Advanced Registered Nurse Practitioner Care
Internet Edition, March, 1996, Volume 7, Number 3
Official Newsletter of ARNPs United

Table of Contents

What Shall We Call Ourselves???
by Patti Varly

At the February, 1996 ARNPs United Board Meeting, the issue of the name ARNPs United was discussed. The Board decided that since we are licensed in Washington State as Advanced Registered Nurse Practitioners we should use it! The name ARNPs United clearly defines itself as representing ARNPs of all specialties. ARNPs United has functioned well in bringing together advanced practice nurses of all specialties in our state.

Instead of changing the name, we believe it should be the mission of every individual ARNP to help educate their community and especially their legislators about what ARNP stands for and who we are. This is the title and name given to us by Washington state, let’s use it to our advantage.

General Membership Meeting in March Canceled Due to Lack of Response.
Proposed By-Law Changes will be Voted on by Mail.

Unified Physicians Seeking ARNPs to be Participating Providers
by Theresa Dodd, Director, Networks & Contracts Unified Physicians of Washington

Unified Physicians of Washington, a new health plan, is now offering participating provider contracts to Advanced Registered Nurse Practitioners. With ARNPs as participating providers, patients enrolling in Unified Physicians will have more choices among primary care providers. Unified Physicians plans to communicate with ARNPs over the next four to six weeks to talk about contracting with the company. If you have not received participating provider information or have questions about Unified Physicians, contact Kim Reed or Elaine Marans at 206.815.1888 or 800.418.0357.

Unified Physicians will reimburse ARNPs at the same level as primary care physicians for the same services. In addition, ARNPs can expect very responsive service from the company, already known for its commitment to establishing strong relationships with providers and setting the standard of excellence for patient care in Washington.

Unified Physicians, headquartered in Federal Way, was founded in 1994 by physicians in Washington state and began service to enrollees on Jan. 1, 1996. Its founding physicians wanted to offer consumers a health plan whose central focus is on the patient-caregiver relationship. Its intent is for caregivers to take the lead in combining patient satisfaction with sound cost management. Edmund W. Gray, MD, a family practitioner in Colville, is chair of the Unified Physicians board of directors, and Jim Peterson is president and CEO.

Today, Unified Physicians' network includes more than 4,000 providers and a majority of hospitals in the state. In addition, contracts have been signed with companies for services covering prescription drugs, durable medical equipment, home infusion therapy, vision, managed mental health and chemical dependency, and chiropractic services. The company intends to operate statewide by 1997.

Unified Physicians is a participating health plan with the state Healthy Options program and Basic Health Plan. In addition, the company offers three commercial products: preferred provider, point of service and closed-panel.

Recommended Childhood Immunization Schedule Update

There has been a lot of media coverage recently about FDA approval of the new varicella vaccine and the most recent Recommended Childhood Immunization Schedule, dated July 1995. Here’s where things stand on these issues at the state level.

The new ACIP/AAP/ACFP Recommended Childhood Immunization Schedule, published in July 1995, makes two recommended changes to the schedule adopted by the Department of Health in April 1995.

The new combined schedule adds the varicella zoster virus (chicken pox) vaccine for children between 12 and 18 months of age. Eleven and 12 year-olds who have not previously received the varicella vaccine or who have not definitively had chicken pox should receive the vaccine by age 13.

A three-dose series of hepatitis B vaccine is recommended for 11 and 12 year-olds who did not receive three doses of the vaccine as infants. This change in the schedule targets the adolescent population that missed the recommended childhood series of hepatitis B.

The July schedule will be on the agenda at the state’s Vaccine Advisory Committee meeting in late November. That committee’s recommendation will be forwarded to the Department of Health for consideration. We will keep you posted on the recommendations made concerning these vaccines.

If you have questions about the new combined schedule or state action related to the recommended schedule, call the Immunization Program at 360.753.3495.

More Immunization News

The March of Dimes has just published a new immunization brochure titled "Be a Good Parent-Vaccinate Your Child" that is available in English or Spanish. For a copy, contact Ruth Williams at the Western Washington March of Dimes office in Seattle at 206.624.1373.

