Basics for New NP Practice

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Things you need to know in your day-to-day practice

I was inspired to write this series to serve as a guide for student and new nurse practitioners. I remember being faced with so many things to consider during my last year of my family nurse practitioner program and my first year after graduation, and wishing I had someone to guide me through that transitional time. Now that I have worked as an NP in a few different specialties, I have compiled information that I feel would benefit new NPs. I love teaching and using knowledge I’ve acquired to help others. It is my hope that this article can provide navigation for student and new NPs.

In follow-up to the first article, “Certification Basics,” Part 2 provides resources that will help student and new NPs in all areas of their practice.

Complimentary Resources for NPs
There are several journals that NPs in the U.S. are eligible to receive complimentary subscriptions to. These publications are a great source of information and several offer continuing education (CE) opportunities, some of which are free, as well as employment classifieds. Complimentary publications include but may not be limited to:

  • The Journal for Nurse Practitioners (JNP)
    • Monthly, peer reviewed
    • Official publication of the American Association of Nurse Practitioners (AANP)
    • Rate to subscribe per year in U.S. is $86 but free to NPs1
  • Nurse Practitioner Perspective
    • Bimonthly, peer reviewed
    • Free for NPs2
  • The Clinical Advisor
    • Monthly, peer reviewed
    • Rate to subscribe per year in U.S. is $75 but free to NPs and PAs3
  • Clinician Reviews
    • Monthly, peer reviewed
    • Rate to subscribe per year in U.S. is $79 but free for NPs and PAs4
  • Consultant
    • Monthly, peer reviewed
    • Rate to subscribe per year in U.S. is $132 but free to NPs, PAs, and MDs5
  • MPR Nurse Practitioners’ Edition
    • Quarterly publication
    • Rate to subscribe per year in U.S. is $59 but NPs can qualify for a complimentary subscription
    • I recommend keeping a copy at home (e.g. on call) and at place(s) of employment so you can always have a copy of this resource at your fingertips6

As I mentioned earlier, some of the complimentary journals previously mentioned offer free CE, e.g. The Clinical Advisor,3 but there are other sources of free CE as well. Online sources offering free CE include but may not be limited to: MedscapeCenters for Disease Control and Prevention (CDC); My CMEOmnia EducationAgency for Healthcare Research and Quality, etc.

Resources for NPs Reference
There are many sources of evidence-based medicine and clinical practice guidelines that NPs can access should they need to consult a reference. These include but are not limited to professional associations, such as the American Academy of Family Physicians and the American Academy of Pediatrics as well as scientific literature.

Such literature can take on many forms, including textbooks and journals. Examples are:

  • Uphold CR, Graham MV. Clinical guidelines in family practice. 5th ed. Gainesville, FL: Barmarrae Books, Inc.; 2013.
  • Wolff K, Johnson RA, Saavedra AP. Fitzpatrick’s color atlas & synopsis of clinical dermatology. 7th ed. New York, NY: McGraw-Hill Medical; 2013.
  • The Journal for Nurse Practitioners (JNP)1
  • The Clinical Advisor3

Additionally, online databases can be useful to NPs, such as UpToDate. An online clinical database for evidence-based medicine, it is also a source of CME. Clinicians can purchase an individual subscription or your employer can purchase a subscription to include all employees.7

Helpful Patient Resources

About NP Brochures: Many times, I have had patients ask me, “What is a Nurse Practitioner?” and “How is that different from a Physician Assistant?” Though you answer their questions, it’s also helpful to give them substantiation to back up what you said, a reference if you will. It’s helpful for practitioners to have such brochures in their clinics to serve as educational tools for patients. It also helps to increase community awareness of the NP profession. AANP marketing and public relations division have a “Your Partner in Health, the Nurse Practitioner” brochure that can be ordered for a fee.8 The following is a link to view this brochure: http://www.aanp.org/all-about-nps/np-brochure

Antibiotic (Resistance) Brochures for Patients: Being that antibiotic resistance is a public health threat and as healthcare providers we often have patients requesting antibiotics when unnecessary or admitting to us incorrect usage of antibiotics, it is very helpful for practitioners to obtain for their clinics, informative and interesting brochures on antibiotic resistance to hand out to our patients. These brochures serve as support for us when we tell them their condition does not necessitate antibiotics, or for those patients we want to understand the importance of taking antibiotics as prescribed, in an effort to educate our patients.

I found the following brochures very helpful for such instances. They can be printed off for free or you can order them in bulk from their respective facilities for a fee. Here are the links to each of the brochures:

Vaccine Information Statements (VISs): These are information sheets produced by the CDC on the different vaccines that federal law requires be handed out before vaccines are given.11 You’re probably familiar with this but you may not know that they come in different languages. It’s helpful to have copies on hand in the language(s) pertinent to the patient population(s) most commonly seen in the clinic.

