The Nurse Practitioner

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The Nurse Practitioner Blog

A forum for discussion on recent news and developments in healthcare and the NP field.

Tuesday, May 30, 2023

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Participating in the peer review process helps advanced practice registered nurses become better at what they do—whether that's caring for patients in the clinic, researching the latest in population health, or advocating for changes to scope of practice or workplace protocols.

If you are an NP who is interested in staying up to date on best practices in your individual field or furthering your professional development with CV entries and CE earnings, consider joining us at The Nurse Practitioner as an expert peer reviewer. All specialties within primary, acute, urgent, or emergency care are welcome, and previous peer review experience is not required.

Give and get back

Acting as a peer reviewer affords individuals with the opportunity to contribute to the fields that they—and the journal—serve. Beyond service, peer reviewers are awarded CE credit for timely, highly rated reviews of manuscripts submitted to The Nurse Practitioner. The journal aims to help NP-reviewers hone their critical thinking and clinical skills through their participation in the peer review process: Our editors are happy to provide personalized feedback on submitted reviews upon request, especially to those who are new to the journal specifically or to manuscript review in general.

Learn how to review

The Nurse Practitioner has partnered with Editage to offer two courses on manuscript peer review for both new and established reviewers. The free basic course is a 3-hour interactive workshop, complete with videos, quizzes, and a Q&A forum to keep you engaged and a downloadable review template for future use. The paid advanced course delivers the same content with some added bonuses, including a practice review assignment (for which course faculty will provide you with personalized feedback) as well as downloadable tools and checklists for you to use during different stages of the peer review process.

Become a reviewer

If interested, please send a copy of your CV to us at [email protected]. In your message, we ask that you include your affiliation information and primary areas of expertise, particularly those within which you would be willing to review manuscript submissions. Of course, if you have any questions before applying, please feel free to write to us.

Establish yourself as an even more valuable part of the field in which you work! Become a part of the scientific publishing process by serving as a peer reviewer.

Other opportunities to earn CE

If you missed us at our spring 2023 National Conference for Nurse Practitioners (NCNP) event, no worries; you still have plenty of time to learn and earn both CE and Rx credit. Register today to gain access to NCNP session recordings—on topics ranging from the 2023 GOLD updates on COPD classification to the latest in gender-affirming surgeries—to watch them on your own time. Then, complete evaluations through the deadline of July 18 to earn up to 55 CE and 31.5 Rx credits. ​

Image credit: Pexels.

Thursday, April 13, 2023

Livestream conference is April 19-21, but sessions will be available online through July 18 for learning and earning credit

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Our less-than-one-week countdown to the National Conference for Nurse Practitioners (NCNP) virtual spring event starts now! Join us at The Nurse Practitioner live next week from April 19 to 21 for an expert-designed and -led program developed specifically to help you stay current in your clinical practice and earn continuing education credits conveniently—either from home or on the go—at your own pace. Busy during the April 19-21 livestream? No problem! Conference sessions are recorded to be available, even if you're not in real time, for 90 days after the event. Register now to learn and earn credits flexibly through July 18, regardless of live attendance.

About the NCNP spring event

For the uninitiated, twice-yearly NCNP provides the full conference experience in a virtual format: It retains networking prospects, eliminates travel hassle and the struggle to choose between simultaneous sessions, and adds benefits—such as the ability to rewatch previously attended sessions—that are not possible with or typical of in-person conferences. This spring's installment offers all participants, regardless of when they participate, the opportunity to earn up to 55 CE and 31.5 Rx credits. NCNP's first-rate planning panel—led by Dr. Margaret A. Fitzgerald—devised a comprehensive spring program with more than 70 topical, cutting-edge sessions to guide NPs through clinical advances, shifts in best-practice guidelines and ideologies, and other developments in the healthcare sphere of which they need to be aware.

You'll find me attending or monitoring various sessions, including:

  • the keynote address, “RSV, COVID-19, and Influenza: Lessons Learned," delivered by conference chairperson Dr. Fitzgerald and Dr. Anne Dabrow Woods;
  • “New Drugs in Dermatology: And There Are A LOT!";
  • What You Need to Know About GERD, Dyspepsia, Dysphagia and Barrett's in 2023"; and
  • ​​“Diabesity: Weighing in on the Diabetes-Obesity Conundrum."

​I'm also looking forward to tuning in to several sessions after the livestream event: In particular, Dr. Laurel Short of our partner organization, the Kansas Advanced Practice Nurses Association (KAPN), will be headlining a session on pharmacologic migraine management, and Dr. Wendy L. Wright, who previously appeared on the journal's podcast, will be educating us further on how to address vaccine hesitancy in practice. (ICYMI: The Nurse Practitioner published original research on vaccine hesitancy in our March 2023 special pediatrics issue that supported the effectiveness of one possible intervention.)

