Practice of a Pediatric Nurse Practitioner

PNP Job Arizona

2009-07-08T23:40:00.000-07:00

Enjoy a life style of a four day work week. Excellent opportunity to join a financially sound premiere private practice with two locations in central Arizona's Red Rock wine country. Spanish speaking a plus not a must. Clinics are in scenic Verde Valley where the elevation is 3500 ft and provides a four season climate. Ample opportunity to explore outdoor activities. For more information about the practice please email CV to:

jjaraczewski@qwestoffice.net

PNP Job Boston, MA

2009-07-08T00:32:00.000-07:00

Our Pediatric Telecom group answers concerns and questions outside of regular clinic hours and works collaboratively with other clinicians delivering comprehensive care. The demonstrated ability to assess clinical problems, determine priorities of care, design and implement a treatment plan and seek and utilize consultation appropriately are essential. Two to four years of pediatric primary or urgent care experience is preferred. The NP must have graduated from a master's level state and NLN approved NP program and possess state licensure to practice in the expanded role. Schedule / hours are: 6p-10p,6p-12a, 9p-8a including every other weekend and holiday.

There is a part-time opportunity (20 hours/week) available. This position will include a minimum of two 9p-8a shifts per month with the remainder of hours made up of 6p-10p or 6p-12a shifts to equal 20 hours per week.

There is also a full-time temporary opportunity for six months – September ‘09 through February ’10. Schedule is three 12 hour shifts 8 p.m.-8 a.m. including every other weekend and holiday. Total 36 hours per week. This is a temporary position for Sept 09 - Feb 09.

Pediatric Urgent Care:

Braintree – 8 hours/week, either two weekends / month or every Saturday or every Sunday each week.
Chelmsford – Per Diem, weekends and holidays
Boston/Kenmore – Per Diem, evenings and weekends
Wellesley – Per Diem, Saturdays, 9-3

Visit our website at: www.harvardvanguard.org

Harvard Vanguard Medical Associates, a 501(c) (3) non-profit corporation, is a multi-specialty, multi-site physician group providing comprehensive healthcare services to approximately 450,000 patients across eastern Massachusetts. A nationally recognized leader in clinical quality, Harvard Vanguard doctors are affiliated with premier Boston-area hospitals. Harvard Vanguard’s outstanding staff of 4,000 employees includes over 600 physicians and 1000 other healthcare professionals such as nurses, physician assistants, speech therapists, and physical therapists. Harvard Vanguard is an affiliate of Harvard Medical School, and many of its physicians teach or support clinical research. Harvard Vanguard is the largest affiliate in Atrius Health.

HISTORY
Harvard Vanguard Medical Associates was originally incorporated in 1969 as the Harvard Community Health Plan, which in 1994 became Harvard Pilgrim Health Care. In 1998, the physicians and other staff of today’s Harvard Vanguard group practice separated from Harvard Pilgrim and incorporated as an independent physician group. Harvard Vanguard physicians remain committed to the highest quality care, medical education, clinical research, and to partnership with their patients to improve their health and well being.

LOCATIONS
Harvard Vanguard’s multi-specialty medical group practice delivers health and wellness services at 21 office locations in eastern Massachusetts. Most of our locations feature convenient on-site laboratory, imaging services, and pharmacy.

APPLY FOR THIS JOB
Contact Person: Sheila O'Connell
Email Address: sheila_o'connell@atriushealth.org

Phone: 617.559.8275
Fax: 617.559.8255
Apply URL: http://www.harvardvanguard.org/careers

PNP Job Georgia

2009-07-03T00:59:00.000-07:00

PEDIATRIC NURSE PRACTITIONER—Covington, GA—Hospital affiliated practice seeking an additional F/T CPNP. Competitive salary, excellent benefits including medical, dental and malpractice liability coverage. Covington is located 34 miles east of Atlanta on I-20, and has been rated as one of the top 50 small towns of the south. Mountains and coast are great day trips. The community offers public and private schools along with several colleges and universities nearby, numerous cultural and recreational activities and reasonable housing.

Contact Person:	Pamela Miller
Email Address:	pammillercp@bellsouth.net

Phone:	770-787-4205
Fax:	770-787-5050

Cracking The Autism Riddle: Common Sense About Vaccines And Autism

2009-06-28T23:06:00.000-07:00

Cracking The Autism Riddle: Common Sense About Vaccines And Autism

by Harvey Karp, pediatrician and faculty at UCLA

Original article from the Huffington Post.

All sorts of arguments are thrown around to persuade parents that shots threaten their children with autism. I'd like to discuss 4 of the commonly repeated concerns, 3 flawed...and 1 that I think has merit.

1) Too many shots can overwhelm a child and cause autism. No!

Babies get more vaccines today than 30 years ago, but if you think that means more things are injected into their young bodies...you'd be wrong! That's because immunizations today are much more purified than those of the past.

For example, in 1980, the DPT shot (Diphtheria/Pertussis/Tetanus) was made from a soup of blendarized bacteria (over 1000 different illness particles - antigens - all mixed together). And, the polio vaccine had live virus that actually protected children by triggering a minute case of...polio! Today, our modern DPT vaccine is highly purified, containing only 3-5 bacterial antigens and the polio shot has absolutely no live virus.

Actually, the current trend to give kids more shots is a win-win for them. They win because they're protected from many more illnesses and because they have fewer antigens put into their bodies.

But, some still worry, "Can too many shots overwhelm a baby's immature immune system?" That idea is pretty close to a baby urban legend.

The immune system is a superb multitasking, fighting machine. Every day, babies are bombarded by thousands of threats: irritating pollen; colonic microbes; bacterial invaders from the skin, eyes, nose, mouth; viral swarms; offending dietary proteins; damaged cells; even tiny, little cancers. The immune system's magnificent ability to protect against many, mild attacks at one time is exactly why most babies tolerate several shots at once with no reaction whatsoever. (In fact, a new theory suggests that allergies and asthma may be on the rise in part because we have made the world so clean it doesn't exercise a baby's immune system enough!)

2) Shots hurt the brains of extra-sensitive children. No!

Each of us has special sensitivities. Some have peanut allergies...some get lots of strep throat....and a very, very few get serious reactions to vaccines. I wish we had a test to detect which infants are susceptible to severe measles or big vaccine reactions, but no such test exists.

The good news, however, is that shot risks are tiny compared to the risks of full-blown illness. For example, influenza and chicken pox hammer the immune system 100-1000 times harder than the impact of the flu or pox vaccines. While most kids breeze through the chicken pox shot, even a mild case of real pox can weaken a child's immunity for weeks to months and lead to ear infections, pneumonia and, rarely, toxic shock syndrome. (And, it can often land an adult in the hospital!)

There is one special case of possible vaccine susceptibility that made headlines last year and became a major new focus for those who claim vaccines cause autism. A 19-month-old child developed autism after getting 5 shots. But - and this is a huge "but" - unlike most autistic kids, this one child also has a rare medical problem - Mitochondrial Disease (MD).

Recently, vaccine avoiders have floated the theory that perhaps many healthy looking kids have hidden MD. They suggest that it may be the combination of vaccines plus hidden MD that is triggering autism in so many seemingly normal children.

But, the research suggests that this is unlikely to affect more than a handful of kids. Here's why:

MD is rare (1 in 5-10,000 children). A Portuguese study found ~93% of autistic children had no evidence of MD (and even that 7% figure has yet to be confirmed). In a recent study, scientists from Harvard and Johns Hopkins could find only 25 children with both MD and autism. And, these kids had serious problems rarely seen in most cases of autism (like, delayed walking, acid reflux, liver disorder, severe fatigue, etc).

Fourteen of these kids seemed to be developing normally then suddenly deteriorated into autism during toddlerhood. But only 1/14 (7%) got worse right after shots. (Had 2 or 3 or 5 kids gotten worse after the shots, one could make the argument that children with MD are at increased risk for getting autism after vaccinations. However, as I mentioned in part 1 of this blog, 7% is very close to the number of cases one would expect to be diagnosed right after shots...just by chance.)