For example, for me it was English and Spanish. However, it’s also helpful to know where to go to be able to print off others in other languages for relevant patient encounters. Have the website saved in ‘my favorites’ on your computer to facilitate speedy access to and retrieval of additional copies in additional languages: www.cdc.gov/vaccines/hcp/vis.

Multi-Cultural Food Pyramids: You are likely familiar with the traditional food pyramid. However, when it comes to different ethnicities and cultures, it is not necessarily a “one size fits all.” Some dietetic associations have different ethnic food pyramids posted on their websites, so you may want to check your local dietetic association’s website. If you are educating/counseling a patient on diet/nutrition, it is helpful if you educate one in a way that is culture appropriate, in a way that that patient is most likely to identify with and understand. Another helpful source, Oldways, is a non-profit organization that has food pyramid resources on their website, which include Mediterranean, African heritage, and Asian diets and pyramids.12

Smoking Cessation Resources: When I worked in reproductive health, we would not actually see/treat patients for smoking cessation; however, we would briefly counsel patients who smoked on smoking cessation, advising them on the dangers of smoking and the importance of quitting. We also had quit kits on hand in the office which we would give to patients that contained strategies for smoking cessation, support sources, and other applicable information.

For example, the Michigan Department of Community Health offers resources for healthcare providers including the Michigan Providers Tobacco Treatment Tool Kit and other quit tobacco tools and resources. Additionally, there is a website created by the Tobacco Control Research Branch of the National Cancer Institute (http://www.smokefree.gov/), which also has helpful information for consumers and healthcare providers alike.

Alcohol and Drug Addiction, and Suicide Prevention Resources: Probably the most well-known organization for this is Alcoholics Anonymous (AA). There are no dues or fees for attending meetings. For locations and meeting times for AA meetings in your area, you can visit their website or call their General Service Office 212-870-3400. Another resource is the National Council on Alcoholism and Drug Dependence (NCADD), which has a HOPE line: 1-800-622-2255 for 24 hr. affiliate referral. Additionally, the Substance Abuse and Mental Health Services Administration has a 24/7 treatment referral line: 1-800-662-4357. Also listed on their website is the Suicide Prevention Lifeline, which is 1-800-273-8255.

Domestic Violence and Sexual Assault Resources: These resources were especially helpful to have on hand while working in reproductive health/family planning. The National Domestic Violence Hotline is 1-800-799-SAFE (1-800-799-7233). The National Sexual Assault Hotline is 1-800-656-HOPE (1-800-656-4673). It’s also helpful to have resources at your clinic on local shelters for those impacted by domestic violence or sexual assault.

Resources for Patients Without Insurance: When I worked in urgent/retail health, I put together a list of clinics, many of which operated on a donation basis or sliding fee scale for patients without insurance unable to afford the copay at the for profit clinic I was working at. It’s helpful to have such resources available as patients’ financial backgrounds vary. For example in Michigan, there is a website, Free Clinics of Michigan where you can find a free clinic by county. Another great resource is the National Association of Free and Charitable Clinics where you can search for a clinic by city and state or zip code.

Free or Discount Antibiotic and Generic Medication Programs: Many pharmacies participate in free or discount prescription programs. It’s helpful to keep a list of these in the clinic. Examples include:

  • Meijer: Free antibiotics including amoxicillin, cephalexin, SMZ-TMP, ciprofloxacin, ampicillin, and penicillin VK, max 14 day supply at normal oral dosages; also select prenatal vitamins.13
  • Walmart: $4 generic medications, $4 for 30 day supply and $10 for 90 day supply; select generic oral contraception, e.g. $9/28 day supply or $24/90 day supply.14
  • Target: $4 generic medications, $4 for 30 day supply and $10 for 90 day supply; also have oral contraception.15
  • Kroger: Free select antibiotics and $4/$10 generics, 30 day supply for $4 and 90 day supply for $10; also generic oral contraception $9.16

*Disclaimer: this list is based on pharmacies in the metro Detroit, MI area and may differ in different cities and states, so best to check with your local pharmacies first.

The Recertification Process
Requirements for recertification will vary based on your certifying body, e.g. AANP or American Nurses Credentialing Center (ANCC), which I addressed in my previous article.