Join us

Join The Nurse Practitioner editors next week—or at any point until July 18—to elevate your conference experience with NCNP. Earn your required CE and Rx credits from wherever you are, whenever you have the time.

The Nurse Practitioner is an NCNP sponsor. You can subscribe to the journal for one year at a discounted rate of $29.90 during conference registration.


Friday, March 17, 2023

Content we're consuming and recommending as editors of The Nurse Practitioner

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SPRING 2023 EDITION


NPR: Parents raise concerns as Florida bans gender-affirming care for trans kids
In recent weeks, a slew of legislation has banned or sought to ban gender-affirming care for transgender minors in various states throughout the nation. Although this NPR feature focuses primarily on Florida, which recently banned gender-affirming care through the power of its medical boards rather than the legislative process, it raises critical questions that are relevant to every place where bans on puberty blockers, cross-sex hormones, and surgical procedures have been enacted or are under discussion. Despite the vote of Florida's medical boards, the vast majority of experts agree that gender-affirming care is medically necessary. Last year, NPs wrote in The Nurse Practitioner that culturally competent gender-affirming care is “essential" to work toward health disparity elimination, and this year, our friends at Plastic and Reconstructive Surgery published a study indicating that, of 1,989 individuals who received gender-affirming surgery, only 6 (0.3%) regretted it.

Nursing2023 Podcast: Advocacy: What is it good for?
Speaking of bans on provider- and science-backed care: let's move right along to advocacy. Our colleagues at Nursing2023 spoke with Amie Porcelli, an ED charge nurse at Penn Medicine, about nursing advocacy in its various forms. Activism isn't just intended for the benefit of patients, Porcelli says: it's for nurses, too. One area where Porcelli would really like to see change? Violence against nurses in their places of work. “It's this secret that nurses keep," Porcelli says, “that we go to work in fear that we're going to get injured. Every single nurse has a story about workplace violence." She's spent years trying to get workplace violence legislation passed: it is currently a felony to assault medical professionals in only 31 states.

The Washington Post: Why are nurses quitting? Ask the nurse [practitioner] no hospital will hire.
If you only have time to read one of the ubiquitous feature articles on ubiquitous nurse burnout, make it this one: it's an examination of the problem through the lens of NP-turned-social-media-influencer Katie Duke, who uses modern (unconventional) methods to break down why so many NPs are leaving the profession in search of greener (unconventional) pastures. Ask any of Duke's 144K followers on Instagram (@thekatieduke) or one of her podcast listeners, and they'll tell you that Duke leads a moment-inspired movement that encourages nurses to shed their idealized image as tireless, compliant caretakers and do what's best for themselves, whether that's advocating from within the system for fair working conditions and environments that prioritize both patient and provider safety or leaving the bedside altogether. Duke's embrace of the entrepreneurial spirit, among other attributes, captures the post-pandemic nursing zeitgeist. #NPLife #ThankYouNPs

The New England Journal of Medicine: Nirsevimab for Prevention of RSV in Healthy Late-Preterm and Term Infants
Earlier in 2023, the FDA accepted for consideration a biologics license application for nirsevimab, a long-acting monoclonal antibody developed jointly by AstraZeneca and Sanofi, for prevention of severe respiratory syncytial virus (RSV) in babies. A leading cause of acute lower respiratory tract infection—and subsequent hospitalization—in infants and young children, RSV caused rampant sickness in the US amid these populations last year at a time much earlier in the season and with a hospital admission rate much higher than normal. The New England Journal of Medicine recently published these results of a phase 3 clinical trial evaluating the safety and efficacy of nirsevimab in healthy late-preterm and term infants at the beginning of their first RSV season, and the trial's promising outcome might pave the way for nirsevimab to become the first RSV shot indicated for use in the broad infant population in the near future. This depends, of course, on FDA approval of the previously submitted application.

NASA: DeskFit: 20 Essential Desk Exercises You Can Do Without Leaving Your Office or Home Workspace
We mean “on our desks" literally; we're office workers, after all! Our NP readership works in different segments of medicine and in all manner of settings, and some of that work requires sitting for long hours. For those of you who find yourselves at desks regularly, check out this guide to in-office exercises meant to neutralize the effects of long hours in front of a screen. Take care of yourselves, and better wellbeing—and better NP practice—will follow.

The New York Times Cooking: Beans and Greens Alla Vodka
We mean “consuming" literally as well. Here's a one-pot recipe for busy people that doesn't taste like a one-pot recipe for busy people. We're currently eating this on repeat, with oat milk substituted for the heavy cream to make us feel healthy.​

Image credit: Pexels.