Another dramatic finding of this study argues against a link between MD and the national rise in autism incidence: classic autism spectrum disorder affects many more boys than girls (3-9 times more boys!)...but children with Mitochondrial Disease + autism are evenly split between the genders.

While it remains to be proven that children with MD are more vulnerable to shots, there is no doubt that they are super-vulnerable to illness. In other words, MD kids who skip shots can get very sick, very fast it they catch a vaccine preventable disease like influenza or pneumonia.

3) Doctors push risky shots on children to make more money. Please!

This accusation is as appalling as it is ridiculous. Pediatricians labor through 23 years of education; wake at all hours to help worried parents; and desert our own families on weekends and holidays to rush to the hospital to care for sick babies.

In fact, a greedy doctor wanting more money would actually discourage parents from giving their children shots...not encourage it! Why? Because doctors make more money caring for sick kids - needing repeat office visits - than caring for the well.

In truth, the only reason doctors cajole, beg and pressure parents to immunize their children is because we want to protect them - and other children - from the pain and suffering of preventable infections.

I agree that there are too many ties between doctors and big pharmaceutical companies. This must be stopped because it creates the appearance of conflict of interest and the real potential of collusion. However, the record of organized medicine is reassuring. Over the past 30 years, doctors have rejected many vaccines when concerns arose that they were not effective enough or caused unacceptable side effects.

4) Shots can be delayed. MAYBE...but only those risking your child's health.

This is one of the most critical issues facing parents: Are shots a personal choice or a civic duty?

As a pediatrician, I recommend all vaccines, but I suggest parents think of shots as falling into 2 different groups: 1) those given primarily to protect your child, 2) those protecting your child and your neighbors' children.

The first group of shots stops infections like, influenza, rotavirus, hepatitis A, chicken pox and hepatitis B. They help your child but don't give great protection to the community. That is either because the illnesses are very common (spread quickly through your neighborhood even if your child gets the shot) or hard to spread (difficult for your child to give it to others). (Note: Older kids, teens and adults are at risk for hepatitis B. It has caused thousands of cases of liver failure and cancer and so all citizens should eventually get this vaccine.)

The second group of shots stops infections that threaten your child and your community (your neighbor's baby, the elderly, chronic disease sufferers, etc.). These shots include, whooping cough, meningitis (Hib), pneumococcus (Prevnar) and measles. They miraculously halt diseases that are so contagious just one cough, one airplane flight or one germy doorknob can spread them like wildfire through your town.

I believe giving the first group of shots is a parent's personal choice because the suffering you risk is mostly limited to your child and family. Skipping the flu shot, for example, may cause your child to be one of the 36,000 Americans who die from influenza this year, but it probably won't stop a flu outbreak (although it may help to reduce it).

However, giving the second group of shots is an important civic responsibility., because delaying them creates a serious public health risk. By immunizing at least 95% of children with these shots we create "herd immunity" that can totally halt the spread of deadly epidemics in our communities. Herd immunity stymies the spread of disease the way that frequent rain keeps lightening strikes from starting raging forest fires.

Some doctors may fairly argue which vaccines should go into which groups, but the important point is that the shot schedule has some flexibility...it is not written in stone. In fact doctors have repeatedly tweaked this schedule to make it safer and more effective (for example, over the past 30 years, the measles vaccine was pushed from 9 months to 12 months...and now is recommended to be given as late as 15 months of age). However, the second group of vaccines is crucial if we are to protect children in our communities who are too young to get their own shots. Parents who skip these shots may not mean to harm others, but their action significantly increases the risk of avoidable suffering and death to innocent children.

For over 10 years, a huge amount of passion and debate about the cause of autism has focused on vaccines. But recently a totally new suspect has surfaced that warrants investigation as a potential autism trigger. In the last installment of this 3-part blog, I'll discuss the worrisome compounds known as...endocrine disrupting chemicals (EDCs).

New Parents Notice

2009-06-28T22:21:00.000-07:00

My daughter recently turned 1. This was a milestone for her as it was for me. I have survived sleep deprivation, turning into a cow, neurotic cleaning, and endless worry. But let me elaborate on each of these points:

Sleep deprivation: No matter how many friends, nurses, parents, and grandparents tell you how difficult the newborn period is, you have no idea until you go through it yourself. Sleep deprivation does amazing things to new parents and surprising things to a couple's relationship. As a parent, I thought the first week at home with Maia was a breeze, relatively speaking. It was hard work, but I was happy to do it. Around week 2, however, things changed as the sleep deprivation kicked in. I had no patience for my poor husband, nothing was good enough, and everyone was wrong. Even now as I look back, it is all a blur. As a pediatric healthcare provider, my priority is the safety and well-being of my pediatric patient, and that often includes their parents. I ask parents, "how's it going?", and usually get a half-truth response... "Oh, we're doing fine, a little tired but fine." While I am sure that they are doing fine, I often like to probe a little deeper. I strongly believe that every mother of a newborn needs at least 1 support person that they are NOT related to. Husbands - are wonderful but are often sleep (and sex) deprived. Mothers - can be both helpful and anti-help, i.e. you end up helping them to help you. So having a support person, such as a friend or neighbor who can offer objective, sound advice and help will go far to help a new mom find her way. On several occasions, when I have asked a new mom how things are going, I get the "fine" response. When I dig a little deeper, the next thing I know, mom is teary and wondering how she will survive the first year. I tell moms: it gets better, and every 2AM feed and 3AM diaper is worth it for every snuggle and smile you get back. Yes, parenting is hard and challenging - it's supposed to be. Unlike other species, we keep our young with us till their at least 18 years old, sometimes longer! We want to give our child every advantage. So, as for that sleep deprivation, I know you're heard this: sleep when you can, sleep when the baby sleeps. Well, I do tell my patients that. But I also know that every mom needs to figure it out for themselves, find their own path of motherhood.
Turning into a cow. "Breast is the best." Even formula companies will chime in with this motto, as they promote their products. Here are my thoughts on breastfeeding. I agree that in most situations, breastfeeding provides optimal nutrition and immune system protection for most babies. The decision to breastfeed is a very personal one. I have recently noticed a stigma on the rise for women who use formula or a bottle, and I strongly feel that that angst is poorly placed. I know of many women who gave breastfeeding their best effort for several months, and for a variety of reasons, it did not work. One woman, a friend, told me she felt guilty that she wasn't able to breastfeed, and I told her to forget about it! It doesn't matter! She gave it every effort, trying for 2 months. And looking at her now 7-month old daughter now, she is healthy, happy, and got the thigh fat rolls to prove it. ---- Even if a mother chooses not to breastfeed, it is still her choice, and society should not look down on her.---- Another thought on breastfeeding is the myth that when you start breastfeeding, the baby latches right away and a choir starts singing in the background. Breastfeeding, while wonderful in many ways, does not usually have such a glorious start. What many people do not tell you (or forget to), is that breastfeeding takes patience and a commitment. For starters, it can be REALLY painful. As engorgement settles in, your breasts no longer feel like they are part of your body. Instead they are these hot, hard alien appendages that, despite their size, seem slow to produce milk those first several days. Then you have the opposite problem - leaking. Now, not all women experience either of these issues, but many do. And many wonder, "is this normal?" "Am I making enough milk?" "Am I making too much? Sound like he's drowning!" ---- Breastfeeding in itself is a journey, an individual journey unique for every mom. So if you are a breastfeeding mom, and no one has told you yet today: you are a great mom. You are doing a great job.
Neurotic cleaning. I once asked my husband, what did we do all the time before our daughter was born? The answer was, "nothing". Now and free time (i.e. non-baby time) is spent cleaning and organizing. And just when it is all clean, it is time to start at the beginning again. When laying in bed at night, I think about what I did for the day and what I need to do tomorrow. If I start thinking about a particular mess, say in the kitchen, I will not be able to sleep. I will get up and clean it. Once the house is clean, then I can relax (ha!). This required sense of order was to me once I had a baby. As a health care provider, I ask new parents about this new sense of order and clean and how they deal with it. I advise parents to pick their battles, i.e. the kitchen or the bathroom for the evening. And then I also advise them to prioritize. An important lesson for me as a parent has been LETTING THINGS GO. Everything cannot be tidy and clean all the time. I do not want to sacrifice time with my family to clean the bathroom. I want to be the parent who is present and participating. I advise my patients to do the same.

When your child turns 1, it is a celebration for everyone. I encourage parents to celebrate for themselves as much as for their child. The first year is a roller coaster of self-sacrifice, setting boundaries, and discovering a new "parenting" you.

So...

Dear Moms & Dads:

You are doing a great job. Keep up the good work.

NAPNAP and US Preventative Services Task Force Unite

2009-06-28T22:20:00.000-07:00

For Immediate Release from NAPNAP.org

Contact: Felicia K. Taylor, Director of Membership, Chapters and Communication

Phone: 856/857-9700

Fax: 856/857-1600

Email: ftaylor@napnap.org

NAPNAP is an official partner of the U.S. Preventive Services Task Force

CHERRY HILL, NJ (June 11, 2009) - The National Association of Pediatric Nurse Practitioners (NAPNAP) has accepted an invitation to join the U.S. Preventive Services Task Force (USPSTF) as an official partner. NAPNAP has selected Carolyn Jaramillo de Montoya, MSN, CPNP to serve as the NAPNAP representative to the USPSTF.

The mission of the USPSTF is to evaluate the benefits of individual services based on age, gender, and risk factors for disease; make recommendations about which preventive services should be incorporated routinely into primary medical care and for which populations; and identify a research agenda for clinical preventive care.

As part of her responsibilities, Carolyn will coordinate the review of USPSTF recommendation statements and other materials. She will work with NAPNAP to help increase the dissemination and implementation of the USPSTF recommendations to the general public and will use materials that are developed from them, including publications, tools and other resources.

“I am delighted to appoint Carolyn to represent NAPNAP on the USPSTF. She will bring a wealth of clinical expertise to this group in the areas of obesity prevention, over weight issues in children and recognizing cultural differences in families. She is a brilliant collaborator and will serve NAPNAP well” said Linda Lindeke, NAPNAP President.

Carolyn will serve as the NAPNAP representative to the USPSTF for two years.

PNP Job Bayfield, WI

2009-06-28T22:13:00.000-07:00

RED CLIFF COMMUNITY HEALTH CENTER

P.O. BOX 529

BAYFIELD, WI 54814

JOB DESCRIPTION

POSITION: Pediatric or Family Nurse Practitioner

EXEMPT POSITION

LOCATION: Red Cliff Community Health Center

REPORTS TO: Health Director

Pediatrician

SCHEDULE: Full time, forty hours per week

WAGE: Negotiable, depending upon qualifications

GENERAL:

The NP will implement the Healthy Steps program in our primary care setting, bridge services for children and families served at the Red Cliff Early Childhood Center, work collaboratively with the public health nurse to provide periodic coverage for perinatal services and offer primary care services in the pediatric setting.

This position is expected to evolve over a period of 4 years. The initial months will primarily entail training and administrative duties. From January 2010 through June 2010, this position will provide selected MCH public health services while the MCH nurse is on leave. The position will eventually integrate a primary care component within the Healthy Steps well care model. Supportive services to the tribal Early Childhood Center will be provided from time of hire forward.

DUTIES AND RESPONSIBILITIES:

HEALTHY STEPS SPECIALIST:

Train in and then educate Health Center staff in the principles of a Healthy Steps pediatric practice, facilitating systems changes needed to implement the Healthy Steps program in a culturally appropriate and sensitive way for the Red Cliff community.
Educate parents using the Brazelton Touchpoints and Healthy Steps models (including the Newborn Observation) and additional tools with the aim of providing anticipatory guidance and providing strategies for prevention, intervention and management of common childhood developmental issues. Necessary training will be provided.
Coordinate with the Red Cliff LAUNCH initiative and Red Cliff Health Center staff to identify community, county and state resources available to our clients and follow up as needed.
Establish billing capacity for Case Management services for children ages 0-8 with special healthcare needs.
Provide outreach to families including: maintain a parent-to-parent bulletin board, cooperate with public health staff in writing/distributing newsletter; maintain a lending library, and participate in selected community-based groups and events.
Develop and staff a Child Development Information Line (telephone).
Coordinate with ABI medical society to maintain and further develop our “Reach Out and Read” program.
Provide training & support for appropriate staff and community members as needed.
Establish and facilitate Healthy Steps parent groups.
Administratively responsible for Healthy Steps reporting requirements.
To best serve the needs of families, work collaboratively with clinic and community health staff to bridge primary care and community health services.
Cross train in maternal & child health (MCH) nursing duties and be able to provide services to expectant and post-partum families as needed. This includes (temporary) clinical oversight of the MCH outreach worker who will provide Pre-natal Care Coordination (PNCC) services to families.

PRIMARY CARE:

Systematically assess, identify and initiate therapeutic management of acute, chronic illness and medical conditions in children.
Make health care decisions based on currently accepted medical and nursing science and the patients’ particular situational, family and cultural determinants.
Follow established protocols for therapeutic care under the direction of the pediatrician.
Use physician consultation and refer clients with health problems which are beyond the scope of the Nurse Practitioner’s practice.
Document patient care activities and maintain patient medical records in accord with clinic policy, sound professional practice and State, Federal laws.
Provide telephone consultation/triage for the Early Childhood Center (ECC) staff.
Provide vision and hearing screenings in a timely manner as required by Head Start regulations for children at the ECC who need this.
Coordinate with ECC to ensure that all children in the community receive at a minimum one oral screening per year and fluoride varnish as needed/indicated.
Provide home visits to assess individual and family health needs, providing appropriate intervention and/or referral to health care provider as needed (Case Management).
Conduct Healthy Steps developmental screening at home visits at recommended or requested intervals.
Teach and model to individuals and families techniques of disease prevention and positive health/lifestyle behaviors.
Provide immunizations to children as part of standard care and by working with the community health department to include monthly immunization (WIC) clinics and outreach during times of increased need such as influenza season.
Oversee and provide nursing services during monthly WIC clinics. This includes preparation for clinics and providing screening and direct services on clinic days.
During Health Director approved 6-month leave of absence for the maternal child health nurse, NP may be asked to provide some nursing duties within the auspices of Red Cliff Community Health.

GENERAL STANDARDS

1. Complete monthly, quarterly, and annual reports as required by Health Center Administration, and regulatory bodies. Maintain a record of supporting documentation as required.

2. Participate in quality assurance and other efforts that assure appropriate care and services.

3. Adhere to and support facility policies, programs and activities.

4. Maintain strict confidentiality and safeguard the privacy of patients.

5. Present a professional, caring image for the Health Center and its programs.

a. Maintain a cooperative relationship with other Health Center staff and tribal employees.

b. Demonstrate tact, courtesy, and respect in communication and interaction with Health Center patients, visitors, and staff and with outside agencies and programs.

c. Promote a working environment noted for effective cooperation and collaboration between programs, services, and co-workers.

d. Dress appropriately to promote professionalism within the Health Center.

6. Advance job knowledge and skills through continuing education efforts after approval of Health Director.

7. Responsible for communication within the department and across departments to ensure that information is shared for effective operations.

8. Attend staff and other meetings, in-services, and other events as directed by supervisor.

9. At the direction of the Health Director, participate in the implementation of grants, contracts, or projects being carried out under the auspices of the Red Cliff Community Health Center. These activities will comply with the directives of Tribal and Health Center Administration. Specific duties will reflect the conditions and stipulations of individual grants, contracts, or projects and the concurrent needs and resources of the Health Center, and will fluctuate due the nature of such programs.

