Marie-Eileen Onieal, PhD, CPNP, FAANP, NP

Last month, another health issue was recognized with a weeklong campaign highlighting the problem, its effects, and prevention strategies. I found it interesting—nearly ironic—that as I saw the poster glaring at me from across the room, I had just finished yawning! I had attended several conferences over the past few years that addressed this common predicament, and I found the data interesting. But it was only after reading the poster that I realized how inured many of us are to this condition: sleep deprivation.

So many of us suffer from inadequate sleep that we tend to minimize the effects. But as far back as the 1930s, researchers documented a link between the speed and accuracy of cognitive functioning and sleep patterns.¹ Nathaniel Kleitman, the father of sleep research, found that even in well-rested individuals, performance decreased in the early morning and late at night.

Situations that require concentration and the ability to make critical decisions can be disastrous when people suffer from sleep deprivation. For example, sleep deprivation has been implicated in the Exxon Valdez and the Challenger incidents and the nuclear accidents at Three Mile Island and Chernobyl.² Even everyday activities are more challenging when we are sleep deprived.

The Institute of Medicine (IOM) Committee on Sleep Medicine and Research concluded that awareness among the general public and health care professionals regarding sleep disorders and the impact of sleep deprivation is minimal compared to the magnitude of the problem.³ Inadequate sleep has been associated with long-term health consequences, including chronic medical conditions such as diabetes, hypertension, and heart disease. In addition, mood disorders have been associated with chronic sleeplessness. And sleep deprivation has been identified as a factor in medical errors.

The impact of sleep deprivation on medical errors was first documented by Friedman, Bigger, and Kornfeld in 1971.⁴ In that study, the researchers found that interns made twice as many errors reading ECGs after working for more than 24 hours than they did after a night of sleep. In a landmark study by the Harvard Work Hours, Health and Safety Group,⁵ researchers found that interns made 35.9% more serious medical errors during the traditional schedule (extended shifts and on-call duties) than during a modified schedule (fewer hours, no extended shifts). In the same study, Landrigan and his colleagues noted a 22% higher rate of serious errors in critical care units when interns worked extended shifts.

And it isn't only those in the health care field for whom sleep deprivation has an adverse impact on their work. In a study by Williamson and Feyer⁶, 30 employees from the transport industry and nine from the army were studied. In one part of the study, the subjects were deprived of sleep for 28 hours; in the other, they consumed doses of alcohol to reach a blood alcohol level of about 0.1%. The researchers found that common levels of sleep deprivation diminished performance to a level similar to that of alcohol intoxication (a blood alcohol level of at least 0.05%). 

Similarly, the National Highway Traffic Safety Administration presents the conservative estimate of 100,000 police-reported crashes each year that are the direct result of driver fatigue.⁷ In the National Sleep Foundation's 2009 Sleep in America Poll™, 54% of adults—about 110 million licensed drivers—reported having driven while drowsy at least once in the past year. Nearly one-third of drivers polled (28%) said that they had nodded off or fallen asleep while driving a vehicle.⁸

Our memory and learning are also impaired by inadequate sleep. Our ability to concentrate and focus on information presented is considerably reduced when we are sleep deprived. We also have difficulty remembering things we have known in the past. This is scary, especially when you consider how busy our lives are and how many times we have "burned the candle" at both ends.

Our lives are consumed by work, family activities, and household chores. All of those activities have caused us to lose sleep and be a drowsy driver at some time, I am sure. I know that I have been guilty of that—and have had to pull over or into a rest stop for a bit. And I have had the occasion when my memory of driving someplace was vague. 

The list of anticipatory guidance for our patients gets longer every year, but we should add maintaining healthy sleep habits to it. Recommendations from sleep specialists⁹ include:

• Maintain a regular sleep-wake schedule.

• Avoid caffeine, alcohol, nicotine, and other chemicals that interfere with sleep.

• Make your bedroom a comfortable sleep environment.

• Establish a calming pre-sleep routine.

• Go to sleep when you're truly tired.

• Do not watch the clock at night.

• Use light to your advantage: Expose yourself to light during the day, and limit light exposure in the evening.

• Do not nap too close to your regular bedtime.

• Get enough food and fluids, but not too much or too soon before bedtime.

• Exercise regularly—but not too close to bedtime.

Years ago, I saw a quip with the question: How much sleep does the average adult need? The answer was: Five more minutes. But that is not enough. We need to get back to a pattern that provides us with sufficient rest to recover our minds and our bodies. We need to follow those steps the sleep experts recommend so that we can properly attend to the responsibilities of our day and make the right decisions. 

Last month, another health issue was recognized with a weeklong campaign highlighting the problem, its effects, and prevention strategies. I found it interesting—nearly ironic—that as I saw the poster glaring at me from across the room, I had just finished yawning! I had attended several conferences over the past few years that addressed this common predicament, and I found the data interesting. But it was only after reading the poster that I realized how inured many of us are to this condition: sleep deprivation.

So many of us suffer from inadequate sleep that we tend to minimize the effects. But as far back as the 1930s, researchers documented a link between the speed and accuracy of cognitive functioning and sleep patterns.¹ Nathaniel Kleitman, the father of sleep research, found that even in well-rested individuals, performance decreased in the early morning and late at night.

Situations that require concentration and the ability to make critical decisions can be disastrous when people suffer from sleep deprivation. For example, sleep deprivation has been implicated in the Exxon Valdez and the Challenger incidents and the nuclear accidents at Three Mile Island and Chernobyl.² Even everyday activities are more challenging when we are sleep deprived.

The Institute of Medicine (IOM) Committee on Sleep Medicine and Research concluded that awareness among the general public and health care professionals regarding sleep disorders and the impact of sleep deprivation is minimal compared to the magnitude of the problem.³ Inadequate sleep has been associated with long-term health consequences, including chronic medical conditions such as diabetes, hypertension, and heart disease. In addition, mood disorders have been associated with chronic sleeplessness. And sleep deprivation has been identified as a factor in medical errors.

The impact of sleep deprivation on medical errors was first documented by Friedman, Bigger, and Kornfeld in 1971.⁴ In that study, the researchers found that interns made twice as many errors reading ECGs after working for more than 24 hours than they did after a night of sleep. In a landmark study by the Harvard Work Hours, Health and Safety Group,⁵ researchers found that interns made 35.9% more serious medical errors during the traditional schedule (extended shifts and on-call duties) than during a modified schedule (fewer hours, no extended shifts). In the same study, Landrigan and his colleagues noted a 22% higher rate of serious errors in critical care units when interns worked extended shifts.

And it isn't only those in the health care field for whom sleep deprivation has an adverse impact on their work. In a study by Williamson and Feyer⁶, 30 employees from the transport industry and nine from the army were studied. In one part of the study, the subjects were deprived of sleep for 28 hours; in the other, they consumed doses of alcohol to reach a blood alcohol level of about 0.1%. The researchers found that common levels of sleep deprivation diminished performance to a level similar to that of alcohol intoxication (a blood alcohol level of at least 0.05%). 

Similarly, the National Highway Traffic Safety Administration presents the conservative estimate of 100,000 police-reported crashes each year that are the direct result of driver fatigue.⁷ In the National Sleep Foundation's 2009 Sleep in America Poll™, 54% of adults—about 110 million licensed drivers—reported having driven while drowsy at least once in the past year. Nearly one-third of drivers polled (28%) said that they had nodded off or fallen asleep while driving a vehicle.⁸

Our memory and learning are also impaired by inadequate sleep. Our ability to concentrate and focus on information presented is considerably reduced when we are sleep deprived. We also have difficulty remembering things we have known in the past. This is scary, especially when you consider how busy our lives are and how many times we have "burned the candle" at both ends.

Our lives are consumed by work, family activities, and household chores. All of those activities have caused us to lose sleep and be a drowsy driver at some time, I am sure. I know that I have been guilty of that—and have had to pull over or into a rest stop for a bit. And I have had the occasion when my memory of driving someplace was vague. 

The list of anticipatory guidance for our patients gets longer every year, but we should add maintaining healthy sleep habits to it. Recommendations from sleep specialists⁹ include:

• Maintain a regular sleep-wake schedule.

• Avoid caffeine, alcohol, nicotine, and other chemicals that interfere with sleep.

• Make your bedroom a comfortable sleep environment.

• Establish a calming pre-sleep routine.

• Go to sleep when you're truly tired.

• Do not watch the clock at night.

• Use light to your advantage: Expose yourself to light during the day, and limit light exposure in the evening.

• Do not nap too close to your regular bedtime.

• Get enough food and fluids, but not too much or too soon before bedtime.

• Exercise regularly—but not too close to bedtime.

Years ago, I saw a quip with the question: How much sleep does the average adult need? The answer was: Five more minutes. But that is not enough. We need to get back to a pattern that provides us with sufficient rest to recover our minds and our bodies. We need to follow those steps the sleep experts recommend so that we can properly attend to the responsibilities of our day and make the right decisions. 

Last month, another health issue was recognized with a weeklong campaign highlighting the problem, its effects, and prevention strategies. I found it interesting—nearly ironic—that as I saw the poster glaring at me from across the room, I had just finished yawning! I had attended several conferences over the past few years that addressed this common predicament, and I found the data interesting. But it was only after reading the poster that I realized how inured many of us are to this condition: sleep deprivation.

So many of us suffer from inadequate sleep that we tend to minimize the effects. But as far back as the 1930s, researchers documented a link between the speed and accuracy of cognitive functioning and sleep patterns.¹ Nathaniel Kleitman, the father of sleep research, found that even in well-rested individuals, performance decreased in the early morning and late at night.

Situations that require concentration and the ability to make critical decisions can be disastrous when people suffer from sleep deprivation. For example, sleep deprivation has been implicated in the Exxon Valdez and the Challenger incidents and the nuclear accidents at Three Mile Island and Chernobyl.² Even everyday activities are more challenging when we are sleep deprived.

The Institute of Medicine (IOM) Committee on Sleep Medicine and Research concluded that awareness among the general public and health care professionals regarding sleep disorders and the impact of sleep deprivation is minimal compared to the magnitude of the problem.³ Inadequate sleep has been associated with long-term health consequences, including chronic medical conditions such as diabetes, hypertension, and heart disease. In addition, mood disorders have been associated with chronic sleeplessness. And sleep deprivation has been identified as a factor in medical errors.

The impact of sleep deprivation on medical errors was first documented by Friedman, Bigger, and Kornfeld in 1971.⁴ In that study, the researchers found that interns made twice as many errors reading ECGs after working for more than 24 hours than they did after a night of sleep. In a landmark study by the Harvard Work Hours, Health and Safety Group,⁵ researchers found that interns made 35.9% more serious medical errors during the traditional schedule (extended shifts and on-call duties) than during a modified schedule (fewer hours, no extended shifts). In the same study, Landrigan and his colleagues noted a 22% higher rate of serious errors in critical care units when interns worked extended shifts.