Wednesday, March 8, 2023

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If ​you're a primary care NP, you know from firsthand experience that vaccine hesitancy has reached new heights amid the COVID-19 pandemic. Patients who are “vaccine hesitant"—that is, uncertain about receipt of one or more recommended shots for themselves or their families—are known to be swayed by social media's endless supply of vaccine misinformation and disinformation. It's easy for providers to feel, particularly as they contend with other current challenges such as burnout and understaffing, that vaccination decisions are beyond their scope of influence.

Mounting evidence, however, suggests that healthcare providers are critical components of the vaccine hesitancy equation. Despite today's climate, most patients report that they trust their providers to deliver sound recommendations and information regarding their health. Multiple studies have drawn the same conclusion: sometimes, all it takes to move a vaccine-hesitant patient toward vaccine acceptance is a conversation with or intervention by an encouraging provider.

In this month's issue

In the latest issue—a special pediatrics-centric edition—of The Nurse Practitioner, Hallas and colleagues at the NYU Rory Meyers College of Nursing describe a successful intervention that converted two groups of vaccine-hesitant women to vaccine acceptors. The team of three NP researchers and one biostatistician shared science-based evidence with vaccine-hesitant participants via online interactive communications that resembled social media content, prompting many women to decide to vaccinate themselves and their children.

The authors targeted two groups, prenatal women and mothers of newborns, for inclusion in the study. First, the team administered surveys to potential participants in both groups to determine their levels of vaccine acceptance. Those determined to be vaccine acceptors were recruited to each group's control arm, whereas those identified as hesitant were placed in the relevant intervention arms. Vaccine refusers were automatically excluded from the study.

The investigators then proceeded to deliver interventions only to vaccine-hesitant participants in each group via interactive questionnaires. The questionnaires furnished individuals who continued to signal hesitancy through their responses with pro-vaccination social media–like posts that appealed to both reason and emotion. The intensity of the interventions increased with each continued expression of vaccine hesitancy. The final (and most powerful) intervention constituted a video of a mother in a pediatric ICU realizing that her infant was suffering from a vaccine-preventable disease.

Ultimately, 82% of pregnant women who were initially vaccine hesitant had full prenatal vaccination coverage after receiving the intervention, thereby exceeding the vaccination rate of the corresponding vaccine-accepting control group at 67%—a statistically significant result. For vaccine-hesitant mothers of newborns, the majority (74%) fully immunized their infants. The authors concluded that conveying vaccine information via video or other similar intervention might therefore be a viable approach for NPs seeking to boost patients' vaccine confidence. More on the study's implications can be found in the article.

Beyond this month's issue

Need more strategies for addressing vaccine hesitancy in clinical practice? Listen to The Nurse Practitioner Podcast episode on vaccine hesitancy with guest Wendy L. Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNA for more background and tactics from an expert. Also consider joining Dr. Wright at the upcoming National Conference for Nurse Practitioners (NCNP) spring virtual event, sponsored by The Nurse Practitioner and easily attended from the comfort of home, for an even more in-depth look at vaccine hesitancy. Registration is now open.

The Nurse Practitioner aims to support you through current challenges in your NP practice. Subscribe today for access or browse our continuing education offerings, which are always free to read. Already a subscriber and interested in hearing from our expert editors and authors on a specific topic? Get in touch: [email protected].

Wednesday, November 3, 2021

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One of the authors of this post (Dr. Breckenridge) recently arrived at the airport to board her flight and was surprised to find it packed with people. It seemed strange, since she hadn't seen packed flights for several months due to the COVID-19 pandemic.  As she oriented herself to her surroundings, she realized she was standing in line with hundreds of Afghan nationals.  Images from the recent news about the Taliban overtaking the country flashed in her head.  She felt an overwhelming desire to welcome these people to the US. She wanted to thank those who had assisted our troops; but as she started to speak to the people next to her in line, she quickly became aware of the language barrier. She found herself frustrated and emotional. She wanted to be able to communicate with them. Her thoughts caused her to reflect further. How would she care for these families in her clinic? She also realized that she needed to learn more about their culture. These thoughts prompted her to write this piece to help other NPs who may encounter patients newly resettled in the US from Afghanistan.

Over 95,000 Afghan refugees are expected due to the recent crisis, and many began their US resettlement process in September 2021. What does the influx of Afghan refugees mean to our healthcare system and communities? What do we need to know about the health needs of this group of refugees? How can we integrate cultural sensitivity into our care for these individuals? What health issues should NPs be aware of when caring for these families and individuals? These are just some of the questions we must ask ourselves as we prepare to support this people group.