10. Responsible for maintaining a clean and safe environment.

11. Perform other duties as assigned.

SUPERVISORY AUTHORITY: None

KNOWLEDGE:

1. Knowledge of or willingness to train in the Healthy Steps model of Well Child Care and the Brazelton Touchpoints approach to Parental support.

2. Demonstrated flexibility to work on an interdisciplinary team.

3. Ability to work with infants, small children, and adolescents.

4. ACLS certification or willingness to acquire.

5. Ability to plan, coordinate and direct varied and complex operations.

6. Good communication skills both written and verbal.

7. Personal abilities and maturity to function in a fast paced environment; to work with a diverse population (clients or patients, co-workers, professional staff, administration, outside agency staff, and the general public).

QUALIFICATIONS:

1. Advanced Practice Nurse Prescriber

2. Eligible for or holding a current license to practice as a Nurse Practitioner in the State of Wisconsin.

PERSONAL CONTACTS:

Daily contact with patients, visitors, primary care providers, Tribal and Health Center Administration, and other Health Center and Early Childhood Center staff.

WORK ENVIRONMENT:

1. Office and clinic settings at the Red Cliff Community Health Center, Red Cliff Early Childhood Center and other private homes and community based settings.

2. Exposure to hazards of the health care industry.

3. Work setting must be maintained as a clean, nonsmoking, well-ventilated area in compliance with all applicable safety regulations. These safety regulations will not necessarily be met in private homes and other community settings.

PHYSICAL REQUIREMENTS:

The duties assigned to this position involve bending, stooping, lifting, and carrying. Items may be placed on overhead storage. Lift up to 50 pounds, assisting patients onto exam tables as necessary. Work requires regular and recurring periods of standing or walking.

TRAVEL REQUIREMENTS:

Must have valid WI driver’s license, vehicle, and at least liability insurance. If no insurance, must get within three weeks. Must also be eligible for the Tribe’s vehicle insurance.

May require overnight travel to attend meetings or training. May be asked to perform visits to patient homes.

POSTED: May 18, 2009

DEADLINE: July 18, 2009 at 4:00 pm or until filled

FOR FURTHER INFORMATION CONTACT:

Red Cliff Personnel Office

88385 Pike Road, Highway 13

Bayfield, WI 54814

(715) 779-3706 ext. 267 or 268

rwygonik@redcliff-nsn.gov

The Red Cliff Community Health Center is a Drug-Free Workplace in accord with the Drug-Free Workplace Act of 1988, P.L. 100-690, and has a Drug-Free Workplace Policy in effect. All new hires are subject to drug test prior to starting.

All applicants for employment with the Red Cliff Tribe will be subject to the background investigation and other requirements of RCCL Chapter 43, and are under a continuing obligation to supplement this application for employment with information concerning any convictions that occur after commencement of employment with the Tribe.

This job description is subject to change at employer’s discretion, after consultation with the employee.

PNP Job Vermont

2009-06-28T22:11:00.000-07:00

Central Vermont Medical Center, a community hospital is located in Berlin, Vermont is recruiting a Pediatric Nurse Practitioner for our outpatient office. Our practice, Associates in Pediatrics, currently includes 2 physicians and one NP. We are recruiting for another physician as well. The Nurse Practitioner is an integral part of the practice and works closely with the staff and physicians. The practice recently moved into a beautiful new office which provides ample space.

We offer a comprehensive benefits package as well as tuition loan repayment support.

Vermont offers a special quality of life with easy access to 4 season of outdoor activities, excellent schools and the option to live in town or buy property with some acreage.

Please take a look at the following websites to learn more about us.

Central Vermont Medical Center: www.CVMC.org

Greater central Vermont Community: www.central-vt.org

Contact Person:	Sarah Child
Email Address:	Sarah.Child@cvmc.org 802-225-1739

Support for Nursing Faculty

2009-06-15T14:47:00.001-07:00

Interest in nurse retention and faculty remains strong on Capitol Hill.
Representative Carol McCarthy (D-NY) this week introduced the “Nurse
Training and Retention Act of 2009” (H.R. 2731) which would, among other
things, fund nurse faculty programs. Grants would be awarded to
institutions of higher education and hospitals to support activities such as
providing incentives to nurses to assume nurse faculty positions and
providing tuition assistance for nurses to attain advanced degrees.
Preference would be given to programs that would improve the diversity of
the nursing population. The bill would authorize such sums as may be
necessary to implement the program; it has been referred to the Energy &
Commerce and Education & Labor Committees.

Bill text is available through thomas.loc.gov [thomas.loc.gov] by searching
for the bill number.

Cracking the Autism Riddle: "Vaccine Theory" Fades as a New Idea Emerges

2009-06-10T22:24:00.000-07:00

This article was sent to me by a friend and fellow mom. The topic of immunizations appeals to me as a nurse practitioner but also as a mother. This article is a good review of research done on autism and immunizations. Here is a link to the original posting.

-------
Cracking the Autism Riddle: "Vaccine Theory" Fades as a New Idea Emerges
by Harvey Karp, pediatrician and faculty at UCLA

If a foreign government were suspected of doing something that caused brain problems to 1/166 American children our nation would immediately and vigorously respond...and even go to war! Well, our children are under a mysterious assault that is causing 1/166 to develop autism. And, we must band together and immediately and vigorously make the correction of this problem a true national priority.

As part of our national wake-up call, April was designated National Autism Awareness month and the press repeatedly aired an impassioned debate: Are vaccines a boon or a danger? Do shots protect kids or provoke autism? Unfortunately, all too often the media discussion was highly polarized...creating lots of heat, but shedding little light.

In this 3-part blog, I'd like to discuss in detail the reasons why shots are very safe - and super important - and to present some fresh ideas about a more likely cause of autism: an invisible soup of toxins we're exposed to every day...endocrine disrupting chemicals (EDCs).
*
For more than 10 years, a steady chorus has accused vaccines of causing the autism outbreak: "Shots have too many ingredients." "Too many shots are given together." Some people think the connection is proven because baby shots have increased in number as the autism has increased in frequency.

The rise in autism is scary and all reasonable people should be desperate to solve this mystery. But, is the fact that we give more vaccines proof that they trigger the disorder...or is it a terrible coincidence?

History is filled with good guesses that just fell flat. For example, five years ago, many were convinced that mercury in vaccines was the autism culprit. It was a fair hunch...but ended up wrong. In 2002, over 95% of vaccine mercury was removed. Yet, instead of plummeting autism rates zoomed even higher!

Another popular hunch was that the MMR shot (measles, mumps, rubella) caused autism. But a huge Danish study (examining hundreds of thousands of children) found that kids skipping the MMR had the same exact risk of getting autism as those who were immunized. A Japanese study also showed zero difference between MMR getters and skippers (no benefit was seen even when the MMR was split into separate shots).

To date, dozens of studies -- examining over 1 million children -- have failed to find any credible association between shots and autism...none!

Yet, speculation that shots cause autism continues to stick in parents' minds. Why? One big reason is because we have all heard reports of kids suddenly "got" autism just a week or two after shots.

In fact, one of the scariest characteristics of autism is that it can suddenly afflict a child who seems developmentally normal. But, is it possible that this sudden problem right after shots is just a coincidence? Absolutely, yes! Every day, serious and amazing things occur, purely by chance. Think of it this way, in a large country like the US, a one-in-a-million coincidence happens 300 times a day.

Approximately 24,000 children are diagnosed with autism every year and in about 1/3 of those cases (8000/year...150/w) normally developing kids show abrupt deterioration (so called "regressive" autism). Regression usually appears between a child's 1st and 3rd birthdays, a period during which they get shots 4 separate times. Do the calculations and you quickly realize that, every year, over 600 children will spiral into autism during the four 1-week periods that follow these 4 shot visits... just by pure, utter, random chance.

Such a high chance of coincidence means that a parent who hears about 4-5 toddlers (or even 4-500 toddlers) who worsen after shots may easily be fooled into assuming that the cause of the autism was the shots...but they would be jumping to a totally false conclusion.

Scientists have carefully investigated sudden developmental deterioration and have repeatedly shown that there's no link with vaccines. For example, University of Michigan scientists analyzed 351 children with autism (1/2 with the regressive form). They noted the average age for regression was 19 months and they found no correlation to when vaccines were given.

Perhaps, the primary reason parents have been so open to the vaccine avoiders' unfounded claims is the current "science vacuum." For years, government and organized medicine have reacted to the autism explosion with horribly lethargy. As a result, we lack good answers to many pressing questions. This vacuum has allowed the cold wind of speculation to spread doubt and fear through our hearts.

So many parents have become paralyzed with indecision because of this debate that they've lost track of the fact that shots have saved millions of children (and adults) from disease, deformity, disability and death:

* In the 1930's, whooping cough's painful strangulation was epidemic -- in the 1940's the vaccine became widely used - by the 1950's whooping cough was uncommon.

* In the 1940's, paralytic polio terrorized every family -- in the 1950's the vaccine became widely used - by the 1960's polio was almost eradicated.

* In the 1950's, measles caused thousands to suffer pneumonia, encephalitis and death in the 1960's the vaccine became widely used -- by the 1970's measles was rare.

* In the 1960's, rubella was a common cause of stillbirth, deafness and mental retardation -- in the 1970's the vaccine became widely used -- by the 1980's birth defects from rubella had vanished.

* In the 1970's, H flu meningitis and epiglottitis were seen every day across America -- in the 1980's the vaccine became widely used -- by the1990's deadly H flu was close to eliminated.

And similar stories can be told for shots against pneumonia, chicken pox, Hepatitis B, mumps, etc.

In fact, shots are so important that even the most vocal vaccine avoiders swear they're not "anti-vaccine." Unfortunately, their actions make a travesty of their words. With alarming websites and a relentless, multiyear, media blitz they have single-handedly unleashed a huge vaccine backlash. They've shredded decades of public health investment and triggered a surge of "shot-phobia" that threatens to add epidemics of infection to the tragic rise of autism that already weighs so heavily on children and families.

The coming danger of this anti-vaccine campaign is seen all across the county. Doctors daily encounter fearful parents doubting the safety of vaccines. The New England Journal of Medicine reports a doubling and tripling of parents getting vaccine waivers for their children. The LA Times found that over 50% of children in some schools had asked for exemptions to avoid all vaccines.

This is of grave concern because disease outbreaks can start when as few as 5% of kids in a community skip shots. Recent Colorado studies found that children who delayed shots were 6-23 times more likely to get whooping cough and 22 times more likely to get measles. And, many more may fall seriously ill if this trend continues.

Parents who sidestep vaccines may do so because diseases like polio and whooping cough are so uncommon. But, the great irony is that the only reason these killers have become so uncommon...is because other moms get their kids immunized.

In my next blog, I'll respond to 4 more of the standard arguments of vaccine avoiders (3 flawed...and 1 reasonable). Then, in the final part in this series, I'll discuss the increasingly scary possibility that autism is triggered by a common chemical exposure.

NP Job Wisconsin

2009-06-04T22:21:00.001-07:00

Villard Primary & Specialty Care is seeking a full-time Pediatric Physician Assistant or Family Practice Nurse Practitioner for a primary care office that offers obstetrics and gynecology, as well as pediatrics and other family medicine services. This provider will need to participate in supervised but independent decision making about health care needs and provide care services to individuals and their families. Must demonstrate an ability to work independently yet as an integrated member of our health care team.

We offer competitive wages and benefits. Our reimbursement program rewards the competent & efficient provider.

Contact Person: Carmen Harrell

Email Address: carmenharrell4@hotmail.com

Phone: 414-463-9159

Fax: 414-831-0422

Preserving Patient Access to Primary Care Act of 2009

2009-06-04T22:04:00.000-07:00

Congresswoman Allyson Schwartz (D-PA) and Senators Maria Cantwell (D-WA) and Susan Collins (R-ME) recently introduced the “Preserving Patient Access to Primary Care Act of 2009” (H.R. 2350/S. 1174) to address the shortage of primary care providers.

The bill would create scholarships and loans for primary care providers who serve in critical shortage areas, as well as support an interdisciplinary model in which providers, physicians and nurses, are able to practice collaboratively and to the full extent of their education and licensure on behalf of the patient.

TAKE ACTION:

Please contact your members of Congress and ask them to cosponsor H.R. 2350/S.1174.
Read ANA’s letter of support for the “Preserving Patient Access to Primary Care Act of 2009.”

PNP Job Minneapolis/St. Paul MN

2009-06-02T22:36:00.000-07:00

A PNP is needed to join a stable Neurosurgical Group in Minnesota's Twin Cities area. Live in an area that offers great history and culture along with impressive theaters and beautiful outdoor attractions including Lake of the Isles and Lake Calhoun. This is a Monday through Friday, fulltime, permanent opportunity with call every fifth weekend. Qualified candidates will work with a group of Surgeons, PAs, NPs, and CNRNs to deliver dedicated care in restoring patients wellbeing and will have a Neurology background or experience in the ICU. The PNP will see patients with both brain and spine injuries on the hospital floor and in a clinic setting with responsibilities such as postop visits, rounding in hospital, suture removal and discharges. New graduates with in-depth related RN experience are welcome to apply. The salary range is from 80 to 95++ depending on experience, with full benefits, paid parking, and relocation is considered!

Please apply online at advancedpracticesolutions.com or contact Stephanie at locally 651-439-8484 or toll free 877-439-8484 or Stephanie@onlineaps.com regarding this opportunity.

Advanced Practice Solutions is the nation’s leading NP-owned staffing and recruitment firm. Visit us at advancedpracticesolutions.com, or call toll-free at (877) 439-8484 for more information and a complete listing of available opportunities.

PNP Job Dundee, Michigan

2009-06-02T22:34:00.000-07:00

Growing private pediatric office in Dundee, Michigan looking for a part-time, experienced Pediatric Nurse Practitioner. An ideal candidate is someone who enjoys working with children and families and must be proficient in evaluating both sick and well children ages birth to 21 years. Other responsibilities include parent education, knowledge of the vaccine schedule and ordering and evaluating appropriate laboratory and radiologic testing. Work schedule will be 2-3 days per week and may extend to full time as the practice grows. Compensation ~$300 per day; negotiable based on experience.

Michelle Daill, M.D.
dundeepediatrics@gmail.com

734-823-5437

PNP Job Heme/Onc Long Island, NY

2009-05-26T17:56:00.000-07:00

Transforming care,
Transforming careers.

We’re changing the future of healthcare. You can help.

At North Shore-LIJ Health System, transforming care begins with empowering you to go as far as your talent and ambition can take you. Whatever your position, wherever you are in your career, we’re committed to providing you with the support, resources, training and opportunity you need to achieve greater things, every day. We currently have the following position available at our specialized children's hospital:

Nurse Practitioner - Pediatric Hem Onc (Ambulatory Infusion Program)
Job # SCH0000MQ

Qualifications:
* Current NYS RN and NP licensure/certification
* Demonstrated experience in the specialty as evidenced by 3-5 years of practice in an acute care setting
* BLS
* PALS and specialty certification preferred

To apply, please visit www.nslijcareers.com and search for job # SCH0000MQ.

About Schneider Children's Hospital:
Schneider Children's Hospital is a 154 bed tertiary care pediatric hospital that provides the most advanced and comprehensive health care for children, ranging from the low birth weight and high-risk neonates to the multifaceted needs of the adolescent population in the region. As one of the top 20 children's hospitals in the nation, in fact one of the top two in New York (as ranked by New York Magazine), Schneider Children's Hospital has the standard of care to which patients and professionals aspire.

The new Chemotherapy Center currently under construction will provide young patients with more private space to receive their cutting-edge, life-saving treatments in a caring, healing, comforting environment. The many hours spent in this center by children and their care givers will be more relaxed, with personal access to TVs, DVD, computer games and the Internet. The new space will also allow children greater interaction with our Child Life Specialists and Big Apple Circus clowns, who work to entertain and distract from anxiety and discomfort.

About North Shore-LIJ Health System
North Shore-LIJ Health System is one of the largest and most advanced providers of care in the nation. We're the number one employer on Long Island and among New York City's largest employers. We recognize the contributions of our more than 10,000 nurses. Our nurses play an integral role in patient outcomes, and feel a strong sense of accountability and responsibility to preserve the integrity of patient care. Here you'll apply your skills and knowledge to complex cases, use your critical thinking abilities, and make decisions more independently. You will have a central role in shaping patient care outcomes through evidence based practice standards. The latest approaches to quality patient care are also taking shape in our Patient Safety Institute, the first simulation lab of its kind on Long Island. In addition you will have the opportunity to evolve professionally through on-site educational classes, and more in our own Institute for Nursing. We add value to your life, just as you do for patients.

We are an equal opportunity employer. M/F/D/V

Apply Here.

PNP Job Boston

2009-05-26T17:53:00.000-07:00

Location: MGH Main Campus - Boston
Regular/Temporary: Regular
Standard Hours: 40.00

Full Time/Part Time: Full-Time
Job ID: 2185357

Qualifications: Graduate of an accredited Nurse Practitioner program (ANA certified).
Bachelors degree in nursing or equivalent experience required.
Must be certified by the Nurse Practitioner accreditation board (NAPNAP or ANCC)
Must maintain recertification requirements including mandatory continuing education hours.
Minimum of 3 years recent Intensive Care Unit and/or transplant experience
Pediatric experience is desirable

https://careers.partners.org/psc/EA/EMPLOYEE/HRMS/c/HRS_HRAM.HRS_CE.GBL?Page=HRS_CE_JOB_DTL&HRS_JOB_OPENING_ID=2185357

PNP Job Arizona

2009-05-20T15:24:00.001-07:00

Arizona - Great family community. Beautiful, sunny Tucson Arizona. Full-time Pediatric Nurse Practitioner needed. Excellent salary and benefits. Contact: Dr. Nomaan (520) 293-6686 or fax CV to (520) 887-1736.

Nurse Practitioner Resume/CV

2009-05-15T12:21:00.000-07:00

When it came to job hunting, I struggled putting together my resume/CV. A nurse practitioner's resume differs from a traditional resume given the nature of our profession and the work that we do. I have spent a lot of time refining my resume to make myself a competitive candidate.

Resume v. CV - What's the difference?
A resume and a CV are not the same thing, though both function to tell potential employers who are you and what your qualifications and skills are. They table below outlines some differences between a resume and a CV. SO which is better? It depends on your profession and what your potential employer wants. Many people use the terms resume and CV interchangeably. While they are different, they are similar. When in doubt, just check with your potential employer which they prefer.

	Resume	CV
Scope of content	Summary or work qualifications	Covers your entire professional career; comprehensive
Usage	Often in US; Preferred for non-academic, non-medical professions	Preferred in Europe and abroad, used some in the US; Preferred for academia and medicine
Length	1-2 pages	Can be several pages
Detail	Short & Concise	More detailed in each section
HEADINGS	Less	More
Objective	Yes	No, your objective is better included in a cover letter
Education	Education	May be subdivided, i.e. Degrees, Continuing Education, Advanced Training
Experience	Professional or Work Experience	May be subdivided, i.e. Teaching, Research, Clinical
Honors/Awards	Honors & Awards	Honors & Awards
Others	Skills (i.e. word processing, computer skills)	Research, Publications
		Professional Affilications
		(Publications could be subdivided into: Published, Reviews,Presentations, Abstracts, Unpublished)
References	"Available upon request"	Names can be included, contact info can be included or made available upon request

--------------------------------------------------------------------------
So for nurse practitioners, a CV will be more appropriate. Here are some headings to consider when putting a nurse practitioner CV together: http://www.slc.edu/occ/Sample_Headings_CV.php

Common headings:

Contact Information

Do NOT use label "Contact Information"; it's a given!
Name, Address, Phone Number, E-Mail, Website, if you have one. For more information see below.*

Education

List in reverse chronological order (most recent first)
Include each institution's name, location, degree earned, dates of attendance
Include degrees, clinical training, student organizations, student research, dissertation, etc.

Professional Experience

List in reverse chronological order (most recent first)
Include company name, location, dates of employment, brief summary of work
Include work experience pertinent to your professional career starting with college. (Your high school babysitting can be left off, likely. )

Research

Include research projects, lectures, presentations, publications
Include dates for each item listed

Licensure and Certifications

Professional, state licenses, certifications, i.e. ACLS, PALS, Telemetry, Critical Care, etc.

Professional Affiliations

Any professional organizations to which you belong
Include any positions with professional organizations (Committee memberships, Treasurer, etc.)
List work done within that organization, i.e. organized fundraising for...

References

name and CURRENT contact information for each reference
3 or 4 is appropriate
Can make references "available upon request"

--------------------------------------------------------------------------
*HAVE A WEBSITE!

If you can swing it, have a website that hosts your CV. This way you can refer potential employers to this website. Wit today's technology, many employers and job candidates rely on e-mail and the internet to make job connections. Having your CV available electronically can ease the process and impress your future employer.

If web-hosting is out of reach, have an electronic version of you CV available, preferably as a .PDF file. Most people create their CV's in Microsoft Word, which is fine. Sometimes, however, when word files and transferred and viewed again, the formatting might be altered. Also, te computer viewing your CV may not have your home computer's font available. So converting your CV to a PDF preserves your CV and protects it from formatting changes. PDF readers are readily available, most businesses have them on their computers.

In addition to a PDF version of your CV, have a text version of your CV available too. A text version of your CV can be easily copy and pasted without worry of changes to the formatting.

Examples to come.....

State by State Practice of Nurse Practitioners

2009-05-15T12:14:00.000-07:00

I'm certainly not looking to reinvent the wheel - Here is the Pearson Report (pdf)!

The annual state-by-state national overview of nurse practitioner legislation and healthcare issues,brought to you by Linda J. Pearson through the American Journal of Nurse Practitioners.

PNP Job Arizona

2009-05-15T00:42:00.001-07:00

Job Description

If your idea of fun leans more towards outdoor adventures, hiking,camping, photography and easy travel distances to many National Parks -- and you are interested in joining a practice where you have a ready made panel of patients, then you are a candidate we'd like to meet!
Located in the heart of beautiful Verde Valley, we are a very busy group practice. Qualifications will include the ability to be a team player and an interest in providing the best possible care to our patients.

A guaranteed salary, a generous sign on bonus, paid medical and dental benefits, 401 K, paid vacation along with CME allowance are all part of our generous benefit package, Red Rock Pediatrics is celebrating 9 successful years. Our phone is 928-649-3003, and our fax is 928-649-3030.

Job Requirements

Must be able to work in a fast pace environment. Must be able to work independently, yet know when to ask for help. Must get along with others - and respect and value all employees for their contributions. Humor, a good work ethic and a genuine love of children will enable the PNP to succeed in this fast paced practice.

PNP Job North Carolina

2009-05-13T23:25:00.000-07:00

Goldsboro Pediatrics in Eastern NC is seeking a PNP to work in established practice with seven PNP's and eleven MD's. This full-time position will be offered with a very competative salary and benefit package. There is easy access to both the RDU-Chapel Hill area and the NC coast. PNP's are always under direct supervision and are well established and accepted by our patients. Please call, email, or mail CV to:

Larry Nickens MD

nickensl@bellsouth.net

919-580-7207 office

919-778-3529 home

919-221-4234 cell

CNN Commentary: We don't need more doctors

2009-05-13T22:22:00.000-07:00

The other side of the debate. A friend sent me a link to this commentary after I posted about the AAP's article regarding the independent practice of PNP's. I've pasted the article here, but here is a link to the original article as well:

http://www.cnn.com/2009/POLITICS/05/13/christensen.doctors/index.html

Commentary: We don't need more doctors

Story Highlights
Co-authors: Will the health reform plan truly break with the ways of the past?
Some advocate need for more doctors, but that's not necessary, they say
They say nurses can provide quality care at low cost in clinics
They say that would free up doctors to do more complex work

By Clayton Christensen, Jason Hwang and Vineeta Vijayaraghavan
Special to CNN

Editor's note: Clayton M. Christensen is the Robert and Jane Cizik Professor of Business Administration at Harvard Business School, co-founder of Innosight Institute, and the best-selling author of six books. Jason Hwang, M.D., M.B.A. is co-founder and executive director of healthcare at Innosight Institute. They are co-authors of "The Innovator's Prescription: A Disruptive Solution for Health Care" (McGraw-Hill, January 2009). Vineeta Vijayaraghavan, M.B.A. is a Research Fellow at Innosight Institute.

(CNN) -- Vowing not to "continue down the same dangerous road" of rising health care costs, President Obama announced on Monday a coalition for reform that included some of health care's most powerful stakeholders.

But what is not yet clear is whether this latest attempt to fix the health care system will in fact introduce fundamental change, or simply proceed down another well-trodden road that delivers more of the same.

For example, the urgent need for more doctors, particularly primary care providers, has been raised by the president and other administration officials.

The Association of American Medical Colleges advocates a 30 percent increase in medical school enrollment to produce 5,000 more doctors a year, and one provision in the White House plan would redistribute payments from specialists to primary care doctors to improve pay equity.

On the surface, these seem to be logical steps to circumvent a system of "coverage without care," in which access to health insurance becomes meaningless without comparable access to health care providers.

However, we submit that these actions lead us in the wrong direction, and there is, in fact, no doctor shortage -- as long as we accept the fact that health care can work differently, and better than, the current system.

There IS a shortage of health care services being provided, but many of them are not best offered by a doctor. All parents know the experience of worrying whether their child has an ear infection -- treatment involves considerable pleading for a standby appointment at the doctor's office, followed by a long wait, a 30-second visit with the doctor, and then a trip to the pharmacy for another long wait.

Throw in the half-day of missed work and the stiff bill, and it becomes clear why many advocate the need for more doctors. However, a growing number of visits, incorporating quick and easily interpreted diagnostic tests and algorithm-driven care for conditions such as ear infections, sore throats and minor burns, can be handled better in nurse-run clinics.

MinuteClinic, the largest chain of such retail clinics, records average patient satisfaction scores of 4.9 out of 5, while providing care that is 32 to 47 percent below the cost of primary care physicians. While the rest of the health care system only delivers about 55 percent of recommended care, MinuteClinic staff demonstrated 99.15 percent adherence to clinical guidelines in a study involving over 50,000 visits.

There are of course thorny medical problems for which we need physician care. However, squeezing payments to specialists will only further diminish access to complex care. Instead, we must equip and empower primary care doctors to do more.

Medical school graduates have overwhelmingly chosen specialty fields because of low professional satisfaction with the work primary care providers are expected to do. However, "disruptive" innovations are rapidly changing the scope of their work.

Expert systems software can guide generalists through the same decision-making steps that a specialist would take. Point-of-care diagnostics allow for diagnoses to be made promptly in the clinic, and easy-to-deploy devices are creating more options for immediate treatment.

These innovations deliver convenience to patients, eliminate the need for referrals to costlier specialists, and improve job satisfaction by enabling primary care doctors to deliver increasingly sophisticated care.

There is new technology that makes it easier for non-anesthesiologists to administer conscious sedation, for example, allowing procedures such as colonoscopies to be done under the supervision of just the endoscopist and a nursing team. By removing anesthesiologists from the equation, these procedures can be performed in a clinic setting rather than in hospitals.

By moving more complex care from specialists to primary care providers, the payments will follow. These changes would make primary care more fulfilling and financially rewarding, while freeing up specialists to do even more complicated work that merits their additional training.

One reason people think there's a shortage of doctors is that health care is unevenly distributed around the nation, with inner cities and rural communities struggling the most to find adequate staff.

However, the best solution will not come from increasing the physician supply or introducing salary incentives. Studies of geographical disparities of care have demonstrated that more physicians will likely lead to greater intensity of care -- but not better health outcomes.

Instead, we should embrace eHealth initiatives that enable virtual clinic visits and online house calls, similar to services provided by TelaDoc, American Well, and HelloHealth. Offering such convenient and affordable channels to primary and preventive care is vital to relieving our overburdened emergency departments and public health system.

The definition of quality care in the past has assumed that more expertise is always preferred -- doctors must be better than nurses, specialists must be better than primary care doctors, and brick-and-mortar must be better than a virtual interaction.

But we need to move away from the "guild" mentality that has kept boundaries narrow and created regulatory, licensing and reimbursement obstacles to new models of health care delivery.

Patients want correct diagnoses and effective therapies, but they also value accessibility, convenience, transparency, communication and their time and money -- none of which have been priorities of the traditional health care model.

Rather than calling for more doctors, which would have been difficult for the government to impact anyway, what the country really needs are policies that pave the way to more avenues of care, which is well within the government's control.

The opinions expressed in this commentary are solely those of the authors.

AAP Opposes PNP Independent Practice

2009-05-12T23:58:00.000-07:00

The article (and linked articles) below was a tough read for me. I had a class during my graduate training where we extensively discussed these "turf" wars between physicians and nurse practitioners. I hate this issue because I believe it distracts from the common goal that both physicians and nurse practitioners have: to improve health care and access to it.

-------------------------------

NAPNAP Is Stunned By AAP's Statements About NPs In Pediatric News

The National Association of Pediatric Nurse Practitioners was disturbed and disappointed by the publication of a recent front page article in the April 2009 issue of the Pediatric News which portrays NPs as unsafe and encourages its members to oppose the scope of practice legislation that would permit nurse practitioners to have independent practices. Swift action was taken via a letter sent to AAP on May 1, 2009.

NAPNAP is dismayed and weary of the unfounded opposition to patient access to primary health care nurse practitioners, and to have the American Academy of Pediatrics be an active participant in these types of activities is most disappointing. PNPs have enhanced the health care for children and families for decades by providing comprehensive services in a variety of settings, working both independent of and in collaboration with physicians. Comparative studies have shown that NPs provide safe, effective primary care with clinical outcomes that mirror those of physicians.

It is also NAPNAP's position that it is not in the purview of the American Academy of Pediatrics to clarify the role of the pediatric nurse practitioners. Nursing is an independent profession and as such sets its own standards for all of nursing including defining the role of the nurse practitioner.

"NAPNAP is disappointed to learn that the AAP has published such an article. We will continue to do our best to help educate families about their healthcare choices and the role of the nurse practitioner", said NAPNAP President Linda Lindeke, PhD, RN, CPNP.

"We are done with this turf conversation. No one owns the child or family. We are intentionally turning our attention to the new dialog about healthcare reform in this generation and the rightful place of all qualified primary health care providers of children's healthcare and continue our vitally important work promoting children's health" said NAPNAP CEO Karen KellyThomas, PhD, RN, FAAN, CAE.

NAPNAP is requesting the nursing community to join us in opposition to this article.

Click here to read the letter sent to the AAP on May 1, 2009.

Click here to read the article published in the Pediatric News.

The National Association of Pediatric Nurse Practitioners (NAPNAP) is committed to improving the health care of infants, children, adolescents and young adults. An association of nearly 7,000 health care providers throughout the Unites States, NAPNAP is the only advanced practice registered nursing organization in the world focused on pediatric health and has 48 Chapters in 32 states. For more information call 856/857-9700 or visit NAPNAP's website at http://www.napnap.org.

PNP Job Yakima, WA

2009-05-12T15:22:00.000-07:00

We are currently looking for a Pediatric Nurse Practitioner who has a passion for providing high-quality primary health care in an outpatient clinic. Come join a progressive, well-established organization that has been in the community for over 30 years!

We support our providers with a multidisciplinary team approach and a strong support system.

We offer:

A competitive compensation and benefits package.
Hiring bonus and relocation package.
Loan repayment options.
EMR in all of our clinics.

The Yakima Valley Farm Workers Clinic is a network of Joint Commission-accredited community health centers in Washington and Oregon. It is the largest community health center in the Pacific Northwest providing comprehensive health care services at over 20 different sites. We are dedicated to providing our patients with the highest quality care and to offering them affordable health care options

You will have the added benefit of living in the beautiful Pacific Northwest, where you can enjoy spectacular wilderness areas, scenic ocean beaches and crystal-clear lakes and rivers. You can enjoy fresh seafood, fine Northwest wines, and a spectacular selection of fruits and vegetables. You will also be within an easy drive to a thriving metropolitan area, offering fine dining and shopping, theatres, museums and world-class universities.

If this sounds like the opportunity you have been looking for, please contact us to learn more about what we have to offer.

Our mission celebrates diversity. We are committed to equal opportunity employment.

For Nurse Practitioner:

This person is responsible for providing Yakima Valley Farm Workers Clinic patients with professional medical assessment and intervention.

Education: Graduation from an approved nurse practitioner training program.

Experience: None.

Licenses/Certificates/Registration: State medical licensure (in Washington , Licensure with prescriptive authority); DEA; National certification for nurse practitioner; and CPR/ACLS/BLS/PALS certification (if applicable to practice location).

For Physician Assistant:

This person is responsible for providing Yakima Valley Farm Workers Clinic patients with professional medical assessment and intervention.

QUALIFICATIONS:

Education: Graduation from an approved physician assistant training program.

Experience: Negotiable.

Licenses/Certificates/Registration: DEA; National certification for physician assistant; CPR/ACLS/BLS/PALS certification (if applicable to practice location); and Washington/Oregon state medical licensure.

E-Mail for info.

PNP Job Oklahoma City, Ok

2009-05-12T00:26:00.000-07:00

General Description:

Under limited direction of a physician, provides medical care to acute care patients.

Essential Function/Duties:

In collaboration with a physician, performs comprehensive initial patient evaluations through physical exam, patient history and review of laboratory results. Assesses patients to assist physician in determining a diagnosis and treatment plan. Documents information in patient medical record. Conducts rounds, in addition to physician’s rounds. Develops and implements patient management plans and records progress notes. Obtains orders from medical staff and activates approved treatment protocols. Monitors patient response to treatment and adjusts treatment within the guidelines established by the treatment protocol. Assists physician with procedures in accordance with defined qualifications and competencies. Performs procedures at the request of the physician in accordance with defined qualifications and competencies. Collaborates with other healthcare professionals in interdisciplinary rounds for patient care and discharge to facilitate continuity of care. When appropriate to the patient’s needs, provides educational information to patient and family regarding the patient’s condition. May assist with the educational activities for the staff. Prescribes or administers medications under physician direction and in accordance with Oklahoma State laws. May work varying schedules which include evening and weekend schedules.

Physical Requirements (with or without accommodation):

Position requires walking, standing, sitting, twisting, stooping and bending. May require the pushing and pulling of equipment as well as moving or lifting patients. Requires sufficient manual dexterity to operate medical equipment. Requires sufficient visual acuity to read charts, reports and equipment displays. May be exposed to hazardous chemicals, blood or communicable diseases. Must be able to work under stressful conditions. Must be able to work flexible schedule which may include evenings and weekend schedules.

Knowledge, Skills and Abilities:

Knowledge of practices and procedures of nursing. Good patient assessment and communication skills. Knowledge of proper route for administering medications and dosages levels. Knowledge of Oklahoma’s regulatory laws governing prescription drugs. Ability to work effectively as part of a healthcare team to provide excellent patient care.

Minimum Qualifications:

*Licensure: Possession of a valid Oklahoma nursing license issued by the Oklahoma

State Board of Nursing AND a Certificate of Recognition for Practice

as an Advanced Registered Nurse Practitioner from the Oklahoma State

Board of Nursing. Must have prescriptive authority.

*Education: Master’s Degree in Nursing.

E-Mail for more info.

PNP Job Dracut, MA

2009-05-12T00:19:00.000-07:00

I'm currently on the job hunt for a PNP position. I'm still teaching at UW but PNP jobs seem scarce around Seattle; HOWEVER, they seem abundant else where. Here's what I've found thus far:

Dracut, Massachusetts, 01826

Dracut Pediatrics is a busy pediatrics practice seeking a motivated and dependable Pediatric Nurse Practitioner on either a part time or full time basis. This position is available immediately. Applicants should possess strong organizational and people skills. We provide comprehensive preventative as well as urgent care to the local pediatric community. A minimum of one year experience in a pediatric office setting is preferable. Prior experience with electronic medical records is a plus. Benefits, including a 401K retirement plan are available to the qualified applicant. For more information e-mail me.

Is this normal?

2009-05-07T23:24:00.001-07:00

Some of the most challenging questions that I get regarding the care of children does not come in the office. Rather, they come from friends of mine that are mothers, mostly first-time moms with that persisting question: is this normal?

Throughout my education and training, I learned a lot about different pathologies, how to recognize and treat them. I also learned a great deal about preventative care and health education. Where we spent little time was normal development of babies and children. Perhaps this is because this information may seem fairly straightforward compared to the management of asthma or a former premie with GI complications. Yet I find that most parents are looking for reassurance in the parenting of their child.

A little reassurance often goes a long way. Often parents just need to hear "hey, you're doing a great job!" Being a parent is a thankless job, after all - at least during those trying first years.

So what's the solution?

As many things in life, the solution is multifaceted. I think as PNP's we can always to more to support parents not just in the health of their child but in their parenting skills and resources. Neonates do not come with a manual when you leave the hospital. Being a parent is the most important job in the world yet it requires no degree or certification (and I'm not saying it should!).

Part of better support of parents is access. Some parents struggle with access to their child's health care provider. After calling the office and being put on hold, they often speak with a receptionist. While they are hopefully a very nice person, they do not have medical training. Then depending on the "problem", they are passed onto a triage nurse who will determine if the patient needs to be seen or if reassuring advice on the phone will do. Now, I am not demeaning the value of triage RN's. Their contribution is invaluable. But for the parent who wonders if they can get their 6-month old to sleep through the night, it is not an efficient consult.

So how can we increase access to health care providers for this kind of support. Is direct access really the answer. Honestly - I don't know. While I genuinely feel for the parent who wants more than 4 hours of consecutive sleep, the child with fever and a rash is of higher acuity.

Well, we have more options now, such as e-mail. Surely this is part of the solution. But how can providers bill for their time spent on e-mail? While I would hate to bill a patient for 5 minutes of my time on an email, answering 100 emails certainly merits some compensation.

I've managed to bring up lots of issues with no clear solution. Hopefully this is starting the conversation for better care.

cvb

Welcome!

2009-05-07T22:23:00.001-07:00

Welcome! This blog is dedicated to the practice of Pediatric Nurse Practitioners. I plan to discuss interesting cases, evidenced-based practice, legislative issues, practice issues, and so on. In all truth, this blog is for you: fellow nurse practitioners and curious readers. Learn more about nurse practitioners do and who we are.