When I went through my first recertification, I had questions regarding the basic requirements which I researched and wanted to pass along. I wondered as a FNP if my certifying body, AANP, required a certain number of credits from certain specialties. According to both AANP and ANCC, it needs to be applicable or related to the certification role and specialty, so for a FNP it could be anywhere along the spectrum from pediatrics to geriatrics or if one was a PNP then it would need to be pediatric and adolescent specific, etc.17, 18

I also wondered if the continuing education units (CEUs) needed to be sponsored or specifically approved by my certifying body or if that didn’t matter as long as the CEU activity was applicable to the FNP specialty. According to both AANP and ANCC, CE credits need to be offered by a CE provider approved by AANP and ANCC respectively, and such authorizing entities include: AANP, ANCC, National Association of Pediatric Nurse Practitioners (NAPNAP), American College of Nurse-Midwives (ACNM), National Association of Nurse Practitioners in Women’s Health (NPWH), American Medical Association (AMA) or Accreditation Council for Continuing Medical Education (ACCME), American Academy of Family Physicians (AAFP), and American Academy of Physician Assistants (AAPA).17, 18

At that point, I looked through the sponsors of my CEU activities to make sure they fit the description above and would all count. The following are examples of CE providers that fit the previous requirements: Medical Education ResourcesPartners in Healthcare EducationNurse Practitioner Healthcare FoundationNurse Practitioner Associates for Continuing EducationMedscapeCDC; etc.

I also wondered whether basic life support (BLS) recertification counted toward CE requirements. According to AANP, some advanced life support courses may qualify for CE credit; however, BLS or CPR is not accepted because RNs learn BLS or CPR in nursing school and therefore, it’s not authorized for CE credit as a NP.19According to ANCC, contact hours can be awarded for BLS but it has to be a four or eight hour class and can only be counted once in a five year period.18 Regardless, NPs still do need to renew their BLS. Often healthcare providers go through American Heart Association (AHA). You can go to their website and view a list of classesbeing offered in your area and the contact information for the sponsoring business.

I also wondered about recertifying early. According to AANP and ANCC, even if one recertifies early, the credits will not count toward the next recertification period until the specified date of start of that period. NPs can apply for recertification/renewal eight weeks to one year before the certification expiration date providing all requirements are met.

For the purpose of recertification, AANP requires documentation of CEs including: name of CE topic, date(s) of attendance, number of clock hours, name of CE accreditor, and copy of CE certificate for each offering.19 ANCC requires documentation of: title and brief description of content if the title is generic; date(s); name of sponsor, provider, or institution; whether ANCC approved; whether topic is within specialty focus; number of contact hours awarded and of those the number that are pharmacology related.18 Renewal applications and other supporting documents are to be submitted in a timely manner.

In closing, I hope you find this guide helpful and interesting, as much as I found it to be writing it! Good luck in your practices and may you never stop learning!

References
1. Journal for Nurse Practitioners. http://www.npjournal.org/
2. Nurse Practitioner Perspective. http://nurse-practitioners-and-physician-assistants.advanceweb.com/Editorial/Content/Editorial.aspx?CTIID=3905
3. Clinical Advisorwww.clinicaladvisor.com
4. Clinician Reviewshttp://www.clinicianreviews.com/
5. Consultanthttp://www.consultant360.com/
6. MPR Nurse Practitioners’ Editionhttp://www.empr.com/nurse-practitioner-edition/section/1257/#
7. UpToDate. http://www.uptodate.com/
8. American Association of Nurse Practitioners. NP brochure. http://www.aanp.org/all-about-nps/np-brochure
9. Centers for Disease Control and Prevention. Get smart: know when antibiotics work. http://www.cdc.gov/getsmart/campaign-materials/brochures.html
10. U.S. Food and Drug Administration. Preserve a treasure: know when antibiotics work. http://www.fda.gov/downloads/Drugs/ResourcesForYou/UCM233219.pdf
11. Centers for Disease Control and Prevention. Vaccine information statements. www.cdc.gov/vaccines/hcp/vis
12. Oldways. Heritage pyramids and total diet. http://oldwayspt.org/resources/heritage-pyramids
13. Meijer. Meijer pharmacy. http://www.meijer.com/pharmacy
14. Walmart. Walmart pharmacy. http://www.walmart.com/cp/1078664
15. Target. Target pharmacy. http://www.target.com/pharmacy/generics
16. Kroger. Kroger pharmacy. https://www.kroger.com/topic/pharmacy
17. American Association of Nurse Practitioners Certification Program. Recertification for adult, family, gerontological, and adult-gerontological nurse practitioners.  http://www.aanpcert.org/ptistore/control/recert/index
18. American Nurses Credentialing Center. Renew your nursing certification. http://www.nursecredentialing.org/Certification/CertificationRenewal
19. American Association of Nurse Practitioners Certification Program. Frequently asked questions: AANPCP recertification. http://www.aanpcert.org/ptistore/control/faqs

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About Author

Jenni Hoffman, DNP, FNP-C, CLNC

Jenni L. Hoffman is an assistant professor at Eastern Michigan University School of Nursing and a Nurse Practitioner with the Washtenaw County Department of Public Health.

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