Life in Afghanistan 

Understanding the Afghan cultural environment is critical. Most of Afghanistan is rural countryside where farming is the primary source of income. It is a place where what you do as an occupation carries a lot of weight.  A teacher is held in high regard whereas being a barber is considered  less prestigious.   It is a place of ethnic diversity.  There are over 20 different ethnic groups living in Afghanistan.  Most people are Muslim, both Sunni and Shia.  Healthcare is sparse, especially for those who live in rural Afghanistan. The average lifespan is 51 to 54 years old, and the majority of the population is under the age of 15. Clean water is a privilege in much of the country. Land mines are not uncommon and frequently injure those not aware of their presence. Education in Afghanistan is different from the US. Public elementary school is available for children in urban areas but may or may not be available in rural settings. Middle and high schools are not common, so there is a high rate of illiteracy, though this does not reflect among  refugees.  Most refugees are educated and have worked with the U.S. Government as support staff and interpreters.  The role of women in Afghanistan has changed over the years. Some are now allowed to work, but all women continue to be required to dress conservatively with head coverings (hijab) or other “typical" Islamic dress.  Most men have a beard.  At one time men were jailed if they trimmed or cut their beard. The Afghan families live intergenerationally, often caring for older parents in their home.  Families are typically patriarchal.  Entertainment includes kite flying, soccer, and television (if you are privileged to have electricity).

Transition to US healthcare

Because the medical system in the US is different, Afghan patients may be reluctant to seek medical care as they are unfamiliar with healthcare environments.  Standard clinic routines we take for granted may need explanation.  Language barriers, cultural differences, and lack of relationships with medical providers are additional obstacles.  An example of cultural differences in medical care may be the presence of the husband at a woman's medical visit. The male will often do the talking for the woman. Providing proper interpretation services during a medical visit is essential. Although two primary languages (Pashto and Dari) are spoken in Afghanistan, many dialects exist. Additionally, lack of trust in the government is not uncommon. NPs must be sensitive to body language that could be misinterpreted such as a thumbs up sign and winking. Additionally, these families may struggle with punctuality since it is acceptable to show up unannounced or late in Afghanistan.

In the usual refugee resettlement process, refugees have a medical screening exam prior to leaving their home country and are screened upon arrival in the US with another special screening exam according to guidelines from the CDC and immigration services.  Because of the urgency to leave Afghanistan, many of the new arrivals did not have the usual pre-departure medical screening.   Each person receives a physical exam including mental health screening, communicable disease screening, immunization evaluation, and illicit drug use testing.  Communicable disease screening includes but is not limited to evaluation for tuberculosis and sexually transmitted illnesses. All are treated for parasites. Communicable illnesses that are common in Afghanistan are measles, cholera, smallpox, and respiratory infections such as Covid-19. 

In addition to healthcare needs, we must consider food insecurity among Afghan refugees. Refugee status provides 6 months of medical insurance and financial support from the US.  Changes to immigration regulations have provided these benefits to refugees whose applications are in process (known as “parolees" - an immigration term for an individual whose application for refugee status is in process), but there may be delays in getting the benefits established.  Despite support from the US government and refugee settlement organizations, refugees may find it difficult to overcome relocation barriers. Financial constraints, food preference, and anxiety are some of the concerns hindering food security.  Reluctance to seek mental healthcare is a common problem. Many experience trauma prior to immigrating. Anxiety, depression, and PTSD are frequently encountered; yet NPs may find that refugees are reluctant to seek treatment due to cultural stigma.

As access and cost are two additional significant hurdles to immigrant health, NPs can play a very beneficial role in providing healthcare to this vulnerable population.  Furthermore, immigrants report high satisfaction rates for those receiving care from NPs. 

Important tips for the NP

  1. Stay alert for symptoms and signs of illnesses not often seen in the US but that may be present in refugees, particularly tuberculosis, measles, mumps, rubella, rabies, typhoid, pertussis, diphtheria, cholera, polio, chicken pox, Hepatitis A, Hepatitis E, scabies, malaria, leishmaniasis, and lead poisoning.
  2. Although an initial screening is completed in the immigration process, chronic diseases are not addressed and may have gone untreated for long periods of time.
  3. Routine healthcare recommendations may be unfamiliar or met with hesitancy. Being patient with refugees and being willing to educate them is crucial.
  4. All patients should be evaluated for malnutrition.
  5. Dental assessments should be included in physical exams.
  6. Female patients should only be seen by female practitioners. Males can be evaluated by either male or female.
  7. If caring for these refugees, verify their vaccination status.  Vaccines are part of immigration health services including COVID-19, flu, hepatitis, MMR, and Varicella vaccines.  

NPs strive to provide patient-centered and family-centered care to each patient they encounter.  To do this for Afghan refugees, they must understand their cultural environment.  Due to poverty, an unstable environment, and a lack of resources in Afghanistan, many refugees are at risk for illnesses that are not commonly seen in the US.  Many have endured trauma without access to mental healthcare resources.  NPs should adjust differentials to include communicable diseases, malnutrition, exposure to lead, and the effects of trauma.  As NPs seek to provide care to all members of an ever-changing community, this will include providing culturally sensitive care to Afghan families who have arrived in the US under the hardest of circumstances.