This is part two of our Q&A transcript. (Part one can be seen here.) On July 12th, American Sentinel University and NurseTogether.com sponsored a live chat, to discuss nursing opportunities within physician practices. Here’s a transcript this lively Q&A, which explored emerging roles for nurses within an expanded primary care system, as fewer hospital beds are utilized.
NT.com member comment: Another opportunity for nurses in medical practices is a research nurse or research coordinator. Usually the individual works for a research company but works in the medical practice with the MD’s nurses.
Dr. Garner: What are you looking for in clinical trials nurses? What education do they need?
NT.com member comment: They would need a good basis of clinical knowledge and/or research knowledge. I believe American Sentinel is working on a Certificate Program in Clinical Trials. Am I correct?
Dr. Garner: Yes, we will be offering a post-bachelor’s certificate program for nurses interested in working with clinical trials. We built it with help from the professional staff at Hospital Corporation of America’s Sarah Cannon Research Center.
Dr. Garner: Since hospitals are being penalized for avoidable re-admissions, there is plenty of room for Infection Prevention and Control Nurses, Quality Assurance Managers, and Nurse Informaticists who can track patient care trends.
NT.com member comment: There is a lot of opportunity right there! It is amazing where nursing is going right now!
NT.com member comment: If you haven’t read the American Nurses Association’s letter to the Centers for Medicare and Medicaid regarding accountable care organizations, you might want to check it out: http://www.nursingworld.org/ACOcomments
Dr. Garner: Lots of patients have no primary care providers due to insurance issues. Medical Homes are Medicare/Medicaid supported practices that become the primary care provider or medical home. Yes, more nurse practitioners are forming their own practices and getting certified by Medicare as medical homes as more doctors push back at taking Medicare and Medicaid patients.
Alice: There are many great opportunities and lots of new areas to explore and refine our skills.
Dr. Garner: Many schools of nursing are also running nurse managed health centers for the underserved.
Dr. Garner: American Sentinel is pleased to offer our 10-class online RN to BSN and our online RN to MSN with five specialties: Case Management, Informatics, Infection Prevention and Control, Management and Organizational Leadership, and Education.
NT.com member comment: I am starting in the Nursing Informatics Program at American Sentinel in September!
Alice: EHRs offer many opportunities for improving care, tracking, and identifying patterns and supporting critical thinking, but they need to set up properly. Nurse input is needed.
Dr. Garner: My pharmacist colleague always says, “Why do nurses need to justify why they should be at the table – they are the table!”
NT.com member comment: That is a great comment. We need to realize our full potential!
Dr. Garner: I taught nursing at a school in the Caribbean, and our nursing students ran the blood drive, AIDS screening, and did a women’s health project in the factories. It was fabulous!
Alice: ACA stresses having the patient at the center of care. The patient needs to have a nurse along his or her side.
Dr. Garner: School nursing is another opportunity for work in the community.
Alice: School nursing is important, but again, budget cuts in our state have reduced the number of nurses in schools. I mentioned to a friend of mine that school nurse roles need to be expanded to take care of the school employees as well as the children.
NT.com member comment: School nurses now have so much responsibility. They can be responsible for so many schools with health aids on-site.
NT.com member comment: Perhaps even have a clinic in the school district! That would be excellent!
Dr. Garner: Get entrepreneurial – get some foundation funds locally and provide nurse managed care! Offer to teach a health class at the public library during children’s reading sessions or at an after school program.
Dr. Garner: Home health agencies, managed care organizations, pharmaceutical sales, and informatics companies – all require the BSN for entry and many strongly prefer the MSN. If you expect to leave the bedside at some point in your career, you will need this credential.
NT.com member comment: Dr. Garner, this might be a difficult question to answer, but what kinds of students do you have in your Case Management MSN Program?
Dr. Garner: We have students from all backgrounds: CC, Med-Surg, OB, and Peds. – people who know nursing but need to learn the fundaments of case management.
NT.com member comment: To build on the previous question, what type of students do you have in leadership and the education tracks? Do you know what type of positions (other than obvious ones) those degrees can accomplish?
Dr. Garner: Any nurse can benefit from advanced education – learning to use evidence to change practice and learning to lead through change and conflict are skills that can be used anywhere.
NT.com member comment: It seems to be that since all the future roles are going to be management roles either in informatics, case management, or NP, we get away from the bedside. Will we have to utilize the volunteerism to continue bedside nursing?
Dr. Garner: No. We need smarter, more experienced, educated nurses at the bedside!
