by Dave Gardner
As employers across the business arena struggle with exploding costs
for health insurance, an unfolding
evolution with providers offers hope for increasing efficiency within the health care delivery system.
The ongoing change involves the expanding role of the certified registered nurse practitioner (CRNP). This highly-trained caregiver is an advanced-practice nurse who has continued his or her education into the graduate level, and on a national scale is now delivering up to 90 percent of the services that primary care physicians offer.
According to the American Association of Nurse Practitioners, more than 248,000 CRNPs are now licensed within the United States. Their average age is 49 years,
and even though some specialization
does exist, these caregivers are now
delivering the majority of the nation’s direct primary care.
CRNPs hold prescriptive privileges, including the ability to prescribe controlled substances, in all 50 states and the District of Columbia. In 20 states the CRNPs exercise the right to deliver full practice authority without a physician available.
Becoming a CRNP also offers hope for a lucrative career. During 2017, the mean, full-time base salary for an American CRNP was $105,546.
Mary Jane Hanson, Ph.D., CRNP,
professor and director of graduate and
doctor of nursing practice programs with The University of Scranton, also offers care at an Albrightsville practice where CRNPs handle 85 percent of the primary care because of their cost-effectiveness as providers. When a particularly severe case or one with special types of morbidity occurs, a physician may be called in.
“This system allows every provider to
function to the maximum of their ability,”
In one sense, a CRNP may be a hybrid caregiver because he or she has a minimum of a master’s degree, and others may have earned a doctorate degree in nursing. They can consistently build on the knowledge gained as a nurse while emphasizing a caregiver model that emphasizes wellness and prevention as opposed to simply treating a disease.
“The human factor is vital to an effective CRNP,” said Hanson. “It’s important we see every patient as an individual and respect their belief system.”
With the latitude offered by their position, new patients can be effectively assessed by CRNPs for socio and cultural situations plus psychological, ethnic and behavioral issues. The CRNP has the time to get a feel for each individual patient through the assessment process, hopefully creating collaboration.
“We make it clear that we treat the patient versus just treating disease,” said Hanson. “We must learn about the habits of the patient, and even though time delegation as a caregiver is vital, the time we spend depends on each case situation.”
According to Hanson, during the past 25 years, patients in general have become more informed because of internet access. Increasingly, they ask good questions while with the CRNP and cooperate to develop plans and manage problems that are tailored to each discussion.
Obesity is a significant problem caregivers face within NEPA, and patient compliance with weight loss is imperative. Targeted intervention is necessary to achieve wellness. Diabetes from obesity is particularly rampant.
CRNPs also deal with issues such as cardiac illness, cancer and mental health.
“To develop patient compliance, we educate while sharing applicable data from scientific research, and then strive to create a plan based on that patient’s lifestyle and interests,” Hannon said.
She added the CRNPs’ big push on wellness shows no signs of easing. In reality, promotion of wellness is the best tool the CRNP has to efficiently use the available care resources, as opposed to older care models which emphasized treatment after illness appears.
“Hopefully Pennsylvania’s CRNPs will soon be granted full practice authority, and this will increase our efficiency to an even larger degree,” said Hanson.
Street level practice
Allyson Favuzza, a CRNP with the Wright Center for Graduate Medical Education, specializes in family medicine at the street level. She agrees with Hanson that the primary goal of her peers is to create wellness with the goal of avoiding serious illness, and at the center of this effort must be CRNP-patient collaboration.
A physician is not physically
on-site within the clinic where Favuzza
is stationed, but Dr. William Dempsey
is always available by phone. Favuzza and her peers therefore manage every case, from routine vaccinations to serious illness.
“I love what I do, and the biggest challenge is actually the administrative load and not time with the patients,” said Favuzza. “Case documentation, referrals, review of lab results and fighting with the insurance companies are actually the toughest parts of our jobs and present the biggest challenges.”
Patient behavior is always an issue for the CRNPs, making compliance a goal to constantly strive for. Social economic status often becomes a factor within this push for patient wellness, and according to Favuzza, the best thing a CRNP can do is create a strong relationship with the patient and effectively communicate that the provider is trying to help them through vital engagement.
Burnout is also a reality for the CRNP, as Favuzza stated the constant push for productivity with sparse insurance
dollars increases. Every year, the caregivers are asked to do more with less, including problems such as the scourge of opioid addiction.
“Yes, we do deal with patients who try and opioid shop, but we have to be firm and try to stop them when this is detected,” said Favuzza. “It’s also vital to remember these pain-killing drugs do have important medical uses, so it’s not just a matter of ending their use entirely.”