And it isn't only those in the health care field for whom sleep deprivation has an adverse impact on their work. In a study by Williamson and Feyer⁶, 30 employees from the transport industry and nine from the army were studied. In one part of the study, the subjects were deprived of sleep for 28 hours; in the other, they consumed doses of alcohol to reach a blood alcohol level of about 0.1%. The researchers found that common levels of sleep deprivation diminished performance to a level similar to that of alcohol intoxication (a blood alcohol level of at least 0.05%). 

Similarly, the National Highway Traffic Safety Administration presents the conservative estimate of 100,000 police-reported crashes each year that are the direct result of driver fatigue.⁷ In the National Sleep Foundation's 2009 Sleep in America Poll™, 54% of adults—about 110 million licensed drivers—reported having driven while drowsy at least once in the past year. Nearly one-third of drivers polled (28%) said that they had nodded off or fallen asleep while driving a vehicle.⁸

Our memory and learning are also impaired by inadequate sleep. Our ability to concentrate and focus on information presented is considerably reduced when we are sleep deprived. We also have difficulty remembering things we have known in the past. This is scary, especially when you consider how busy our lives are and how many times we have "burned the candle" at both ends.

Our lives are consumed by work, family activities, and household chores. All of those activities have caused us to lose sleep and be a drowsy driver at some time, I am sure. I know that I have been guilty of that—and have had to pull over or into a rest stop for a bit. And I have had the occasion when my memory of driving someplace was vague. 

The list of anticipatory guidance for our patients gets longer every year, but we should add maintaining healthy sleep habits to it. Recommendations from sleep specialists⁹ include:

• Maintain a regular sleep-wake schedule.

• Avoid caffeine, alcohol, nicotine, and other chemicals that interfere with sleep.

• Make your bedroom a comfortable sleep environment.

• Establish a calming pre-sleep routine.

• Go to sleep when you're truly tired.

• Do not watch the clock at night.

• Use light to your advantage: Expose yourself to light during the day, and limit light exposure in the evening.

• Do not nap too close to your regular bedtime.

• Get enough food and fluids, but not too much or too soon before bedtime.

• Exercise regularly—but not too close to bedtime.

Years ago, I saw a quip with the question: How much sleep does the average adult need? The answer was: Five more minutes. But that is not enough. We need to get back to a pattern that provides us with sufficient rest to recover our minds and our bodies. We need to follow those steps the sleep experts recommend so that we can properly attend to the responsibilities of our day and make the right decisions. 

While listening to the president’s address to Congress on September 9, I found myself remembering discussions I’d had with Senator Kennedy and the hope we shared that one day the system would be “fixed.” I was a staunch supporter of the senator. I campaigned for him and never missed a chance to see him when I was in Washington, DC. When he was in Boston, I frequently took the opportunity to update him on the progress (or lack thereof) of health care bills that directly affected access to the services of NPs and PAs.

I always enjoyed the “day on the Hill” when fellow NPs would join me in a visit to his DC office. Senator Kennedy was quite the host. He took the time (as though he had nothing else on his calendar) to sit and talk with us, asking visitors to tell him the most challenging part of being a health care provider. He always seemed somewhat in awe of what we did. In one session, he even took notes about an NP who was struggling to keep open a clinic where homeless people could receive necessary health care.

He was always interested in improving access for those unable to afford the care that he and his family could. In the late 1960s, after visiting a health center in a Massachusetts housing project and being impressed with the clinic’s ability to provide treatment to low-income populations, the senator successfully secured funding for a nationwide program of community health centers. He introduced an amendment to the Economic Opportunity Act, garnering $51 million to start 30 additional centers. There is now a network of more than 1,200 sites across the United States—a direct result of Kennedy’s hands-on approach to health care access for the most vulnerable.

In 1988 (or thereabouts), when Title VIII of the Public Health Service Act (the Nurse Education Act) was under review, word got out that the new provisions included significant penalties for defaulting on student loans—but only those held by nurses and NPs. Many students in the health professions had been awarded loans with the understanding that they would work in underserved areas once they graduated. For the most part, NPs were in competition with physicians for those placements, and often the physicians were selected to fill the positions. Despite the growing (even then) number of underinsured or uninsured people, communities needing providers were not always considered underserved.

With the help of NPs across the US, we bombarded the senator’s office with phone calls and faxes. Senator Kennedy soon learned (not that he didn’t know before) that NPs were a force to be reckoned with and that we were not about to take the proposed changes sitting down. With the threat of a “march on Washington,” Senator Kennedy reached out to determine why his normally supportive constituents were so upset.

I had the distinct privilege of giving him that information (perhaps not very politely) and suggested some alternatives to increase the number of eligible sites where NPs could work for loan repayment. During our conversation, Senator Kennedy and I discussed the logic of having health centers be considered “loan repayment sites.” I thought it would be a wonderful complement to the work he had already done to establish health centers and would enable the centers to benefit from a pool of qualified, affordable providers ready and willing to make a positive impact on the health of the people.

In 1995, other NPs from Massachusetts and I visited Kennedy in Washington. In extending my sympathies for the recent loss of his mother, I told him that I too had lost my mother that January. As though we were old friends, he welcomed me to sit down and we talked (albeit briefly) about our mothers and how, on a daily basis, we sorely missed them. As we both stood to walk outside for a group photograph, he put his arm around my shoulder. We didn’t need to say anything; we understood each other’s loss.

Years later, I called his office to make an appointment, telling his staff that it was important that the senator grant us a few minutes of his time. Just a quick meet and greet, I said, no hot issues. When I arrived with my colleagues, we held up our end of the bargain. As we were leaving, the senator commented that I didn’t have an agenda, asking why. I corrected him by admitting that I did have an agenda: One of my colleagues had promised me a meeting with Senator John Glenn if I could get him a meeting with Senator Kennedy. I can still hear his laugh!

In his Congressional address, President Obama read from one of Senator Kennedy’s last letters: “[H]ealth care … is above all a moral issue; at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.”1 Just as Ted Kennedy believed, I too believe that this is the year we will finally realize health care reform. And when the bill is passed, we will all hear his laugh and his hurrah for business no longer “unfinished.”

Send your comments to [email protected].

While listening to the president’s address to Congress on September 9, I found myself remembering discussions I’d had with Senator Kennedy and the hope we shared that one day the system would be “fixed.” I was a staunch supporter of the senator. I campaigned for him and never missed a chance to see him when I was in Washington, DC. When he was in Boston, I frequently took the opportunity to update him on the progress (or lack thereof) of health care bills that directly affected access to the services of NPs and PAs.

I always enjoyed the “day on the Hill” when fellow NPs would join me in a visit to his DC office. Senator Kennedy was quite the host. He took the time (as though he had nothing else on his calendar) to sit and talk with us, asking visitors to tell him the most challenging part of being a health care provider. He always seemed somewhat in awe of what we did. In one session, he even took notes about an NP who was struggling to keep open a clinic where homeless people could receive necessary health care.

He was always interested in improving access for those unable to afford the care that he and his family could. In the late 1960s, after visiting a health center in a Massachusetts housing project and being impressed with the clinic’s ability to provide treatment to low-income populations, the senator successfully secured funding for a nationwide program of community health centers. He introduced an amendment to the Economic Opportunity Act, garnering $51 million to start 30 additional centers. There is now a network of more than 1,200 sites across the United States—a direct result of Kennedy’s hands-on approach to health care access for the most vulnerable.

In 1988 (or thereabouts), when Title VIII of the Public Health Service Act (the Nurse Education Act) was under review, word got out that the new provisions included significant penalties for defaulting on student loans—but only those held by nurses and NPs. Many students in the health professions had been awarded loans with the understanding that they would work in underserved areas once they graduated. For the most part, NPs were in competition with physicians for those placements, and often the physicians were selected to fill the positions. Despite the growing (even then) number of underinsured or uninsured people, communities needing providers were not always considered underserved.

With the help of NPs across the US, we bombarded the senator’s office with phone calls and faxes. Senator Kennedy soon learned (not that he didn’t know before) that NPs were a force to be reckoned with and that we were not about to take the proposed changes sitting down. With the threat of a “march on Washington,” Senator Kennedy reached out to determine why his normally supportive constituents were so upset.

I had the distinct privilege of giving him that information (perhaps not very politely) and suggested some alternatives to increase the number of eligible sites where NPs could work for loan repayment. During our conversation, Senator Kennedy and I discussed the logic of having health centers be considered “loan repayment sites.” I thought it would be a wonderful complement to the work he had already done to establish health centers and would enable the centers to benefit from a pool of qualified, affordable providers ready and willing to make a positive impact on the health of the people.

In 1995, other NPs from Massachusetts and I visited Kennedy in Washington. In extending my sympathies for the recent loss of his mother, I told him that I too had lost my mother that January. As though we were old friends, he welcomed me to sit down and we talked (albeit briefly) about our mothers and how, on a daily basis, we sorely missed them. As we both stood to walk outside for a group photograph, he put his arm around my shoulder. We didn’t need to say anything; we understood each other’s loss.

Years later, I called his office to make an appointment, telling his staff that it was important that the senator grant us a few minutes of his time. Just a quick meet and greet, I said, no hot issues. When I arrived with my colleagues, we held up our end of the bargain. As we were leaving, the senator commented that I didn’t have an agenda, asking why. I corrected him by admitting that I did have an agenda: One of my colleagues had promised me a meeting with Senator John Glenn if I could get him a meeting with Senator Kennedy. I can still hear his laugh!

In his Congressional address, President Obama read from one of Senator Kennedy’s last letters: “[H]ealth care … is above all a moral issue; at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.”1 Just as Ted Kennedy believed, I too believe that this is the year we will finally realize health care reform. And when the bill is passed, we will all hear his laugh and his hurrah for business no longer “unfinished.”

Send your comments to [email protected].

While listening to the president’s address to Congress on September 9, I found myself remembering discussions I’d had with Senator Kennedy and the hope we shared that one day the system would be “fixed.” I was a staunch supporter of the senator. I campaigned for him and never missed a chance to see him when I was in Washington, DC. When he was in Boston, I frequently took the opportunity to update him on the progress (or lack thereof) of health care bills that directly affected access to the services of NPs and PAs.

I always enjoyed the “day on the Hill” when fellow NPs would join me in a visit to his DC office. Senator Kennedy was quite the host. He took the time (as though he had nothing else on his calendar) to sit and talk with us, asking visitors to tell him the most challenging part of being a health care provider. He always seemed somewhat in awe of what we did. In one session, he even took notes about an NP who was struggling to keep open a clinic where homeless people could receive necessary health care.

He was always interested in improving access for those unable to afford the care that he and his family could. In the late 1960s, after visiting a health center in a Massachusetts housing project and being impressed with the clinic’s ability to provide treatment to low-income populations, the senator successfully secured funding for a nationwide program of community health centers. He introduced an amendment to the Economic Opportunity Act, garnering $51 million to start 30 additional centers. There is now a network of more than 1,200 sites across the United States—a direct result of Kennedy’s hands-on approach to health care access for the most vulnerable.

In 1988 (or thereabouts), when Title VIII of the Public Health Service Act (the Nurse Education Act) was under review, word got out that the new provisions included significant penalties for defaulting on student loans—but only those held by nurses and NPs. Many students in the health professions had been awarded loans with the understanding that they would work in underserved areas once they graduated. For the most part, NPs were in competition with physicians for those placements, and often the physicians were selected to fill the positions. Despite the growing (even then) number of underinsured or uninsured people, communities needing providers were not always considered underserved.

With the help of NPs across the US, we bombarded the senator’s office with phone calls and faxes. Senator Kennedy soon learned (not that he didn’t know before) that NPs were a force to be reckoned with and that we were not about to take the proposed changes sitting down. With the threat of a “march on Washington,” Senator Kennedy reached out to determine why his normally supportive constituents were so upset.

I had the distinct privilege of giving him that information (perhaps not very politely) and suggested some alternatives to increase the number of eligible sites where NPs could work for loan repayment. During our conversation, Senator Kennedy and I discussed the logic of having health centers be considered “loan repayment sites.” I thought it would be a wonderful complement to the work he had already done to establish health centers and would enable the centers to benefit from a pool of qualified, affordable providers ready and willing to make a positive impact on the health of the people.

In 1995, other NPs from Massachusetts and I visited Kennedy in Washington. In extending my sympathies for the recent loss of his mother, I told him that I too had lost my mother that January. As though we were old friends, he welcomed me to sit down and we talked (albeit briefly) about our mothers and how, on a daily basis, we sorely missed them. As we both stood to walk outside for a group photograph, he put his arm around my shoulder. We didn’t need to say anything; we understood each other’s loss.

Years later, I called his office to make an appointment, telling his staff that it was important that the senator grant us a few minutes of his time. Just a quick meet and greet, I said, no hot issues. When I arrived with my colleagues, we held up our end of the bargain. As we were leaving, the senator commented that I didn’t have an agenda, asking why. I corrected him by admitting that I did have an agenda: One of my colleagues had promised me a meeting with Senator John Glenn if I could get him a meeting with Senator Kennedy. I can still hear his laugh!

In his Congressional address, President Obama read from one of Senator Kennedy’s last letters: “[H]ealth care … is above all a moral issue; at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.”1 Just as Ted Kennedy believed, I too believe that this is the year we will finally realize health care reform. And when the bill is passed, we will all hear his laugh and his hurrah for business no longer “unfinished.”

Send your comments to [email protected].

The recent H1N1 flu pandemic sent many people scurrying for their disaster plans—although we don’t call them disaster plans anymore. We like to put a positive spin on unplanned events these days; now they are known as preparedness plans.

Nonetheless, for many private and public entities, the dust had collected on those binders full of information on phone chains, continuation of operations, and business recovery. The fear that predictions of a widespread illness—one that could paralyze the entire country—were coming true raised the anxiety level of many administrators and health care workers. The use of pandemic to describe the event caused many to wonder whether this was the outbreak of the century, in which millions of people could sicken and die.

Daily updates from the CDC were often met with mixed responses: relief or concern, depending on whether one’s own community was affected and/or whether medication would be available, coupled with anxiety about whether it was safe to go out in public. The goals of the CDC updates were to reduce transmission of the disease and to educate people about staying healthy. Yet near-panic persisted and daily questions about what to do, whom to test, and how to treat those who were ill seemed endless. And it made me wonder—at a personal level, how well prepared were we? On the larger societal level, would we ever be ready to face a disease outbreak that threatened the existence of every citizen?

So I started at the beginning—in my own circle of friends and family. Did they receive their annual flu vaccine? Most had. Was anyone traveling? Most were or planned to be. Was anyone exposed to someone with flu-like symptoms? And there was the rub—who knew? The person sitting next to them on the train (or bus or plane) had been sneezing; the person they shared office space with at work was out “with a cold”; the neighbors went to Mexico during the school break. Concerns flourished, but often common sense withered. At least I had credibility with them; at work, it was another story. 

My next step was to look at my workplace. My main focus was my patient population: adolescents, the majority of whom live in secure residential settings. This, by default, places them at a higher risk for any communicable disease. While I do not provide direct care to them, my responsibility is to coordinate and monitor the health services provided to them. Annual vaccinations are a component of the services they receive; however, the data on how many had received the flu vaccine were nearly impossible to extract. That the opportunity to be exposed to the flu was constrained did little to quell the anxiety that we would have a full-blown outbreak in all of the residences. 

To compound that, we had no information about the vaccination status of the employees—the greatest potential source of introduction of the flu to the residents. While the employees are not under my purview, their communicability is my concern. And so the daily phone consults—who had a child that was home because the school was closed due to the flu; which employees had the sniffles or a sore throat; should they all to be sent home for a week’s quarantine?—continued for weeks. My response to “follow the CDC guidelines” was not always the answer people wanted. The best I could do was assuage their concerns that while the number of people with the flu was rapidly increasing, most cases were mild. 

All of this was made worse by the local news programs, which made the latest statistics appear as if, one by one, we would all be wiped out by the flu. When the World Health Organization (WHO) declared the pandemic, all hell broke loose. I spent days explaining what it meant that we had a pandemic (ie, it had crossed geographic borders) and what needed to be done. Thankfully, the WHO representatives reiterated the importance of getting vaccinated and reducing the risk for transmission as much as possible as the key methods of controlling the flu.  

The recent declaration by the WHO that the H1N1 flu is “unstoppable” made me realize that the frenzy will recommence soon. As I write, the Advisory Committee on Immunization Practices (ACIP) has announced plans for an “emergency or off-cycle meeting” on swine flu to be held on July 29. The ongoing concerns about availability of vaccines and identification of priority populations for vaccination, on the part of both WHO and ACIP, suggest that during the next flu season we may have more questions to answer.

Many more people probably contracted the H1N1 virus this spring but were not identified because the symptoms were mild. That may not be the case for the next round. The scientists at the CDC have some indication that the new H1N1 strain causes more severe illness, but it doesn’t appear to be as easily transmitted. This is good news. The lessons we learned in kindergarten should serve us well: Cover your mouth when you cough or sneeze, wash your hands, and stay home if you are sick. 

Am I ready for the second wave of this flu, which is sure to hit this fall? I’m not certain I’ll ever be ready, but I will (and firmly recommend that others) get the latest flu vaccine. Bottles of hand sanitizer will be readily available. And I’ll get stats on how many of my population are up-to-date on their vaccinations.

What about all of you? Let me know how you intend to prepare for the next flu season by sending an e-mail to NPEditor@qhc .com.

The time to prepare is now—not when you get the first bulletin from the CDC.

The recent H1N1 flu pandemic sent many people scurrying for their disaster plans—although we don’t call them disaster plans anymore. We like to put a positive spin on unplanned events these days; now they are known as preparedness plans.

Nonetheless, for many private and public entities, the dust had collected on those binders full of information on phone chains, continuation of operations, and business recovery. The fear that predictions of a widespread illness—one that could paralyze the entire country—were coming true raised the anxiety level of many administrators and health care workers. The use of pandemic to describe the event caused many to wonder whether this was the outbreak of the century, in which millions of people could sicken and die.

Daily updates from the CDC were often met with mixed responses: relief or concern, depending on whether one’s own community was affected and/or whether medication would be available, coupled with anxiety about whether it was safe to go out in public. The goals of the CDC updates were to reduce transmission of the disease and to educate people about staying healthy. Yet near-panic persisted and daily questions about what to do, whom to test, and how to treat those who were ill seemed endless. And it made me wonder—at a personal level, how well prepared were we? On the larger societal level, would we ever be ready to face a disease outbreak that threatened the existence of every citizen?

So I started at the beginning—in my own circle of friends and family. Did they receive their annual flu vaccine? Most had. Was anyone traveling? Most were or planned to be. Was anyone exposed to someone with flu-like symptoms? And there was the rub—who knew? The person sitting next to them on the train (or bus or plane) had been sneezing; the person they shared office space with at work was out “with a cold”; the neighbors went to Mexico during the school break. Concerns flourished, but often common sense withered. At least I had credibility with them; at work, it was another story. 

My next step was to look at my workplace. My main focus was my patient population: adolescents, the majority of whom live in secure residential settings. This, by default, places them at a higher risk for any communicable disease. While I do not provide direct care to them, my responsibility is to coordinate and monitor the health services provided to them. Annual vaccinations are a component of the services they receive; however, the data on how many had received the flu vaccine were nearly impossible to extract. That the opportunity to be exposed to the flu was constrained did little to quell the anxiety that we would have a full-blown outbreak in all of the residences. 

To compound that, we had no information about the vaccination status of the employees—the greatest potential source of introduction of the flu to the residents. While the employees are not under my purview, their communicability is my concern. And so the daily phone consults—who had a child that was home because the school was closed due to the flu; which employees had the sniffles or a sore throat; should they all to be sent home for a week’s quarantine?—continued for weeks. My response to “follow the CDC guidelines” was not always the answer people wanted. The best I could do was assuage their concerns that while the number of people with the flu was rapidly increasing, most cases were mild. 

All of this was made worse by the local news programs, which made the latest statistics appear as if, one by one, we would all be wiped out by the flu. When the World Health Organization (WHO) declared the pandemic, all hell broke loose. I spent days explaining what it meant that we had a pandemic (ie, it had crossed geographic borders) and what needed to be done. Thankfully, the WHO representatives reiterated the importance of getting vaccinated and reducing the risk for transmission as much as possible as the key methods of controlling the flu.  

The recent declaration by the WHO that the H1N1 flu is “unstoppable” made me realize that the frenzy will recommence soon. As I write, the Advisory Committee on Immunization Practices (ACIP) has announced plans for an “emergency or off-cycle meeting” on swine flu to be held on July 29. The ongoing concerns about availability of vaccines and identification of priority populations for vaccination, on the part of both WHO and ACIP, suggest that during the next flu season we may have more questions to answer.

Many more people probably contracted the H1N1 virus this spring but were not identified because the symptoms were mild. That may not be the case for the next round. The scientists at the CDC have some indication that the new H1N1 strain causes more severe illness, but it doesn’t appear to be as easily transmitted. This is good news. The lessons we learned in kindergarten should serve us well: Cover your mouth when you cough or sneeze, wash your hands, and stay home if you are sick. 

Am I ready for the second wave of this flu, which is sure to hit this fall? I’m not certain I’ll ever be ready, but I will (and firmly recommend that others) get the latest flu vaccine. Bottles of hand sanitizer will be readily available. And I’ll get stats on how many of my population are up-to-date on their vaccinations.

What about all of you? Let me know how you intend to prepare for the next flu season by sending an e-mail to NPEditor@qhc .com.

The time to prepare is now—not when you get the first bulletin from the CDC.

The recent H1N1 flu pandemic sent many people scurrying for their disaster plans—although we don’t call them disaster plans anymore. We like to put a positive spin on unplanned events these days; now they are known as preparedness plans.