NT.com member comment: Regarding bedside nurses, I think there is a need for all of us. It just wasn’t for me, and when the opportunity to do otherwise arose, I grabbed it. Communicating with MD’s, patients, families, payers, and Medicare is just what I love to do.
Alice: Nurses at the bedside need to be independent, critical thinkers who will provide safe care and be on alert when patients’ needs change, all the while supporting the patient and family.
NT.com member comment: I have experience as a case manager since the inception of PPS and now education is my focus in acute care. I have certification as a case manager and as an Administrator of Case Management. I thought this was an MSN program and might focus on leadership, program development, finance, etc.
Alice: As a student in the executive leadership program, I can tell you that we all have diverse backgrounds. The skills we learn can be used in any setting from independent business to clinic management and hospital management.
Dr. Garner: The Clinical Nurse Leader is a relatively new role that recognizes the value of bedside nursing.
Alice: Time management and priority setting are important skills for the bedside nurse.
Dr. Garner: There are just so many opportunities for each of us to pursue our own interests and loves.
NT.com member comment: Dr. G, do you find advanced education tends to lead to the making of “bean counters” from good nurses attempting to take the human factor out of patient care?
Dr. Garner: It depends upon the organizational setting and the expectations of the role. That said, a good nurse manager is there as an advocate for quality patient care and stewardship of resources – all of which lead to satisfaction and good economics.
NT.com member comment: I don’t have an MSN, but I am a seasoned case manager/RN. My hope was to be able to teach case management since health care reform is going to increase the need for nurses with strong clinical skills who can take it to this step.
Dr. Garner: Take our MSN, Nursing Education and go forth! I am really looking for good CM educators for our MSN program, but you need that MSN.
NT.com member comment: Dr. Garner, what do you think of the free clinics for uninsured patients that are staffed by nurses and doctors?
Dr. Garner: I loved working in these clinics. They add so much and provide more opportunities for creative approaches to care. I think sometimes the lack of resources helps you be more creative!
NT.com member comment: I would love to volunteer in one some time, but they aren’t close to where I live.
Dr. Garner: Check out mission work that can be done a week at a time and volunteer your vacation time. Take your family and give them a sense of what the world needs.
NT.com member comment: Absolutely. It allows a nurse to be an advocate and be creative. It provides an opportunity for nurses to “pay it forward” by providing information and education to community members who are utilizing these clinics to prevent progression of chronic illness.
Dr. Garner: I did work in Honduras, and it was totally eye-opening for my teenage boys to see how the world works.
NT.com member comment: There are a terrific number of organizations in need of health care workers to go on short trips for humanitarian work in developing countries. In California, there is Catholic Healthcare West, Flying Samaritans, Project Smile, and numerous others.
NT.com member comment: We had nurses go to El Salvador last year, and one practitioner went down to the Caribbean to “donate” a week or two of care. Their global nursing experience was invaluable to each of them. They came back transformed!
NT.com member comment: What opportunities are available for working with social media and public health care?
Dr. Garner: Blogs and tweets give us an opportunity to put a different face to nursing than “Hawthorne.” Many health care organizations are looking for creative ways to use media to reach the public. Ask your PR department if they would like some help.
NT.com member comment: Dr. G, what about internet “clinics” or phone “clinics?” We live in such a computer age that many seek advice from WebMD first.
Dr. Garner: We have two DNP students who work in Walgreen’s clinics. They do a lot of education and phone consulting.
NT.com member comment: I have found much reward working in the community at such events as the New York State Fair, etc. performing wellness checks and providing health prevention education.
NT.com member comment: That’s great! Keep up the good work you are doing!
Dr. Garner: Well, it seems that there are many opportunities for nurses out there in a variety of roles and settings outside the hospital. Education is important for role preparation, so keep American Sentinel in mind. We also have an MBA Health Care for those who want to pursue the business side!
NT.com member comment: Dr. G, you have certainly discussed many opportunities for nursing in the future and volunteer opportunities galore. Do you have any idea about 3rd party reimbursement for these services?
Dr. Garner: The new health reform act has opened up reimbursement significantly for advanced nurse professionals. The new models of care like ACO’s provide for revenue sharing also. Work with your state hospital and nursing organizations to make sure nursing gets its fair share of the pie!
Dr. Garner: Thank you for joining us today! Best of luck with your careers in nursing!
Alice: This has been very informative. Thank you, everyone.
For more information about accountable care organizations, see our blog series: