As of today, nurse practitioners in Kentucky can submit a form to dissolve the collaborative agreement with physicians for non-scheduled medications, provided they have been prescribing for 4 years. This is an exciting change on the road to full practice authority. Next stop, the removing the barriers for scheduled prescribing!
Visit the Kentucky Coalition of Nurse Practitioners and Midwives for the most up-to-date legislation on APRN practice in Kentucky!
Wednesday, July 16, 2014
Saturday, April 12, 2014
Abstract Accepted!
For the fourth year running, I am honored to have a presentation accepted for the American Psychiatric Nurses Association annual conference. As with most topics, you can tell what is going on personally by what I present professionally. This one is especially meaningful because I am stepping out of my clinical comfort zone to do the research while having the perspective as both provider and patient. In keeping to my roots, references will be available via my social network sites - stay tuned for the pinterest board!
Grieving Though Grateful: Reconciling the Traumatic and Disappointing Birth Experience
Grieving Though Grateful: Reconciling the Traumatic and Disappointing Birth Experience
Purpose*
|
When a woman experiences a
traumatic or disappointing birth, there often exists an emotional
dichotomy between gratefulness for the child and grief toward the the
experience. This presentation describes characteristics that contribute
to traumatic birth and resources for the PMH nurse to aid in prevention,
diagnosis, treatment, and collaboration.
|
Summary of evidence*
|
Though up to 30% of women
world-wide experience traumatic birth, a review of the literature
reveals a paucity of research, and the DSM-5 lacks discussion in the sections
on perinatal mood disorders, trauma and stress-related disorders,
or bereavement.
|
Description of practice or
protocol*
|
Traumatic birth may be missed or
mistaken for other postpartum mood disorders by clinicians, and
under-reported by mothers due to stigma. Platitudes such as "all that
matters is a healthy baby" minimize and invalidate the mother's grief
toward the experience and contribute to feelings of guilt, anger,
helplessness, or diminished self-esteem.
|
Validation of Evidence / Method of
Evaluation*
|
Factors including psychiatric
history, unplanned or emergent obstetric intervention, pain, loss of control,
and lack of interpersonal support contribute to negative birth experiences,
and put the mother at risk for ineffective maternal role attainment and
mental health disorders.
|
Relevance to PMH Nursing / Results*
|
A comprehensive
understanding of traumatic birth provides the PMH nurse a foundation
for enhanced assessment, intervention, integrative strategies, and
interdisciplinary collaboration to help women at risk for or experienced
traumatic birth.
|
Future implications*
|
Birth is not a mearly a means to
an end, but an experience independent of the outcome.
Understanding the risk factors, characteristics, and resources results
in refined diagnosis, effective treatment planning, and the opportunity to
build connections with peer obstetric clinicians.
|
Tuesday, February 11, 2014
SB7 Passed! A Small Step with a Huge Compromise
The fight to eliminate the anachronistic farce of a collaborative agreement in Kentucky has been underway since before I became a nurse practitioner. Though gaining more support every year it has come up in the legislative session, the opposition has found ways to keep nurse practitioners beholden to the dispensation of physicians in a manner that reeks of FTC violation and hinders healthcare delivery to a woefully underserved rural population across the commonwealth. This time, there were no stall-tactics, no tacking on of offensive amendments, no removal of mutually beneficial components, or other means of killing the bill.
Senate Bill 7, the first bill to be passed by the General Assembly this year, eliminates the mandated non-controlled substance collaborative agreement for nurse practitioners provided they have been in a prescriptive practice for 4 years. There are also key language amendments in this new section of KRS Chapter 314 that further clarifies that nurses oversee nursing practice - something that has been a huge area of misunderstanding by our physician colleagues. The bill passed on January 14th 2014 with only one "nay" (see voting record), and will go into effect this summer. The official signing ceremony is set for February 28th and I expect with Governor Steve Beshear, there will be bourbon to celebrate.
The Kentucky Collation of Nurse Practitioners and Nurse Midwives has worked tirelessly to move us another step closer to achieving the ideals of the Institute of Medicine's vision for the future of nursing. While the ideal is to get to full independent practice to the full scope of our education and training, Kentucky is not a state that embraces change without a lot of time to mull it over. To the bone. Even when the preponderance of evidence recommends action. My only question is whether the next step will focus on the controlled-substance collaborative agreement, or the 4-year mandate.
Patience is a nuisance.
Sunday, October 6, 2013
APNA 2013 Poster
I have been on a writing hiatus. Between the new position at work and being 28 weeks pregnant, I am out of the habit of blogging. Though I would have really enjoyed doing a podium presentation again, I had a feeling it might have been more than I could tack on to an already packed schedule. . . as evidenced by the fact I just completed and ordered the hardcopy today and am leaving on Wednesday for the conference. This was really a fun one to research over the past few months, and I am looking forward to another great APNA conference. See you there!
Friday, May 10, 2013
Will the DSM-5 Define Normal?
Or rather, neuro-typical?
I realize phrases like "I'm not normal" and "Who wants to be normal?" and "I never wanted a normal life" are often a person's way of differentiating themselves from what they believe is mainstream (i.e. boring) living. Yet there are many, many people living quiet little wild lives unbeknownst to their neighbor. What looks like the white-bread nuclear family to the casual observer may be anything but. People get altogether too comfortable in their assumptions of how others live and think. Fact is, most of us are actually normal in that we feel a full range of different emotions, can generally trust our senses, have desires, and respond to the trials and tribulations of life with some balance of primal instinct and societal expectation.
Yeah? Well prove it.
Unfortunately, the one diagnostic reference that tells you all of the ways you are abnormal fails to provide guidelines for what is considered within normal limits.
While physical health is somewhat generically considered absence of disease, there are any number of standardized, objective tests that show clinicians where a patient falls within the range of normal. You know if someone's blood sugar has been in control for a few months by drawing a Hemoglobin A1C. You know if someone has a blockage of their coronary artery by performing a cardiac catheterization. You know if someone has a broken arm by getting an x-ray. With mental health disorders, it is subjective report of symptoms coupled with the observation and interaction skills of the clinician that leads to a diagnosis. There is yet no blood test for depression - though we certainly know that low thyroid or Vitamin D levels can contribute. While we can detect brain injury and atrophy, there is no MRI that can yet detect the difference between hallucinations from schizophrenia, bipolar disorder, depression, or substance use. We know certain lifestyle factors correlate with development of mental health problems, from malnutrition, infection, or drug use while in utero to taking too many blows to the head playing football, however thresholds of these biological factors have not been established.
Perhaps if we had a definition of normal mental health, we could identify high-risk individuals and provide primary mental health prevention with education, screening, and management prior to onset or exacerbation of a disorder. Normal grief, normal sadness, normal anger, normal worry, normal happiness - all emotions are appropriate throughout the lifespan, the issues is helping people get in touch with those emotions and be able to evaluate for themselves individual normal limits.
In the meantime, we have yet another tired update to the Diagnostic and Statistical Manual of Mental Disorders, a book developed by the American Psychiatric Association in collaboration with, well, no one except their own psychiatrists, to let the thousands of non-physician mental health providers (you know, the ones that comprise the bulk of the field - social workers, therapists, psychologists, nurses) know how to consistently label people for the purposes of proper billing and coding. Not treatment. Just billing and coding.
It is unsurprising that the National Institute of Mental Health has come out with harsh criticism and calling for more of a biological base to classifications and thereby increase the validity of diagnosis to guide effective treatment. Though they have not formally entered the competitive ring, it is time the American Psychiatric Association monopoly on mental health definitions fall into line with what is happening in the treatment room. It’s called collaboration. This includes interdisciplinary input from clinicians as well as the lived-experience of the mental health consumer.
Let’s see if the NIMH can do better: http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml
I realize phrases like "I'm not normal" and "Who wants to be normal?" and "I never wanted a normal life" are often a person's way of differentiating themselves from what they believe is mainstream (i.e. boring) living. Yet there are many, many people living quiet little wild lives unbeknownst to their neighbor. What looks like the white-bread nuclear family to the casual observer may be anything but. People get altogether too comfortable in their assumptions of how others live and think. Fact is, most of us are actually normal in that we feel a full range of different emotions, can generally trust our senses, have desires, and respond to the trials and tribulations of life with some balance of primal instinct and societal expectation.
Yeah? Well prove it.
Unfortunately, the one diagnostic reference that tells you all of the ways you are abnormal fails to provide guidelines for what is considered within normal limits.
While physical health is somewhat generically considered absence of disease, there are any number of standardized, objective tests that show clinicians where a patient falls within the range of normal. You know if someone's blood sugar has been in control for a few months by drawing a Hemoglobin A1C. You know if someone has a blockage of their coronary artery by performing a cardiac catheterization. You know if someone has a broken arm by getting an x-ray. With mental health disorders, it is subjective report of symptoms coupled with the observation and interaction skills of the clinician that leads to a diagnosis. There is yet no blood test for depression - though we certainly know that low thyroid or Vitamin D levels can contribute. While we can detect brain injury and atrophy, there is no MRI that can yet detect the difference between hallucinations from schizophrenia, bipolar disorder, depression, or substance use. We know certain lifestyle factors correlate with development of mental health problems, from malnutrition, infection, or drug use while in utero to taking too many blows to the head playing football, however thresholds of these biological factors have not been established.
Perhaps if we had a definition of normal mental health, we could identify high-risk individuals and provide primary mental health prevention with education, screening, and management prior to onset or exacerbation of a disorder. Normal grief, normal sadness, normal anger, normal worry, normal happiness - all emotions are appropriate throughout the lifespan, the issues is helping people get in touch with those emotions and be able to evaluate for themselves individual normal limits.
In the meantime, we have yet another tired update to the Diagnostic and Statistical Manual of Mental Disorders, a book developed by the American Psychiatric Association in collaboration with, well, no one except their own psychiatrists, to let the thousands of non-physician mental health providers (you know, the ones that comprise the bulk of the field - social workers, therapists, psychologists, nurses) know how to consistently label people for the purposes of proper billing and coding. Not treatment. Just billing and coding.
It is unsurprising that the National Institute of Mental Health has come out with harsh criticism and calling for more of a biological base to classifications and thereby increase the validity of diagnosis to guide effective treatment. Though they have not formally entered the competitive ring, it is time the American Psychiatric Association monopoly on mental health definitions fall into line with what is happening in the treatment room. It’s called collaboration. This includes interdisciplinary input from clinicians as well as the lived-experience of the mental health consumer.
Let’s see if the NIMH can do better: http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml
The DSM-5 is scheduled for release on May 27th – will you get yours?
Wednesday, April 17, 2013
APNA27 Abstract Accepted
Wow! Three years running I have been honored to have my work accepted at the American Psychiatric Nurses Association Annual Conference. I have put to rest my social networking research and gone back to my roots of practice and interest. Check out the summery, and get ready for APNA27 this October in San Antonio!
Serotonin OTC: The Latest in Mental Health Nutraceuticals
Abstract: The U.S. vitamin and supplement industry grosses nearly $30 billion per year with a growing number of products targeted to the prevention and alleviation of mental health related conditions. Although the industry is regulated by the FDA and products must adhere to Good Manufacturing Practices (GMP), broad claims of efficacy for mood, sleep, concentration, and other general psychiatric symptoms are not subject to scientific validation. Popular nutraceuticals including GABA, n-acetylcysteine (NAC), and Ashwagandha are advertised as natural alternatives or augmenters to standard psycho-pharmacy, and while consumers who self-medicate without informing their providers may experience a measurable benefit, they put themselves at risk for deleterious outcomes. Consumer interest, desire to decrease pill burden, and product proliferation in the marketplace have encouraged increased research to substantiate health claims, determine potential interactions with medication, and provide a basis for recommendation. This presentation will provide an overview of the functions of 10 common and novel mental health focused nutraceuticals, evaluate the base of evidence for implementation into practice, and provide strategies for educating patients on appropriate use of OTC supplements.
Presentation Summary: This presentation provides an overview of the functions of common and novel mental health focused nutraceuticals, evaluates the base of evidence for implementation into practice, and provides strategies for educating patients on appropriate use of OTC supplements.
Objective 1: Identify the key functions of 10 nutraceuticals supplements frequently used in management of mental health disorders.
Objective 2: Describe potential interactions between classes of psychiatric medication and OTC mental health nutraceuticals.
Objective 3: Evaluate the evidence base for use of OTC mental health supplements in PMH practice
Serotonin OTC: The Latest in Mental Health Nutraceuticals
Abstract: The U.S. vitamin and supplement industry grosses nearly $30 billion per year with a growing number of products targeted to the prevention and alleviation of mental health related conditions. Although the industry is regulated by the FDA and products must adhere to Good Manufacturing Practices (GMP), broad claims of efficacy for mood, sleep, concentration, and other general psychiatric symptoms are not subject to scientific validation. Popular nutraceuticals including GABA, n-acetylcysteine (NAC), and Ashwagandha are advertised as natural alternatives or augmenters to standard psycho-pharmacy, and while consumers who self-medicate without informing their providers may experience a measurable benefit, they put themselves at risk for deleterious outcomes. Consumer interest, desire to decrease pill burden, and product proliferation in the marketplace have encouraged increased research to substantiate health claims, determine potential interactions with medication, and provide a basis for recommendation. This presentation will provide an overview of the functions of 10 common and novel mental health focused nutraceuticals, evaluate the base of evidence for implementation into practice, and provide strategies for educating patients on appropriate use of OTC supplements.
Presentation Summary: This presentation provides an overview of the functions of common and novel mental health focused nutraceuticals, evaluates the base of evidence for implementation into practice, and provides strategies for educating patients on appropriate use of OTC supplements.
Objective 1: Identify the key functions of 10 nutraceuticals supplements frequently used in management of mental health disorders.
Objective 2: Describe potential interactions between classes of psychiatric medication and OTC mental health nutraceuticals.
Objective 3: Evaluate the evidence base for use of OTC mental health supplements in PMH practice
Tuesday, April 2, 2013
Rats! Foiled Again.
For yet (what is it, the third year in a row?) legislative session, the Kentucky senate figures our rural population can take their health problems and shove them in the coal mine. Enormous problems with obesity, smoking-related illness, and opiate abuse are prevalent all over the state, but hey, just think how much worse it would be if Nurse Practitioners were allowed to get involved by administering independent care to the full scope of their training and practice? Because after all, Nurse Practitioners are just a bunch of greedy harpies who were too dumb to get into medical school, have totally rigged the statistics showing cost-effective and equivalent outcomes in primary care, and are only in the healthcare business to divert narcotics, defraud the public, and take money out of the hands of the poor, selfless, hardworking medical doctors who work in cities.
This is why I can never run for office.
Here is the official press release from the AANP:
Access to Health Care
The American Association of Nurse Practitioners expresses disappointment
AUSTIN, TX (March 28, 2013)–
Angela Golden, President of the American Association of Nurse Practitioners (AANP), said today that the Kentucky legislature's failure to act on Senate Bill 43 will make it harder for state residents to obtain quality health care by barring access to direct and comprehensive services provided by nurse practitioners (NPs).
"The American Association of Nurse Practitioners is extremely disappointed that Kentucky continues to prevent patients from directly accessing high-quality health care services provided by NPs. Nowhere in the industry is it acceptable to limit patients the best that health care had to offer not two or even three, but four decades ago. However, that is exactly what states are doing when we keep these dated state practice laws in place.
"The health care services we provide – writing prescriptions, evaluating patients, making diagnoses, ordering and interpreting diagnostic tests, and managing acute and chronic health conditions – have been proven safe and effective for more than 40 years. There are more than 60 medically underserved counties across the state and every one would have benefited from the provisions in this bill.
"It is equally disappointing that the community of organized medicine in Kentucky went beyond simply opposing the bill by introducing counter legislation to increase state restrictions on NPs. This move flies in the face of recommendations by a growing number of independent entities (e.g., the National Academy of Sciences' Institute of Medicine) that call for modernizing state practice laws governing NPs. Such organizations understand that these changes are necessary in today's health care environment.
"The legislation that was before the Kentucky legislature did not expand NPs' scope of practice. It simply retired an outdated, bureaucratic piece of paper that prevents patients from having direct and full access to NP care. Removing this dated provision would have opened access points in rural and underserved counties, and streamlined care in all sites around the state.
"AANP and those who supported these measures remain committed to ensuring access and health delivery improvement. These pro-patient bills are planned to be reintroduced in 2014."
Lets get this fixed! For some real-world social networking, meet me in Las Vegas for the AANP national conference. For all of the details and registration, visit the AANP National Conference Page
And for more information on how to do Vegas your own fabulous way, check out my Pinterest Conference Board
This is why I can never run for office.
Here is the official press release from the AANP:
Access to Health Care
The American Association of Nurse Practitioners expresses disappointment
AUSTIN, TX (March 28, 2013)–
Angela Golden, President of the American Association of Nurse Practitioners (AANP), said today that the Kentucky legislature's failure to act on Senate Bill 43 will make it harder for state residents to obtain quality health care by barring access to direct and comprehensive services provided by nurse practitioners (NPs).
"The American Association of Nurse Practitioners is extremely disappointed that Kentucky continues to prevent patients from directly accessing high-quality health care services provided by NPs. Nowhere in the industry is it acceptable to limit patients the best that health care had to offer not two or even three, but four decades ago. However, that is exactly what states are doing when we keep these dated state practice laws in place.
"The health care services we provide – writing prescriptions, evaluating patients, making diagnoses, ordering and interpreting diagnostic tests, and managing acute and chronic health conditions – have been proven safe and effective for more than 40 years. There are more than 60 medically underserved counties across the state and every one would have benefited from the provisions in this bill.
"It is equally disappointing that the community of organized medicine in Kentucky went beyond simply opposing the bill by introducing counter legislation to increase state restrictions on NPs. This move flies in the face of recommendations by a growing number of independent entities (e.g., the National Academy of Sciences' Institute of Medicine) that call for modernizing state practice laws governing NPs. Such organizations understand that these changes are necessary in today's health care environment.
"The legislation that was before the Kentucky legislature did not expand NPs' scope of practice. It simply retired an outdated, bureaucratic piece of paper that prevents patients from having direct and full access to NP care. Removing this dated provision would have opened access points in rural and underserved counties, and streamlined care in all sites around the state.
"AANP and those who supported these measures remain committed to ensuring access and health delivery improvement. These pro-patient bills are planned to be reintroduced in 2014."
Lets get this fixed! For some real-world social networking, meet me in Las Vegas for the AANP national conference. For all of the details and registration, visit the AANP National Conference Page
And for more information on how to do Vegas your own fabulous way, check out my Pinterest Conference Board
Wednesday, March 13, 2013
Kentucky Battle Cry . . . Y'all
Seriously, if you live in Kentucky or know someone who does, please take a moment to voice your support for SB 43 which will end the collaborative agreement for non-scheduled drugs for nurse practitioners and decrease direct supervisory time for new-graduate physician assistants. Just click the link to email your senator - it takes less than 3 minutes: Vote "YES!" to SB43
The postcards below are from the previous SB52. The facts are still the facts.
Monday, March 4, 2013
Laugh and Discuss
A few years ago I ran across this video that humorously illustrates the dangers of narrow focus. I was reminded of it the other day when discussing frustrations related to provider communication issues and stigmatization. There are a number of similar scenarios between different specialties that pop up after the video, including some amusing psychiatry vs. physical medicine interactions, but this remains my favorite.
I needed a laugh today - have one with me:
I needed a laugh today - have one with me:
Tuesday, February 26, 2013
Countdown to Vegas!
 |
| RIP 2006 |
We had our first beer on the flight up and I am pretty sure I stayed pleasantly inebriated for the entire trip. I remember his family felt guilty for the drama that made them want to run away and wound up coming anyway. The mentionable events that stick out:
- Walking the strip, thinking "I hope I can afford to stay at a fancy place like Treasure Island . . . how do families afford to stay here at $200/night?"
- Aerialists hanging from the ceiling at Ra in Luxor (now LAX) and finding myself in the center of the dance floor with a handsome partner and an attentive audience
- Going to the Stardust showroom to see if it was dark. Yep. To this day I often pack for my trips with Nomi Malone!
- The yellow brick road at MGM, a wizard sticking out of Excalibur, and general theming on the south side of the strip
- Carrying a cup of change with my whole $20 in gambling/drink tip money (I left with $16).
- Wait, the drinks are free?!?
- Seeing "Bottoms Up", the topless afternoon show at Flamingo where admission was only a $7 Heineken with coupon.
- Taking a ride on the Big Shot at Stratosphere
- Learning that marriage in Vegas is not the place for sentimentality. These people have a schedule to keep and your 30 minutes start the second you hit the dressing room (yet I still teared up!)
- Taking off at twilight and while we were taxiing down the runway, I gazed longingly at the strip as the lights came on, sad to be leaving but thinking, "I will see you later, Las Vegas strip. I will see you later."
While the strip has changed dramatically since that first visit, the vibe of Las Vegas holds the same promise of excitement, the same respite from everyday reality, and the same unpredictable wonder that keeps me coming back.
 |
| You woke up. Celebrate. |
So for those attending the conference who have never been to Vegas and for those reluctant to revisit, I have started board on Pinterest to help make the most of the free time you have have. And maybe even entice you to spend a couple of extra days exploring the Entertainment Capital of the World!
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