Nonetheless, for many private and public entities, the dust had collected on those binders full of information on phone chains, continuation of operations, and business recovery. The fear that predictions of a widespread illness—one that could paralyze the entire country—were coming true raised the anxiety level of many administrators and health care workers. The use of pandemic to describe the event caused many to wonder whether this was the outbreak of the century, in which millions of people could sicken and die.

Daily updates from the CDC were often met with mixed responses: relief or concern, depending on whether one’s own community was affected and/or whether medication would be available, coupled with anxiety about whether it was safe to go out in public. The goals of the CDC updates were to reduce transmission of the disease and to educate people about staying healthy. Yet near-panic persisted and daily questions about what to do, whom to test, and how to treat those who were ill seemed endless. And it made me wonder—at a personal level, how well prepared were we? On the larger societal level, would we ever be ready to face a disease outbreak that threatened the existence of every citizen?

So I started at the beginning—in my own circle of friends and family. Did they receive their annual flu vaccine? Most had. Was anyone traveling? Most were or planned to be. Was anyone exposed to someone with flu-like symptoms? And there was the rub—who knew? The person sitting next to them on the train (or bus or plane) had been sneezing; the person they shared office space with at work was out “with a cold”; the neighbors went to Mexico during the school break. Concerns flourished, but often common sense withered. At least I had credibility with them; at work, it was another story. 

My next step was to look at my workplace. My main focus was my patient population: adolescents, the majority of whom live in secure residential settings. This, by default, places them at a higher risk for any communicable disease. While I do not provide direct care to them, my responsibility is to coordinate and monitor the health services provided to them. Annual vaccinations are a component of the services they receive; however, the data on how many had received the flu vaccine were nearly impossible to extract. That the opportunity to be exposed to the flu was constrained did little to quell the anxiety that we would have a full-blown outbreak in all of the residences. 

To compound that, we had no information about the vaccination status of the employees—the greatest potential source of introduction of the flu to the residents. While the employees are not under my purview, their communicability is my concern. And so the daily phone consults—who had a child that was home because the school was closed due to the flu; which employees had the sniffles or a sore throat; should they all to be sent home for a week’s quarantine?—continued for weeks. My response to “follow the CDC guidelines” was not always the answer people wanted. The best I could do was assuage their concerns that while the number of people with the flu was rapidly increasing, most cases were mild. 

All of this was made worse by the local news programs, which made the latest statistics appear as if, one by one, we would all be wiped out by the flu. When the World Health Organization (WHO) declared the pandemic, all hell broke loose. I spent days explaining what it meant that we had a pandemic (ie, it had crossed geographic borders) and what needed to be done. Thankfully, the WHO representatives reiterated the importance of getting vaccinated and reducing the risk for transmission as much as possible as the key methods of controlling the flu.  

The recent declaration by the WHO that the H1N1 flu is “unstoppable” made me realize that the frenzy will recommence soon. As I write, the Advisory Committee on Immunization Practices (ACIP) has announced plans for an “emergency or off-cycle meeting” on swine flu to be held on July 29. The ongoing concerns about availability of vaccines and identification of priority populations for vaccination, on the part of both WHO and ACIP, suggest that during the next flu season we may have more questions to answer.

Many more people probably contracted the H1N1 virus this spring but were not identified because the symptoms were mild. That may not be the case for the next round. The scientists at the CDC have some indication that the new H1N1 strain causes more severe illness, but it doesn’t appear to be as easily transmitted. This is good news. The lessons we learned in kindergarten should serve us well: Cover your mouth when you cough or sneeze, wash your hands, and stay home if you are sick. 

Am I ready for the second wave of this flu, which is sure to hit this fall? I’m not certain I’ll ever be ready, but I will (and firmly recommend that others) get the latest flu vaccine. Bottles of hand sanitizer will be readily available. And I’ll get stats on how many of my population are up-to-date on their vaccinations.

What about all of you? Let me know how you intend to prepare for the next flu season by sending an e-mail to NPEditor@qhc .com.

The time to prepare is now—not when you get the first bulletin from the CDC.

I must admit, when I heard that the American College of Physicians (ACP) had published a policy monograph¹ relating to NPs, I groaned. I dreaded yet one more attempt by a non–nursing professional organization to weigh in on what they believe is the scope of nursing practice. When I read the document, I was somewhat surprised that in fact, I agreed with many of the tenets of the policy; I just had a different way of seeing how they should be applied.
Yes, NPs, PAs, and MDs have all been educated differently. But I disagree that the physician is “often the most appropriate professional” to provide primary care. With much of primary care geared toward health promotion, the strength of NP care is preventing disease and teaching patients about how to get healthy and stay healthy. That does not mean we’re incapable of caring for those who are ill or for those with comorbidities. It does mean that we work with our patients to prevent the untoward sequelae of their health problems. The educational guidance NPs provide in the course of care is, in my opinion, far more valuable and therapeutic than most of the prescriptions that are written.

I also want to point out that many of the skills physicians have obtained, they learned from, or with the assistance of, a nurse. I, for one, have not only mentored many interns and residents but have also been the person many of my physician colleagues have consulted because of my expertise and years of experience. So this discussion isn’t about our educational beginnings, but rather how we have developed our knowledge, skills, and abilities, and how we continue to hone them.

The comments in the ACP policy regarding the doctorate of nursing practice are not unique to the ACP. Many have vacillated on the degree and whether it should be an “entry-level” requirement for NPs. The ACP is accurate in noting that the competency areas of the DNP are focused on systems-based practice and policy. On this issue—at the risk of being ostracized by some of my colleagues—I will publicly acknowledge my opposition to the DNP as entry level into the NP role. Where I disagree with the ACP is its statement that the use of the title Doctor could lead to “confusion and misconceptions” among patients. I think it is more misleading when physicians refer to the medical assistants in their practice as “the nurse.” The title Doctor is used in academia, in psychology, and in pharmacy. For patients to be provided information about the different health care providers in the practice is important, but people who have earned their doctoral degree have every right to use the title. It is not owned by the medical profession.

The acknowledgment that NPs provide access to health care in both rural and urban areas is rather a left-handed compliment. As I read and reread the document, it appeared to me that the ACP believes the need for access to care is not a sufficient reason for reimbursement, prescriptive authority, or an “expanded role” for NPs. However, they do support NPs’ providing care in “underserved areas.” I agree that we provide that essential access, but we provide it in all areas and by patient choice—not just to the underserved. Moreover, we have continued to provide that care in locations that our physician colleagues have either avoided or abandoned.

What continues to be a barrier to providing NP services for those whose primary care provider is an NP is the issue of reimbursement. In my opinion, the system of paying for the provider, not the service, is one of the key reasons our health care expenditures have gotten out of control. That the reimbursement language is often “physician service”–based is problematic. I find it interesting that the ACP, though recognizing “the important role” NPs play in meeting the need for access to care, does not include a recommendation that reimbursement for NPs be standardized.

Research has been conducted repeatedly to determine whether the care we NPs provide is of high quality, safe, and affordable. While I agree that continued research on our professions may put to rest the ever-surfacing questions about patient outcomes, it is just as important to study all health care providers in that research and for the research team to include NPs, PAs, and MDs, rather than just one profession examining another. That the ACP recommends viewing “with caution” the research findings on patient outcomes amuses me. Apparently, many studies had “methodological limitations,” and only one study with sufficient power had been done. If that one study had examined outcomes for physicians’ patients, would the ACP have made the same cautionary remarks?

The recommendation that research is needed “to develop effective systems of consultation” leads me to question whether the authors of the ACP document have ever observed a nurse practitioner in action—or, for that matter, any of the other professionals with whom they consult and collaborate in their everyday practice. There are well-established systems already in place, and HMOs, college health services, and community health centers are shining examples. In all of these settings, the health care team functions as an efficient, effective body, offering patients excellent care and access to the professional most appropriate for their management and treatment. The research we really need is on how to replicate those successful systems and make them the paradigm for primary care throughout the United States.

The best health care system is one in which all the providers share the ultimate responsibility for the care provided. Each professional has the obligation to function to the fullest extent of his or her scope of practice and capability. The days of a hierarchical system in which the physician is the “captain of the ship” are gone. The idea that one profession can constrain another profession is ludicrous. In this regard, it appears the ACP agrees that the nursing discipline is the body to be charged with developing scope-of-practice statutes and regulations. I encourage the ACP to work with other physician groups to embrace this notion and to refrain from interfering with legislation that guarantees NPs the ability to function to the fullest extent of their profession.

I will be interested to read the ACP policy on physician assistants. I was appalled that in the current document, the authors referred to my PA colleagues in the possessive (“physician’s assistants”)—but I will leave it to PA Editor-in-Chief Randy Danielsen to deal with that faux pas.      

I must admit, when I heard that the American College of Physicians (ACP) had published a policy monograph¹ relating to NPs, I groaned. I dreaded yet one more attempt by a non–nursing professional organization to weigh in on what they believe is the scope of nursing practice. When I read the document, I was somewhat surprised that in fact, I agreed with many of the tenets of the policy; I just had a different way of seeing how they should be applied.
Yes, NPs, PAs, and MDs have all been educated differently. But I disagree that the physician is “often the most appropriate professional” to provide primary care. With much of primary care geared toward health promotion, the strength of NP care is preventing disease and teaching patients about how to get healthy and stay healthy. That does not mean we’re incapable of caring for those who are ill or for those with comorbidities. It does mean that we work with our patients to prevent the untoward sequelae of their health problems. The educational guidance NPs provide in the course of care is, in my opinion, far more valuable and therapeutic than most of the prescriptions that are written.

I also want to point out that many of the skills physicians have obtained, they learned from, or with the assistance of, a nurse. I, for one, have not only mentored many interns and residents but have also been the person many of my physician colleagues have consulted because of my expertise and years of experience. So this discussion isn’t about our educational beginnings, but rather how we have developed our knowledge, skills, and abilities, and how we continue to hone them.

The comments in the ACP policy regarding the doctorate of nursing practice are not unique to the ACP. Many have vacillated on the degree and whether it should be an “entry-level” requirement for NPs. The ACP is accurate in noting that the competency areas of the DNP are focused on systems-based practice and policy. On this issue—at the risk of being ostracized by some of my colleagues—I will publicly acknowledge my opposition to the DNP as entry level into the NP role. Where I disagree with the ACP is its statement that the use of the title Doctor could lead to “confusion and misconceptions” among patients. I think it is more misleading when physicians refer to the medical assistants in their practice as “the nurse.” The title Doctor is used in academia, in psychology, and in pharmacy. For patients to be provided information about the different health care providers in the practice is important, but people who have earned their doctoral degree have every right to use the title. It is not owned by the medical profession.

The acknowledgment that NPs provide access to health care in both rural and urban areas is rather a left-handed compliment. As I read and reread the document, it appeared to me that the ACP believes the need for access to care is not a sufficient reason for reimbursement, prescriptive authority, or an “expanded role” for NPs. However, they do support NPs’ providing care in “underserved areas.” I agree that we provide that essential access, but we provide it in all areas and by patient choice—not just to the underserved. Moreover, we have continued to provide that care in locations that our physician colleagues have either avoided or abandoned.