The DOH Immunization Program is revising the School and Child Care Immunization Manual. The new edition will be easier to read and use and will incorporate changes in school and child care immunization regulations. An advisory group made up of people who regularly use the manual is guiding the revision process. The manual was last updated in August 1992. The Department expects the new manual to be available in early spring 1996. Questions? Call Joyce McCollough at 360.664.9655. New immunization public service announcements (PSAs) are available from CDC in Spanish. Contact HMA Associates in Washington, DC at 202.452.8764 for a packet which includes a list of Hispanic television and radio stations in the US; new immunization fact sheets in Spanish; a 30-second television PSA; and a 60-second radio PSA script.

A Free Immunization Video "Before It’s Too Late, Vaccinate" is also available. The 14 minute video, produced by the American Academy of Pediatrics (AAP), draws attention to the need for timely childhood vaccinations. The video is available in both English and Spanish, free of charge. The DOH Immunization Program has several copies of the video in English to loan out; call Joyce McCollough at 360.664.9655. Or to order your own copy contact the AAP’s Division of Public Education at 1.800.433.9016.

NPACE has joined ACNP

The American College of Nurse Practitioners welcomes NPACE as a new organizational member.

Information Needed
by Ted Ritter

One of the many challenges we face in the changing health care environment is how we are reimbursed.

When I recently sold my practice. I went from being in private practice in a rural community for 13 years where it was strictly fee for service and insurance payments (from those companies that were forced to accept ARNPs) to working for a large organization and being salaried. The push in my organization is toward production based reimbursement, similar to the physicians. While this sounds good on the surface it will force us to embrace the medical model more closely. In order to be reimbursed fairly we have to increase production. This means seeing more patients more quickly and not having the time to do what we all do best. We all have different styles of practice and some of us are comfortable with "cranking out the patients". Most of us, however, are not. Our practice is more esoteric than the bottom line. Educating our patients, listening, preventive care, being patient advocates, anticipatory guidance, holistic care, are the areas in which we all excel if given the opportunity.

But, you guessed it, there are no good methods of tracing these and being reimbursed for them. If, as expected by many, the predominant type of coverage becomes one of managed care, our unique strengths as professionals should stand us in good stead, if we can develop and successfully present reimbursement strategies. It is incumbent on us as a profession to come up with ways to track how we practice. We must be able to document and quantify cost effectiveness, patient satisfaction, patient compliance, patient outcomes and production.

We have to be able to justify and demand higher salaries based on these findings. We have to stand up to the administrators and let them know that it is not OK to have a 6 figure difference in salaries between MDs and NPs and PAs. Especially not if you are working side by side in the same clinic and essentially seeing the same patients. The huge discrepancies in reimbursement between professions are not acceptable. We as a group must no longer be willing to settle for what "we can get" or be afraid that we will price ourselves out of the market. We must prove that we are worth much more.

I challenge those of you who are students to use your research expertise (and theses) to help generate the data we need. I challenge educators to teach their students the realities of 20th century salaries, let alone 21st. I challenge those of you working for organizations to be more aggressive. I challenge those of you in private practice to stay there. Believe in your power, believe in your skills. I await your input and most especially your insights.

First National Midwife Study Released

An article by Jane Berkowitz printed in the Kansas City Nursing News, January 15, 1996, describes a recently released 254-page consumer guide entitled "Delivering a Better Childbirth Experience." It describes 414 hospital based nurse-midwifery practices and 41 free standing birth centers in 47 states. A companion report for use by policy makers (Encouraging the Use of Nurse-Midwives) was also released by the Public Citizen’s Health Research Group. The study is quoted as stating that the "...Increased use of certified nurse midwives is an excellent example of how the quality of care can be increased while saving money on health care costs.." The costs referenced are those associated with unnecessary medical interventions.

Interestingly, 64% of the respondents (practitioner) indicated feeling restricted by hospital policy, doctor policy and state law. Key barriers included lack of admitting privileges, limits on prescribing privileges, policies that assume a medical model of care for everyone, and lack of information about CNMs in the community.

To purchase a copy of the Consumer’s Guide and Report for Policy Makers, send $15.00 to the Public Citizen, Consumer Service, 1600 20th St. NW; Washington DC 20009.

ARNP Privileges

As we enter the 1996 legislative session, it is interesting to note the nationwide efforts engaged in by Advanced Practice Nurses of all specialties to seek prescriptive privileges (or to expand those held), to obtain hospital admitting privileges and third party reimbursement. It is also worth noting the high regard Advanced Practice Nurses in other states have for those of us in Washington and Oregon because of the strides made to secure professional autonomy for advanced practice nurses. As we embark on a session which as always will be fraught with many stressful choices, we must all take a moment to understand the benefits of working in a state that has been among the first to recognize the value of granting advanced practice nurses a broad scope of practice. The increased interest across the country in issues that are near and dear to our own hearts creates a hopeful backdrop for our legislative energies. The very fact that both Republicans and Democrats have crafted bills to provide reimbursement for ARNPs is a clear message that we have come to the proverbial table.

Recycle Old Nursing and Medical Journals

For those of us who have begun to be buried in old journals or health care books, there are at least two places that would be quite grateful to receive them.

International Medassist is helping to set up medical libraries in Lithuania and other ex-Soviet areas. They are located at 40 Hillcrest Road, Belmont, MA 02178. The World Bank Volunteer Services; The Margaret McNamara Memorial Fund will accept books and journals sent to it in the Greater Washington DC area. They will ship them throughout the world to vetted sites. They pay all shipping costs. This organization can be reached by calling 202.473.8751.

Classified Ads

College of Nursing Professor

University of Texas at El Paso, Medical-Surgical Nursing, College of Nursing and Health Sciences: Full time tenure track, positions to begin fall semester 1996. Three positions are open: Professor, Associate Professor and Assistant Professor in Nurse Midwifery, Family Nurse Practitioner and certification in area of specialty required. Teaching experience preferred. Salary competitive and commensurate with experience. Excellent opportunity in a comprehensive University that services a bicultural community. All programs accredited. Send letter of interest, curriculum vita and listing of three current references (name, address, telephone) to: Helen M. Castillo, PhD, RN, CNA, FAAN, Chair, Department of Nursing, College of Nursing and Health Sciences, 1101 N Campbell, El Paso, TX 79902. Positions open until filled. UTEP does not discriminate on the basis of race, color, national origin, sex, religion, age or disability in employment or the provision of services.

Family Nurse Practitioner

Kaiser Permanente has two positions available for a Family Nurse Practitioner at our medical office Longview/Kelso, WA, a primary care group of 17 physicians and seven allied health staff. One position is 16 hours/week in the urgent care clinic on Fridays and Saturdays. The second position is temporary, 24 hours/week, from June through August and involves primarily women’s health care. Forward resume to Judy Parmenter, Kaiser Permanente, 500 NE Multnomah, Suite 100, Portland, OR 97232, or call 503.813.3874 for more information. EOE.

Planned Parenthood ARNP

Planned Parenthood has a part-time clinician opening in our Bremerton Clinic. Requires at least two years experience as practicing NP and current WA State RN & ARNP (WHNP, FNP, Adult NP or CNM) licenses. Please mail CV/resume to PP/HR, 2211 E Madison, Seattle, WA 98112. EOE.

Nurse Practitioner

24 hours/week position with SW Washington Health District. Comprehensive health care to women and men: history, physical, counseling and education; primarily Women’s Health Care (birth control methods, testing/treatment of STDs). Requires WA State ARNP certification, prescriptive privileges, one year of clinical practitioner experience. Submit District application form to Personnel Coordinator, 2000 St. Vancouver Way, Vancouver, WA 98663. 360.695.9215 EOE.

Pediatric Nurse Practitioner

Part-time or full-time opportunity for a PNP to join our premier pediatric practice of 5 Peds and 2 PNPs in twin city community of Longview and Kelso, WA, one hour north of Portland. Good schools and great community with all advantages of rural living. Competitive salary and benefits package with exceptional working environment. Contact Blaine E. Tolby, MD, Ph.D, 971 11th Ave, Longview, WA 98632, phone 360.577.1771.

