might seem like cause for concern. However, if you really delve into it, this gives nurses more power and opportunities to really be nurses and patient advocates!

Dr. Garner: I always tell students to take out the yellow book and look up community agencies and spend time learning about them and the opportunities for nurses in unique roles.

To be continued — watch for part two of this chat transcript!