What continues to be a barrier to providing NP services for those whose primary care provider is an NP is the issue of reimbursement. In my opinion, the system of paying for the provider, not the service, is one of the key reasons our health care expenditures have gotten out of control. That the reimbursement language is often “physician service”–based is problematic. I find it interesting that the ACP, though recognizing “the important role” NPs play in meeting the need for access to care, does not include a recommendation that reimbursement for NPs be standardized.

Research has been conducted repeatedly to determine whether the care we NPs provide is of high quality, safe, and affordable. While I agree that continued research on our professions may put to rest the ever-surfacing questions about patient outcomes, it is just as important to study all health care providers in that research and for the research team to include NPs, PAs, and MDs, rather than just one profession examining another. That the ACP recommends viewing “with caution” the research findings on patient outcomes amuses me. Apparently, many studies had “methodological limitations,” and only one study with sufficient power had been done. If that one study had examined outcomes for physicians’ patients, would the ACP have made the same cautionary remarks?

The recommendation that research is needed “to develop effective systems of consultation” leads me to question whether the authors of the ACP document have ever observed a nurse practitioner in action—or, for that matter, any of the other professionals with whom they consult and collaborate in their everyday practice. There are well-established systems already in place, and HMOs, college health services, and community health centers are shining examples. In all of these settings, the health care team functions as an efficient, effective body, offering patients excellent care and access to the professional most appropriate for their management and treatment. The research we really need is on how to replicate those successful systems and make them the paradigm for primary care throughout the United States.

The best health care system is one in which all the providers share the ultimate responsibility for the care provided. Each professional has the obligation to function to the fullest extent of his or her scope of practice and capability. The days of a hierarchical system in which the physician is the “captain of the ship” are gone. The idea that one profession can constrain another profession is ludicrous. In this regard, it appears the ACP agrees that the nursing discipline is the body to be charged with developing scope-of-practice statutes and regulations. I encourage the ACP to work with other physician groups to embrace this notion and to refrain from interfering with legislation that guarantees NPs the ability to function to the fullest extent of their profession.

I will be interested to read the ACP policy on physician assistants. I was appalled that in the current document, the authors referred to my PA colleagues in the possessive (“physician’s assistants”)—but I will leave it to PA Editor-in-Chief Randy Danielsen to deal with that faux pas.      

I must admit, when I heard that the American College of Physicians (ACP) had published a policy monograph¹ relating to NPs, I groaned. I dreaded yet one more attempt by a non–nursing professional organization to weigh in on what they believe is the scope of nursing practice. When I read the document, I was somewhat surprised that in fact, I agreed with many of the tenets of the policy; I just had a different way of seeing how they should be applied.
Yes, NPs, PAs, and MDs have all been educated differently. But I disagree that the physician is “often the most appropriate professional” to provide primary care. With much of primary care geared toward health promotion, the strength of NP care is preventing disease and teaching patients about how to get healthy and stay healthy. That does not mean we’re incapable of caring for those who are ill or for those with comorbidities. It does mean that we work with our patients to prevent the untoward sequelae of their health problems. The educational guidance NPs provide in the course of care is, in my opinion, far more valuable and therapeutic than most of the prescriptions that are written.

I also want to point out that many of the skills physicians have obtained, they learned from, or with the assistance of, a nurse. I, for one, have not only mentored many interns and residents but have also been the person many of my physician colleagues have consulted because of my expertise and years of experience. So this discussion isn’t about our educational beginnings, but rather how we have developed our knowledge, skills, and abilities, and how we continue to hone them.

The comments in the ACP policy regarding the doctorate of nursing practice are not unique to the ACP. Many have vacillated on the degree and whether it should be an “entry-level” requirement for NPs. The ACP is accurate in noting that the competency areas of the DNP are focused on systems-based practice and policy. On this issue—at the risk of being ostracized by some of my colleagues—I will publicly acknowledge my opposition to the DNP as entry level into the NP role. Where I disagree with the ACP is its statement that the use of the title Doctor could lead to “confusion and misconceptions” among patients. I think it is more misleading when physicians refer to the medical assistants in their practice as “the nurse.” The title Doctor is used in academia, in psychology, and in pharmacy. For patients to be provided information about the different health care providers in the practice is important, but people who have earned their doctoral degree have every right to use the title. It is not owned by the medical profession.

The acknowledgment that NPs provide access to health care in both rural and urban areas is rather a left-handed compliment. As I read and reread the document, it appeared to me that the ACP believes the need for access to care is not a sufficient reason for reimbursement, prescriptive authority, or an “expanded role” for NPs. However, they do support NPs’ providing care in “underserved areas.” I agree that we provide that essential access, but we provide it in all areas and by patient choice—not just to the underserved. Moreover, we have continued to provide that care in locations that our physician colleagues have either avoided or abandoned.

What continues to be a barrier to providing NP services for those whose primary care provider is an NP is the issue of reimbursement. In my opinion, the system of paying for the provider, not the service, is one of the key reasons our health care expenditures have gotten out of control. That the reimbursement language is often “physician service”–based is problematic. I find it interesting that the ACP, though recognizing “the important role” NPs play in meeting the need for access to care, does not include a recommendation that reimbursement for NPs be standardized.

Research has been conducted repeatedly to determine whether the care we NPs provide is of high quality, safe, and affordable. While I agree that continued research on our professions may put to rest the ever-surfacing questions about patient outcomes, it is just as important to study all health care providers in that research and for the research team to include NPs, PAs, and MDs, rather than just one profession examining another. That the ACP recommends viewing “with caution” the research findings on patient outcomes amuses me. Apparently, many studies had “methodological limitations,” and only one study with sufficient power had been done. If that one study had examined outcomes for physicians’ patients, would the ACP have made the same cautionary remarks?

The recommendation that research is needed “to develop effective systems of consultation” leads me to question whether the authors of the ACP document have ever observed a nurse practitioner in action—or, for that matter, any of the other professionals with whom they consult and collaborate in their everyday practice. There are well-established systems already in place, and HMOs, college health services, and community health centers are shining examples. In all of these settings, the health care team functions as an efficient, effective body, offering patients excellent care and access to the professional most appropriate for their management and treatment. The research we really need is on how to replicate those successful systems and make them the paradigm for primary care throughout the United States.

The best health care system is one in which all the providers share the ultimate responsibility for the care provided. Each professional has the obligation to function to the fullest extent of his or her scope of practice and capability. The days of a hierarchical system in which the physician is the “captain of the ship” are gone. The idea that one profession can constrain another profession is ludicrous. In this regard, it appears the ACP agrees that the nursing discipline is the body to be charged with developing scope-of-practice statutes and regulations. I encourage the ACP to work with other physician groups to embrace this notion and to refrain from interfering with legislation that guarantees NPs the ability to function to the fullest extent of their profession.

I will be interested to read the ACP policy on physician assistants. I was appalled that in the current document, the authors referred to my PA colleagues in the possessive (“physician’s assistants”)—but I will leave it to PA Editor-in-Chief Randy Danielsen to deal with that faux pas.      

In their book Freakonomics, authors Steven Levitt and Stephen Dubner address unquestioned theories, seemingly logical explanations for changes in society, that became conventional wisdom. Specifically, such beliefs about economic causes and effects are analyzed and summarily dismissed as false.

At the risk of falling victim to a similar kind of logic, I've been wondering about a very different cause-and-effect scenario—namely, the repercussions of America's severely weakened economy on the emotional and physical health of our adolescent population. 

Adolescents, of course, are not the breadwinners in families. Nevertheless, they can be seriously impacted by economic strain as they witness its effects on their parents and other family members and perhaps worry about their own future in the job market. And because adolescents are frequently more susceptible to external pressures than adults, they are more likely to pursue risky activities, for perceived benefits unique to their age-group, in order to relieve that stress.

Although the recent push by Congress to provide health insurance to millions of low-income children (including adolescents) is admirable, it is imperative that we go even further by putting a greater emphasis on healthy lifestyles and avoidance of risky behaviors when we see adolescent patients.

We know that adolescents are a particularly vulnerable population because they tend to think of themselves as immortal, due to their underdeveloped socioemotional and cognitive-control systems. The socioemotional system becomes very active during puberty and makes adolescents more susceptible to social influences, intense emotions, and physical arousal. The cognitive-control system is the part of the brain that regulates behavior and makes decisions, but it is still maturing during adolescence. Therefore, we need to pay attention to situations that challenge the adolescent's ability to refrain from engaging in risky behaviors.

Violence is one of the more risky behaviors that attract our youth. Fights involving weapons and fistfights that inflict serious injuries are obvious examples. Television, video games, and the Internet have all been cited as being causal risk factors in increasing the likelihood of violent behavior in adolescents. Add the exposure to violence via the media to the immaturity of their cognitive control system and you have a recipe for tragedy.

But violent activities aren't the only concern. Other behaviors that adolescents engage in can be just as destructive. Behaviors thought to be innocent communications or merely games can have devastating outcomes.

Posing sexually oriented questions on public Web sites such as "chat rooms," for example, can expose adolescents to sexual predators or unwanted conversations with adults pretending to be teenagers. Engaging in choking or asphyxial games or inhaling common substances in an attempt to get a momentary high can result in serious injury or even death.  

Another important thing to keep in mind is that risk-taking behaviors tend to cluster—if an adolescent engages in one, he or she is more likely to engage in others. We need to keep ourselves apprised of what our youth are doing and be attuned to the subtle clues that suggest they are at risk. 

The considerable energies of the adolescent must be creatively channeled into activities that mitigate involvement in risk-taking behaviors. Researchers from the University of Washington1 recently demonstrated that adolescents frequently display on public Web sites risk-taking behavior information, such as describing sexual behaviors or substance use.

The researchers found that intervention using social networking sites shows promise in reducing sexual references in the online profiles of at-risk adolescents. They also found that involvement in church activities, sports, or hobbies was associated with a decrease in references to violence and other such behaviors.

Involving youth in organized activities is a wonderful concept and ideal. But school and community programs that help engage youth in after-school activities have fallen victim to budget cuts over the past few years and are sure to be the target of further cuts. The decimation of such activities can put adolescents at risk to engage in unhealthy behaviors as the number of unsupervised hours in their lives increases.

We need to take every opportunity to reach out to our young patients and assist them in making healthy choices by teaching them how to improve and maintain their physical and mental health. Ask them what they do in their free time and what kind of relationships they have with friends and family. Open the door to discussions about what's going on in their life.

Keeping our future generations healthy is about more than insurance. It's about getting them involved in activities that keep them physically and emotionally healthy and teaching them to manage their lives creatively.

In today's difficult economic environment, with so much uncertainty surrounding our youth at every turn, this is more important than ever.  

In their book Freakonomics, authors Steven Levitt and Stephen Dubner address unquestioned theories, seemingly logical explanations for changes in society, that became conventional wisdom. Specifically, such beliefs about economic causes and effects are analyzed and summarily dismissed as false.

At the risk of falling victim to a similar kind of logic, I've been wondering about a very different cause-and-effect scenario—namely, the repercussions of America's severely weakened economy on the emotional and physical health of our adolescent population. 

Adolescents, of course, are not the breadwinners in families. Nevertheless, they can be seriously impacted by economic strain as they witness its effects on their parents and other family members and perhaps worry about their own future in the job market. And because adolescents are frequently more susceptible to external pressures than adults, they are more likely to pursue risky activities, for perceived benefits unique to their age-group, in order to relieve that stress.

Although the recent push by Congress to provide health insurance to millions of low-income children (including adolescents) is admirable, it is imperative that we go even further by putting a greater emphasis on healthy lifestyles and avoidance of risky behaviors when we see adolescent patients.

We know that adolescents are a particularly vulnerable population because they tend to think of themselves as immortal, due to their underdeveloped socioemotional and cognitive-control systems. The socioemotional system becomes very active during puberty and makes adolescents more susceptible to social influences, intense emotions, and physical arousal. The cognitive-control system is the part of the brain that regulates behavior and makes decisions, but it is still maturing during adolescence. Therefore, we need to pay attention to situations that challenge the adolescent's ability to refrain from engaging in risky behaviors.

Violence is one of the more risky behaviors that attract our youth. Fights involving weapons and fistfights that inflict serious injuries are obvious examples. Television, video games, and the Internet have all been cited as being causal risk factors in increasing the likelihood of violent behavior in adolescents. Add the exposure to violence via the media to the immaturity of their cognitive control system and you have a recipe for tragedy.

But violent activities aren't the only concern. Other behaviors that adolescents engage in can be just as destructive. Behaviors thought to be innocent communications or merely games can have devastating outcomes.

Posing sexually oriented questions on public Web sites such as "chat rooms," for example, can expose adolescents to sexual predators or unwanted conversations with adults pretending to be teenagers. Engaging in choking or asphyxial games or inhaling common substances in an attempt to get a momentary high can result in serious injury or even death.  

Another important thing to keep in mind is that risk-taking behaviors tend to cluster—if an adolescent engages in one, he or she is more likely to engage in others. We need to keep ourselves apprised of what our youth are doing and be attuned to the subtle clues that suggest they are at risk. 

The considerable energies of the adolescent must be creatively channeled into activities that mitigate involvement in risk-taking behaviors. Researchers from the University of Washington1 recently demonstrated that adolescents frequently display on public Web sites risk-taking behavior information, such as describing sexual behaviors or substance use.

The researchers found that intervention using social networking sites shows promise in reducing sexual references in the online profiles of at-risk adolescents. They also found that involvement in church activities, sports, or hobbies was associated with a decrease in references to violence and other such behaviors.

Involving youth in organized activities is a wonderful concept and ideal. But school and community programs that help engage youth in after-school activities have fallen victim to budget cuts over the past few years and are sure to be the target of further cuts. The decimation of such activities can put adolescents at risk to engage in unhealthy behaviors as the number of unsupervised hours in their lives increases.

We need to take every opportunity to reach out to our young patients and assist them in making healthy choices by teaching them how to improve and maintain their physical and mental health. Ask them what they do in their free time and what kind of relationships they have with friends and family. Open the door to discussions about what's going on in their life.

Keeping our future generations healthy is about more than insurance. It's about getting them involved in activities that keep them physically and emotionally healthy and teaching them to manage their lives creatively.

In today's difficult economic environment, with so much uncertainty surrounding our youth at every turn, this is more important than ever.  

In their book Freakonomics, authors Steven Levitt and Stephen Dubner address unquestioned theories, seemingly logical explanations for changes in society, that became conventional wisdom. Specifically, such beliefs about economic causes and effects are analyzed and summarily dismissed as false.

At the risk of falling victim to a similar kind of logic, I've been wondering about a very different cause-and-effect scenario—namely, the repercussions of America's severely weakened economy on the emotional and physical health of our adolescent population. 

Adolescents, of course, are not the breadwinners in families. Nevertheless, they can be seriously impacted by economic strain as they witness its effects on their parents and other family members and perhaps worry about their own future in the job market. And because adolescents are frequently more susceptible to external pressures than adults, they are more likely to pursue risky activities, for perceived benefits unique to their age-group, in order to relieve that stress.

Although the recent push by Congress to provide health insurance to millions of low-income children (including adolescents) is admirable, it is imperative that we go even further by putting a greater emphasis on healthy lifestyles and avoidance of risky behaviors when we see adolescent patients.

We know that adolescents are a particularly vulnerable population because they tend to think of themselves as immortal, due to their underdeveloped socioemotional and cognitive-control systems. The socioemotional system becomes very active during puberty and makes adolescents more susceptible to social influences, intense emotions, and physical arousal. The cognitive-control system is the part of the brain that regulates behavior and makes decisions, but it is still maturing during adolescence. Therefore, we need to pay attention to situations that challenge the adolescent's ability to refrain from engaging in risky behaviors.

Violence is one of the more risky behaviors that attract our youth. Fights involving weapons and fistfights that inflict serious injuries are obvious examples. Television, video games, and the Internet have all been cited as being causal risk factors in increasing the likelihood of violent behavior in adolescents. Add the exposure to violence via the media to the immaturity of their cognitive control system and you have a recipe for tragedy.

But violent activities aren't the only concern. Other behaviors that adolescents engage in can be just as destructive. Behaviors thought to be innocent communications or merely games can have devastating outcomes.

Posing sexually oriented questions on public Web sites such as "chat rooms," for example, can expose adolescents to sexual predators or unwanted conversations with adults pretending to be teenagers. Engaging in choking or asphyxial games or inhaling common substances in an attempt to get a momentary high can result in serious injury or even death.  

Another important thing to keep in mind is that risk-taking behaviors tend to cluster—if an adolescent engages in one, he or she is more likely to engage in others. We need to keep ourselves apprised of what our youth are doing and be attuned to the subtle clues that suggest they are at risk. 

The considerable energies of the adolescent must be creatively channeled into activities that mitigate involvement in risk-taking behaviors. Researchers from the University of Washington1 recently demonstrated that adolescents frequently display on public Web sites risk-taking behavior information, such as describing sexual behaviors or substance use.

The researchers found that intervention using social networking sites shows promise in reducing sexual references in the online profiles of at-risk adolescents. They also found that involvement in church activities, sports, or hobbies was associated with a decrease in references to violence and other such behaviors.

Involving youth in organized activities is a wonderful concept and ideal. But school and community programs that help engage youth in after-school activities have fallen victim to budget cuts over the past few years and are sure to be the target of further cuts. The decimation of such activities can put adolescents at risk to engage in unhealthy behaviors as the number of unsupervised hours in their lives increases.

We need to take every opportunity to reach out to our young patients and assist them in making healthy choices by teaching them how to improve and maintain their physical and mental health. Ask them what they do in their free time and what kind of relationships they have with friends and family. Open the door to discussions about what's going on in their life.

Keeping our future generations healthy is about more than insurance. It's about getting them involved in activities that keep them physically and emotionally healthy and teaching them to manage their lives creatively.

In today's difficult economic environment, with so much uncertainty surrounding our youth at every turn, this is more important than ever.  

After 21 months of campaigning, incessant coast-to-coast travel, and seemingly countless promises made, our President-Elect and House and Senate representatives have finally been identified. Whether or not your candidates will be sitting in new or existing seats, there is no question that the true challenge when it comes to health care reform now lies ahead.

The presidential campaign was marked by the unrelenting demand for health care reform, an issue that has been on many candidates’ platforms for years, yet still goes unresolved. Some skeptics have posited that health care reform is an unreachable goal. Others insist that any change will be met with resistance because the costs (both financial and nonmonetary) are beyond what the United States can or is willing to afford.

Of course, there are two fundamental views on health care reform—and to some degree they are distinctly different with regard to the changes that need to be implemented and also the when and how of putting those changes into effect. There are key differences on what are seen as the primary goals of health care reform. Do we reach for universal or near-universal health insurance coverage? Or something less ambitious?

There are also divergent opinions as to the purpose of health insurance. Is it to provide comprehensive insurance that encourages preventive care and protects the consumer from the financial burdens of an illness? Or is it to provide a plan with significant deductibles but with protection against catastrophic illness, allowing for saving accounts and pretax dollars to pay for routine health care? The supporters of the latter option submit that such a plan makes people better consumers of health care. But regardless of the payment structure, it is imperative to remember that the core problems in the health care conundrum are economic in nature, and the ultimate challenge is making sure that everyone has access to affordable care. 

Still, in the midst of all the debates about cost and coverage, the issues of provider shortages, reimbursements, and scope of practice in many ways took a back seat during this election year. When the issue of access is addressed, it is usually only with regard to affordable health care.

Throughout all of the discussions about reform, one key solution—increased recognition of the importance of NP and PA practice—has yet to be mentioned. Despite being significant providers, in numbers and in experience, in the health care arena, NPs and PAs still wear a virtual cloak of invisibility. In many instances, we are overlooked when national data are collected on patient visits, laboratory tests ordered, and number of prescriptions written.

One might ask, “Why does this matter?” Quite simply, the data confirm our contributions to the health care system in the US and offer proof that our professions are necessary to meet the needs of primary and specialty care in the future. Being invisible means that we are not considered a part of the solution to the shortage of primary care providers, that we are not part of the solution to people having access to care in their home communities.

Health policy researchers have suggested that stakeholders look to recent changes in Massachusetts geared toward relieving the burden of broader access in the aftermath of mandatory insurance enacted in 2007. This year, the Massachusetts legislature allowed for the recognition of NPs as primary care providers (Chapter 305 of the Acts of 2008), which resulted in an instant and significant increase in the number of providers available to residents of the Commonwealth. Just as the need for more providers in Massachusetts became apparent and NPs proved to be the answer, it is imperative that any national reform includes allowing professionals who have met the requisite licensing and qualifications standards to fully function in their roles as health care providers. 

However, our health care system is still inextricably tied to the physician model in ways that often hinder our ability to reach out to those who are disenfranchised from the system or to provide expanded access to care. Don’t misunderstand, there is a need for our physician colleagues—and we will always turn to them for assistance in problem solving on a difficult case (in the same way they consult with each other and with us). However, in many states, the requirement that NPs and PAs must have charts cosigned by a physician, or that there must be a certain ratio of NPs or PAs to MDs in a practice, constrains our ability to function as responsible, educated, autonomous providers. I submit that it is these restrictions and oversight requirements that contribute to skyrocketing health care costs and impede access to care.

Now, with the elections over, the rhetoric about fixing the health care system in America is primed to become reality, and it’s roll-up-your-sleeves time (again). It is incumbent upon us to continue to lobby for the issues that impact not only our ability to practice but also the health care consumer’s choice of provider and access to care. We have already seen a momentous change in the composition of our leadership. Our first African-American president will be inaugurated next month, and there are more women in governing seats than ever before. Maybe, just maybe, during these administrations that are about to begin—on federal, state, and local levels—we will also finally see a parallel change in the recognized and reimbursable composition of our health care providers.          