Family Nurse Practitioner

Looking for positive, outgoing, self-motivated FNP with sense of humor to join staff of Family Practice office and provider with similar features (1 MD, 1 ARNP). Comprehensive health care for men/women, pediatrics to geriatrics. Strong women’s health component including obstetrics, colposcopy. Excellent location, well- incorporated into Valley Medical Center’s medical community. Part time/full time. Requires WA State ARNP certification, prescriptive privledges, 1 year clinical practitioner experience. Send CV to Sherilyn Cook, MD or Fran Morgen, ARNP at 4300 Talbot Rd S., Ste 400, Renton, WA 98055 or call 206.656.5070.

Continuing Education

Clinical Pharmacology Series 1996

March, 1996. A series of six one-day courses (8 hr sessions) is designed as a pharmacology update for NPs working in a variety of specialties, including Neonatal, Pediatric, Geriatric, Adult, Women’s Health and Neuropsychotropic Drug Therapy. Sponsored by the U of W School of Nursing. The first session begins March 2, 1996. For further information, please contact Sheila Keener at 206.543.1047.

Psychopharmacology of Anti-Depressants Seminar

April 20, 1996. This Saturday seminar for psychosocial/mental health clinical specialists and ARNPs will address a variety of topics related to the use of antidepressants. How do abnormal lab values affect prescriptive decisions? What is the role of polypharmacy in treating depression: Where do antidepressants fit in with hormone replacement therapy for perimenopausal and menopausal women? A panel of practitioners will discuss prescribing for the depressed patient using selected case studies. The panel members will facilitate discussion groups at the luncheon. Contact Pacific Lutheran University CCNL, Phone 206.535.7683, Fax 206.535.7590, Internet bennettl@PLU.edu.

Washington State Chapter of the National Association
of Pediatric Nurse Associates and Practitioners

May 2 &3, 1996. This seminar is titled "Pediatric Update 1996" Keeping our Kids Safe and Healthy. CEUs: May 2-7.2 advanced practice credits, May 3-7.0 pharmacology credits. Location: Shoreline Conference Center. Contact: Susan Kline, phone/fax 206.781.3287, for further information e-mail skline@u.washington.edu.

Current Concepts in Pediatric Acute Care

May 4, 1996. Saturday at Jackson Hall Auditorium in Tacoma, WA. Presented by Mary Bridge Children’s Hospital, MultiCare’s Department of CME & Pediatric Critical Care, P.S. For more information please call 206.552.1493.

Pharmacotherapeutics for ARNPs

May 17, 1996 Friday. A variety of pharmacotherapeutic topics of interest to all ARNPs specialties will be presented in general and concurrent sessions. Location: Best Western Executive Inn, Tacoma, WA. Contact Pacific Lutheran University CCNL, Phone 206.535.7683, Fax 206.535.7590, Internet bennettl@PLU.edu.

Ad Information

Copy deadline is the second Tuesday of the month prior to publication. Ads may be accepted later than this on a space available basis. Position Available Ads per insertion of less than 66 words are $45, of 66 to 130 words are $75. Continuing Education Announcements per offering for up to three (3) insertions of a BRIEF description are $35, sponsoring organizations of ARNPs United may publish CE announcements at no charge. New Product Announcements per product for one insertion of 130 words or less are $75. Ad Inserts are $480 for one issue. All ads are subject to space limitations and editing. Call for detailed rate information. Mail copy to ARNP Care, 220 Railroad Ave N, Kent, WA 98032. Phone 206.852.9042. Fax 206.480.0002. E-mail care@nurse.org

Please Join Us!

You may believe that because this newsletter arrives every month you are a member of ARNPs United. That is wrong. Since 1989 ARNP Care has been sent to every ARNP in Washington regardless of membership status. This is in imminent danger of stopping due to a lack of funds. Remember the number of members is what makes an organization strong and credible with the legislature and others. So join us today. Individual memberships are $150 per year. Lifetime memberships are $1000. Students currently enrolled in an ARNP program may join for $50 per year. Make your check out to ARNPs United and mail it to: ARNPs United, 212 Railroad Ave N, Kent WA 98032.

Nurse Practitioner Support Services
212 Railroad Ave N, Kent, WA 98032. Phone: 253.852.9042 Fax: 253.852.7725
npss@nurse.net
Copyright 1998 Nurse Practitioner Support Services