After 21 months of campaigning, incessant coast-to-coast travel, and seemingly countless promises made, our President-Elect and House and Senate representatives have finally been identified. Whether or not your candidates will be sitting in new or existing seats, there is no question that the true challenge when it comes to health care reform now lies ahead.

The presidential campaign was marked by the unrelenting demand for health care reform, an issue that has been on many candidates’ platforms for years, yet still goes unresolved. Some skeptics have posited that health care reform is an unreachable goal. Others insist that any change will be met with resistance because the costs (both financial and nonmonetary) are beyond what the United States can or is willing to afford.

Of course, there are two fundamental views on health care reform—and to some degree they are distinctly different with regard to the changes that need to be implemented and also the when and how of putting those changes into effect. There are key differences on what are seen as the primary goals of health care reform. Do we reach for universal or near-universal health insurance coverage? Or something less ambitious?

There are also divergent opinions as to the purpose of health insurance. Is it to provide comprehensive insurance that encourages preventive care and protects the consumer from the financial burdens of an illness? Or is it to provide a plan with significant deductibles but with protection against catastrophic illness, allowing for saving accounts and pretax dollars to pay for routine health care? The supporters of the latter option submit that such a plan makes people better consumers of health care. But regardless of the payment structure, it is imperative to remember that the core problems in the health care conundrum are economic in nature, and the ultimate challenge is making sure that everyone has access to affordable care. 

Still, in the midst of all the debates about cost and coverage, the issues of provider shortages, reimbursements, and scope of practice in many ways took a back seat during this election year. When the issue of access is addressed, it is usually only with regard to affordable health care.

Throughout all of the discussions about reform, one key solution—increased recognition of the importance of NP and PA practice—has yet to be mentioned. Despite being significant providers, in numbers and in experience, in the health care arena, NPs and PAs still wear a virtual cloak of invisibility. In many instances, we are overlooked when national data are collected on patient visits, laboratory tests ordered, and number of prescriptions written.

One might ask, “Why does this matter?” Quite simply, the data confirm our contributions to the health care system in the US and offer proof that our professions are necessary to meet the needs of primary and specialty care in the future. Being invisible means that we are not considered a part of the solution to the shortage of primary care providers, that we are not part of the solution to people having access to care in their home communities.

Health policy researchers have suggested that stakeholders look to recent changes in Massachusetts geared toward relieving the burden of broader access in the aftermath of mandatory insurance enacted in 2007. This year, the Massachusetts legislature allowed for the recognition of NPs as primary care providers (Chapter 305 of the Acts of 2008), which resulted in an instant and significant increase in the number of providers available to residents of the Commonwealth. Just as the need for more providers in Massachusetts became apparent and NPs proved to be the answer, it is imperative that any national reform includes allowing professionals who have met the requisite licensing and qualifications standards to fully function in their roles as health care providers. 

However, our health care system is still inextricably tied to the physician model in ways that often hinder our ability to reach out to those who are disenfranchised from the system or to provide expanded access to care. Don’t misunderstand, there is a need for our physician colleagues—and we will always turn to them for assistance in problem solving on a difficult case (in the same way they consult with each other and with us). However, in many states, the requirement that NPs and PAs must have charts cosigned by a physician, or that there must be a certain ratio of NPs or PAs to MDs in a practice, constrains our ability to function as responsible, educated, autonomous providers. I submit that it is these restrictions and oversight requirements that contribute to skyrocketing health care costs and impede access to care.

Now, with the elections over, the rhetoric about fixing the health care system in America is primed to become reality, and it’s roll-up-your-sleeves time (again). It is incumbent upon us to continue to lobby for the issues that impact not only our ability to practice but also the health care consumer’s choice of provider and access to care. We have already seen a momentous change in the composition of our leadership. Our first African-American president will be inaugurated next month, and there are more women in governing seats than ever before. Maybe, just maybe, during these administrations that are about to begin—on federal, state, and local levels—we will also finally see a parallel change in the recognized and reimbursable composition of our health care providers.          

After 21 months of campaigning, incessant coast-to-coast travel, and seemingly countless promises made, our President-Elect and House and Senate representatives have finally been identified. Whether or not your candidates will be sitting in new or existing seats, there is no question that the true challenge when it comes to health care reform now lies ahead.

The presidential campaign was marked by the unrelenting demand for health care reform, an issue that has been on many candidates’ platforms for years, yet still goes unresolved. Some skeptics have posited that health care reform is an unreachable goal. Others insist that any change will be met with resistance because the costs (both financial and nonmonetary) are beyond what the United States can or is willing to afford.

Of course, there are two fundamental views on health care reform—and to some degree they are distinctly different with regard to the changes that need to be implemented and also the when and how of putting those changes into effect. There are key differences on what are seen as the primary goals of health care reform. Do we reach for universal or near-universal health insurance coverage? Or something less ambitious?

There are also divergent opinions as to the purpose of health insurance. Is it to provide comprehensive insurance that encourages preventive care and protects the consumer from the financial burdens of an illness? Or is it to provide a plan with significant deductibles but with protection against catastrophic illness, allowing for saving accounts and pretax dollars to pay for routine health care? The supporters of the latter option submit that such a plan makes people better consumers of health care. But regardless of the payment structure, it is imperative to remember that the core problems in the health care conundrum are economic in nature, and the ultimate challenge is making sure that everyone has access to affordable care. 

Still, in the midst of all the debates about cost and coverage, the issues of provider shortages, reimbursements, and scope of practice in many ways took a back seat during this election year. When the issue of access is addressed, it is usually only with regard to affordable health care.

Throughout all of the discussions about reform, one key solution—increased recognition of the importance of NP and PA practice—has yet to be mentioned. Despite being significant providers, in numbers and in experience, in the health care arena, NPs and PAs still wear a virtual cloak of invisibility. In many instances, we are overlooked when national data are collected on patient visits, laboratory tests ordered, and number of prescriptions written.

One might ask, “Why does this matter?” Quite simply, the data confirm our contributions to the health care system in the US and offer proof that our professions are necessary to meet the needs of primary and specialty care in the future. Being invisible means that we are not considered a part of the solution to the shortage of primary care providers, that we are not part of the solution to people having access to care in their home communities.

Health policy researchers have suggested that stakeholders look to recent changes in Massachusetts geared toward relieving the burden of broader access in the aftermath of mandatory insurance enacted in 2007. This year, the Massachusetts legislature allowed for the recognition of NPs as primary care providers (Chapter 305 of the Acts of 2008), which resulted in an instant and significant increase in the number of providers available to residents of the Commonwealth. Just as the need for more providers in Massachusetts became apparent and NPs proved to be the answer, it is imperative that any national reform includes allowing professionals who have met the requisite licensing and qualifications standards to fully function in their roles as health care providers. 

However, our health care system is still inextricably tied to the physician model in ways that often hinder our ability to reach out to those who are disenfranchised from the system or to provide expanded access to care. Don’t misunderstand, there is a need for our physician colleagues—and we will always turn to them for assistance in problem solving on a difficult case (in the same way they consult with each other and with us). However, in many states, the requirement that NPs and PAs must have charts cosigned by a physician, or that there must be a certain ratio of NPs or PAs to MDs in a practice, constrains our ability to function as responsible, educated, autonomous providers. I submit that it is these restrictions and oversight requirements that contribute to skyrocketing health care costs and impede access to care.

Now, with the elections over, the rhetoric about fixing the health care system in America is primed to become reality, and it’s roll-up-your-sleeves time (again). It is incumbent upon us to continue to lobby for the issues that impact not only our ability to practice but also the health care consumer’s choice of provider and access to care. We have already seen a momentous change in the composition of our leadership. Our first African-American president will be inaugurated next month, and there are more women in governing seats than ever before. Maybe, just maybe, during these administrations that are about to begin—on federal, state, and local levels—we will also finally see a parallel change in the recognized and reimbursable composition of our health care providers.          

In this inaugural editorial as the NP Editor-in-Chief of Clinician Reviews, I would like to expand on the July message of my colleague Randy Danielsen, PhD, PA-C, who wrote of the importance of preceptors. Equally important, I believe, is the need to “give back”—not only to our professions but to society as a whole.

But first, I want to say how honored I am to be asked to rejoin the Clinician Reviews team. Some of you may remember my column, “Onieal’s Observations,” which used to run in this journal’s former sister publication, Clinician News. Now I get to offer more observations, but from a higher vantage point, so to speak, with somewhat more responsibility than before. I am looking forward to working with the Clinician Reviews team and with Randy. We are committed to bringing you the most up-to-date and most relevant clinical and professional information that will improve your practice and the lives of your patients. Having both a PA and an NP Editor-in-Chief demonstrates the ongoing commitment of the journal to advocate for both professions.

What, you may ask, has that got to do with giving back? Let me explain.

Perhaps you saw the movie Pay It Forward, about a schoolboy who is tasked with developing a plan that will change the world through direct action. In his July editorial, Randy recalled the “dedication demonstrated by physicians and NP and PA preceptors.” That was a direct action. But giving back involves more than that—it extends beyond the classroom and clinical setting and into the communities where we live, work, and play.

I had a friend whose entire adult life was dedicated to helping those less fortunate than she was. She organized walks for hunger, Easter dinner preparations for a homeless shelter, and activities to fund residences for homeless elders. She was a role model for community activism. That was her giving back. Her passing left me with a sense of obligation to continue, in some way, the commitment that she had to improving the community.

Giving back is a broad concept and, as such, presents endless opportunities for us to repay a debt or show respect for the person or persons who took the time to help us and enabled us to reap a benefit. In my early days as an NP and as one of the founders of the American Academy of Nurse Practitioners, it was my friend Dave Mittman, a PA, who introduced me to the world of physician assistants. We both worked to improve communications and help dispel the myth that PAs and NPs are rivals. Having the good fortune now to serve as the NP Editor-in-Chief of Clinician Reviews provides me with an opportunity to give back to Dave and all the PAs with whom I have had the honor of working as a colleague.

I owe a debt of gratitude to those people in my life who helped me grow as a nurse and an NP. Many helped me in my clinical practice; others helped me through nursing school, my NP program, graduate school, and doctoral studies. There were many occasions, I’m sure, when my needs were excessive, but these friends and supporters never hesitated to answer my calls and were always generous with their time. I know I always thanked them, but my way of showing respect and appreciation for the time and effort they gave me is to offer my help to the next generation of nurses and nurse practitioners. I do this by serving on the faculty at the Rocky Mountain University of Health Professions, in its Doctor of Nursing Practice program.

In addition, I always try to say yes whenever one of my colleagues on the faculty at another institution asks me to give a lecture. Some of my friends have children, a spouse, or a significant other attending nursing or nurse practitioner school this year. They all have my phone number for those times when the inevitable fear and frustration can only be assuaged by talking with someone who has been through it. I haven’t had a call from any PA students—yet.

What about you? If teaching doesn’t interest you, think about how often you’re contacted to support someone’s walk in a fundraising event, a race, or a golf tournament to benefit a cause. Of course you contribute, but what else could you do? How many times have you seen students collecting donations to support their team events? Have you ever thought about doing something more proactive to help them out than putting spare change in a bucket? What about offering some health-related service?

Years ago, a coworker and I were asked if we knew someone who could do the sports clearance physicals for a junior high football team. A local pediatrician used to do this and was paid for it; whatever money the team had left went toward buying new uniforms or equipment. The players still had to raise money through bake sales and similar events. We got our health center administration to allow us to use a wing of the center to do the physicals. Parents paid as usual, but we refused payment, so all the money went to the team. It was a rewarding experience, and it gave us the opportunity to expose the students and parents to the NP profession.

I have several friends who volunteer at camps or serve as coaches for sports teams. One volunteers his services as an athletic trainer for a high school soccer team, years after his daughter stopped playing.

We have all benefited in some way from another person taking the time to help us. And we all benefit from the public services in our community—our schools, the parks, the police and fire departments. Now it is time for us to do likewise. Pick a cause and make it your own. Set aside the time to give back in honor of someone, as thanks to someone, or as the return on that investment society made so that you could be who you are today.

Remember that credit card commercial that cites several purchases and their cost and then notes that having that particular card to pay for them is “priceless”? Well, the reward for giving back, no matter how you do it, has nothing to do with money. It is the knowledge that you had a positive impact on someone else, that you made a difference in his or her life.

And that, dear colleagues, is what is truly priceless in this world. That’s what giving back is all about.

It’s good to be back. I welcome your comments at [email protected].       

In this inaugural editorial as the NP Editor-in-Chief of Clinician Reviews, I would like to expand on the July message of my colleague Randy Danielsen, PhD, PA-C, who wrote of the importance of preceptors. Equally important, I believe, is the need to “give back”—not only to our professions but to society as a whole.

But first, I want to say how honored I am to be asked to rejoin the Clinician Reviews team. Some of you may remember my column, “Onieal’s Observations,” which used to run in this journal’s former sister publication, Clinician News. Now I get to offer more observations, but from a higher vantage point, so to speak, with somewhat more responsibility than before. I am looking forward to working with the Clinician Reviews team and with Randy. We are committed to bringing you the most up-to-date and most relevant clinical and professional information that will improve your practice and the lives of your patients. Having both a PA and an NP Editor-in-Chief demonstrates the ongoing commitment of the journal to advocate for both professions.

What, you may ask, has that got to do with giving back? Let me explain.

Perhaps you saw the movie Pay It Forward, about a schoolboy who is tasked with developing a plan that will change the world through direct action. In his July editorial, Randy recalled the “dedication demonstrated by physicians and NP and PA preceptors.” That was a direct action. But giving back involves more than that—it extends beyond the classroom and clinical setting and into the communities where we live, work, and play.

I had a friend whose entire adult life was dedicated to helping those less fortunate than she was. She organized walks for hunger, Easter dinner preparations for a homeless shelter, and activities to fund residences for homeless elders. She was a role model for community activism. That was her giving back. Her passing left me with a sense of obligation to continue, in some way, the commitment that she had to improving the community.

Giving back is a broad concept and, as such, presents endless opportunities for us to repay a debt or show respect for the person or persons who took the time to help us and enabled us to reap a benefit. In my early days as an NP and as one of the founders of the American Academy of Nurse Practitioners, it was my friend Dave Mittman, a PA, who introduced me to the world of physician assistants. We both worked to improve communications and help dispel the myth that PAs and NPs are rivals. Having the good fortune now to serve as the NP Editor-in-Chief of Clinician Reviews provides me with an opportunity to give back to Dave and all the PAs with whom I have had the honor of working as a colleague.

I owe a debt of gratitude to those people in my life who helped me grow as a nurse and an NP. Many helped me in my clinical practice; others helped me through nursing school, my NP program, graduate school, and doctoral studies. There were many occasions, I’m sure, when my needs were excessive, but these friends and supporters never hesitated to answer my calls and were always generous with their time. I know I always thanked them, but my way of showing respect and appreciation for the time and effort they gave me is to offer my help to the next generation of nurses and nurse practitioners. I do this by serving on the faculty at the Rocky Mountain University of Health Professions, in its Doctor of Nursing Practice program.

In addition, I always try to say yes whenever one of my colleagues on the faculty at another institution asks me to give a lecture. Some of my friends have children, a spouse, or a significant other attending nursing or nurse practitioner school this year. They all have my phone number for those times when the inevitable fear and frustration can only be assuaged by talking with someone who has been through it. I haven’t had a call from any PA students—yet.

What about you? If teaching doesn’t interest you, think about how often you’re contacted to support someone’s walk in a fundraising event, a race, or a golf tournament to benefit a cause. Of course you contribute, but what else could you do? How many times have you seen students collecting donations to support their team events? Have you ever thought about doing something more proactive to help them out than putting spare change in a bucket? What about offering some health-related service?

Years ago, a coworker and I were asked if we knew someone who could do the sports clearance physicals for a junior high football team. A local pediatrician used to do this and was paid for it; whatever money the team had left went toward buying new uniforms or equipment. The players still had to raise money through bake sales and similar events. We got our health center administration to allow us to use a wing of the center to do the physicals. Parents paid as usual, but we refused payment, so all the money went to the team. It was a rewarding experience, and it gave us the opportunity to expose the students and parents to the NP profession.

I have several friends who volunteer at camps or serve as coaches for sports teams. One volunteers his services as an athletic trainer for a high school soccer team, years after his daughter stopped playing.

We have all benefited in some way from another person taking the time to help us. And we all benefit from the public services in our community—our schools, the parks, the police and fire departments. Now it is time for us to do likewise. Pick a cause and make it your own. Set aside the time to give back in honor of someone, as thanks to someone, or as the return on that investment society made so that you could be who you are today.

Remember that credit card commercial that cites several purchases and their cost and then notes that having that particular card to pay for them is “priceless”? Well, the reward for giving back, no matter how you do it, has nothing to do with money. It is the knowledge that you had a positive impact on someone else, that you made a difference in his or her life.

And that, dear colleagues, is what is truly priceless in this world. That’s what giving back is all about.

It’s good to be back. I welcome your comments at [email protected].       

In this inaugural editorial as the NP Editor-in-Chief of Clinician Reviews, I would like to expand on the July message of my colleague Randy Danielsen, PhD, PA-C, who wrote of the importance of preceptors. Equally important, I believe, is the need to “give back”—not only to our professions but to society as a whole.

But first, I want to say how honored I am to be asked to rejoin the Clinician Reviews team. Some of you may remember my column, “Onieal’s Observations,” which used to run in this journal’s former sister publication, Clinician News. Now I get to offer more observations, but from a higher vantage point, so to speak, with somewhat more responsibility than before. I am looking forward to working with the Clinician Reviews team and with Randy. We are committed to bringing you the most up-to-date and most relevant clinical and professional information that will improve your practice and the lives of your patients. Having both a PA and an NP Editor-in-Chief demonstrates the ongoing commitment of the journal to advocate for both professions.

What, you may ask, has that got to do with giving back? Let me explain.

Perhaps you saw the movie Pay It Forward, about a schoolboy who is tasked with developing a plan that will change the world through direct action. In his July editorial, Randy recalled the “dedication demonstrated by physicians and NP and PA preceptors.” That was a direct action. But giving back involves more than that—it extends beyond the classroom and clinical setting and into the communities where we live, work, and play.

I had a friend whose entire adult life was dedicated to helping those less fortunate than she was. She organized walks for hunger, Easter dinner preparations for a homeless shelter, and activities to fund residences for homeless elders. She was a role model for community activism. That was her giving back. Her passing left me with a sense of obligation to continue, in some way, the commitment that she had to improving the community.

Giving back is a broad concept and, as such, presents endless opportunities for us to repay a debt or show respect for the person or persons who took the time to help us and enabled us to reap a benefit. In my early days as an NP and as one of the founders of the American Academy of Nurse Practitioners, it was my friend Dave Mittman, a PA, who introduced me to the world of physician assistants. We both worked to improve communications and help dispel the myth that PAs and NPs are rivals. Having the good fortune now to serve as the NP Editor-in-Chief of Clinician Reviews provides me with an opportunity to give back to Dave and all the PAs with whom I have had the honor of working as a colleague.

I owe a debt of gratitude to those people in my life who helped me grow as a nurse and an NP. Many helped me in my clinical practice; others helped me through nursing school, my NP program, graduate school, and doctoral studies. There were many occasions, I’m sure, when my needs were excessive, but these friends and supporters never hesitated to answer my calls and were always generous with their time. I know I always thanked them, but my way of showing respect and appreciation for the time and effort they gave me is to offer my help to the next generation of nurses and nurse practitioners. I do this by serving on the faculty at the Rocky Mountain University of Health Professions, in its Doctor of Nursing Practice program.

In addition, I always try to say yes whenever one of my colleagues on the faculty at another institution asks me to give a lecture. Some of my friends have children, a spouse, or a significant other attending nursing or nurse practitioner school this year. They all have my phone number for those times when the inevitable fear and frustration can only be assuaged by talking with someone who has been through it. I haven’t had a call from any PA students—yet.

What about you? If teaching doesn’t interest you, think about how often you’re contacted to support someone’s walk in a fundraising event, a race, or a golf tournament to benefit a cause. Of course you contribute, but what else could you do? How many times have you seen students collecting donations to support their team events? Have you ever thought about doing something more proactive to help them out than putting spare change in a bucket? What about offering some health-related service?

Years ago, a coworker and I were asked if we knew someone who could do the sports clearance physicals for a junior high football team. A local pediatrician used to do this and was paid for it; whatever money the team had left went toward buying new uniforms or equipment. The players still had to raise money through bake sales and similar events. We got our health center administration to allow us to use a wing of the center to do the physicals. Parents paid as usual, but we refused payment, so all the money went to the team. It was a rewarding experience, and it gave us the opportunity to expose the students and parents to the NP profession.

I have several friends who volunteer at camps or serve as coaches for sports teams. One volunteers his services as an athletic trainer for a high school soccer team, years after his daughter stopped playing.

We have all benefited in some way from another person taking the time to help us. And we all benefit from the public services in our community—our schools, the parks, the police and fire departments. Now it is time for us to do likewise. Pick a cause and make it your own. Set aside the time to give back in honor of someone, as thanks to someone, or as the return on that investment society made so that you could be who you are today.

Remember that credit card commercial that cites several purchases and their cost and then notes that having that particular card to pay for them is “priceless”? Well, the reward for giving back, no matter how you do it, has nothing to do with money. It is the knowledge that you had a positive impact on someone else, that you made a difference in his or her life.

And that, dear colleagues, is what is truly priceless in this world. That’s what giving back is all about.

It’s good to be back. I welcome your comments at [email protected].