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 April 1, 2013 | UNIVERSITY OF WYOMING JOINS EFFORT TO TRANSFORM NURWSING - As part of an ambitious initiative, the University of Wyoming’s Fay W. Whitney School of Nursing is poised to help address some of the nation’s most pressing health care issues — access, quality and costs. This week, UW announced the nursing school’s Wyoming Center for Nursing and Health Care Partnerships has been designated as one of the organizations in only 20 states that will be part of the Future of Nursing State Implementation Program, a $3 million effort aimed at bolstering those three critical challenges “amidst an aging and more diverse population.” “Our focus is on transformation of nursing education that will truly enhance health care in Wyoming and this was a key factor in being selected,” says Mary Burman, Fay W. Whitney dean, in a news release. “We are part of a powerful movement working to shape the future of health care for all Americans. We are very grateful for this support, which will strengthen our work.” Burman said UW’s Center for Nursing and Health Care Partnerships will focus on enhancing clinical education for all of the state’s nursing programs. The Future of Nursing State Implementation Program’s goal, UW noted, is to “transform health care through nursing.” It’s a joint initiative, joined by AARP and the Robert Wood Johnson Foundation, and is designed to implement nursing recommendations made by the Institute of Medicine. The program provides two-year grants up to $150,000 to 20 coalitions. “The campaign provides a voice and a vehicle for nurses, at all levels, to lead system change to improve care for patients and families by collaborating with business, consumer and other health professional organizations,” UW reports in the news release. “This grant is designed to spur progress in Wyoming, which already is doing impressive work to transform nursing education, practice and leadership,” says Susan B. Hassmiller, a senior nursing adviser for the Robert Wood Johnson Foundation, in the release. “The foundation is committed to helping states build a more highly-educated, diverse nursing workforce that will improve health outcomes for patients, families and communities.” Burman said UW’s school of nursing constantly considers ways to transform nursing education in an effort to adapt to a changing health care climate. “One of the challenges we face in nursing education is it can actually take a heck of a lot to get a student ready to get to the hospital and get in to have their clinical,” she said. “So we’re looking at processes that will allow us to do that more seamlessly. (article courtesy of Continental Nurse Practitioners) |
| April 1, 2013 | ORANGE REGIONAL MEDICAL CENTER AWARDED REGISTERED NURSE GRANT - Orange Regional Medical Center has been awarded a grant to support continued education of licensed practical nurses interested in becoming registered nurses.The hospital's grant application focused on tuition funding for a select group of currently employed LPNs to pursue their R.N. degrees. Twelve employees of the "LPN to RN Pathway to Excellence" program are attending local higher educational institutions including Excelsior College, SUNY Orange, SUNY Rockland and SUNY Sullivan, according to Joanne Ritter-Teitel, Orange Regional's vice president and chief nursing officer. The 1199SEIU health workers' union provided Orange Regional with the support needed to launch this program, she added. Each nursing scholar has been paired with an Orange Regional mentor who will provide support and assistance throughout the course of studies. The training is expected to last 18 months and, upon completion and R.N. licensure, graduates will be promoted to carrying out roles and responsibilities of an R.N. throughout various units at the hospital. Funding for the program is provided through the New York state Department of Labor's Registered Nurse Upgrade Project. (article courtesy of Continental Nurse Practitioners) |
| April 1, 2013 | UNIVERSITY OF TENNESSEE'S COLLEGE OF NURSING OFERS NEW TRAINING OPTION IN DOCTOR OF NURSING PRACTICE PROGRAM - The dean of the University of Tennessee's College of Nursing says there's a shortage of pediatric and neonatal nurse practitioners. To meet the need, the UT Health Science Center is offering a new advanced training option in its doctor of nursing practice degree program. The medical school will take applications April 1 through June 1. Application packets are available by email to RGermain(at)uthsc.edu or by calling (901) 448-6125. Classes for the PNP and NNP options begin on August 1, 2013. .Academic requirements include a BSN or MSN degree, and a minimum 3.0 grade point average. (article courtesy of Continental Nurse Practitioners) |
| April 1, 2013 | MORE TRAINING AND INCREASED ROLES FOR NURSE PRACTITIONERS - In North Carolina, there are nearly 4,500 nurse practitioners, who are increasingly on the front lines of the American health care system. They can write prescriptions and make diagnoses under the supervision of doctors. Most are nurses who have earned a master’s degree to increase their training in direct patient care. But starting in the fall, those seeking to be advanced nurses will have the option – and eventually, the requirement – to gain more education. Last month, the UNC system’s Board of Governors approved the Doctor of Nursing Practice, or DNP degree, for six public campuses: East Carolina, UNC-CH, UNC-Charlotte, UNC-Greensboro, Winston-Salem State University and Western Carolina University. Two private universities, Duke and Gardner-Webb, already offer the more advanced degree. Eventually, the three-year program is expected to replace the two-year Master of Science in nursing for those seeking to be nurse practitioners, clinical nurse specialists, certified nurse midwives and certified registered nurse anesthetists. Current nurse practitioners and other advanced nurses will be allowed to continue practicing with their master’s level education. (article courtesy of Continental Nurse Practitioners) |
| March 29, 2013 | UNIVERSITY OF SOUTHERN MISSISSIPPI NURSING SCHOOL RECEIVES $1M DONATION - University of Southern Mississippi officials are keeping close tabs on Jackson these days, hoping that the Legislature will honor its $20 million request for a new College of Nursing building. "We're confident that we've put together a good package, and we're confident that they're taking a good look at it, and we're hopeful that we'll get the $20 million," said USM's executive assistant to the president Chad Driskell. In the meantime, the project received a sizable shot in the arm Wednesday with the announcement of a $1 million donation from Joe and Kathy Sanderson of Laurel. Joe Sanderson is the chief executive officer of Sanderson Farms, based in Laurel. College of Nursing Dean Katherine Nugent said she takes the gift as a gesture of faith in the university's nursing program.
"It validates our worth," said Nugent. It also pushes USM past the $5 million mark in its $8 million private fundraising campaign — meaning the campaign has funded all but the nursing building's $3 million endowment. Joe Sanderson said this is his first major gift to USM, and it began with former Southern Miss President Martha Saunders.
(article courtesy of Continental Nurse Practitioners) |
| March 28, 2013 | NUMBER OF MALES IN NURSING GROWING - In 2011, there were 330,000 men employed as nurses in the United States ‐about 9 percent of all nurses. Though now seen as a predominately female occupation, men had significant representation in nursing until the 1800s because of the early association between nursing and the military and religious orders. As the need for nurses expanded during the Civil War along with a shortage of men to provide nursing care, women were allowed to fill the gap. By the early 1900s, many nursing schools only admitted women and the newly‐formed Army Nurse Corps and Navy Nurse Corps were limited to women. Men were not allowed to serve as nurses until after the Korean War. As such, men’s representation in nursing experienced significant decline in the 1900s. However, men’s representation in nursing has been growing since the 1970s. A predicted shortage of nurses has increased recruiting and occupational retraining efforts to increase the pool of employable workers in this field. These efforts have included recruiting men into nursing. Schools are now actively pursuing higher male enrollment in their nursing programs. The relatively high wages and expanding job opportunities makes this field attractive, offering stability even during recessions. There were 3.5 million employed nurses in 2011, about 3.2 million of whom were female and 330,000 male. Of the employed nurses (both sexes), 78 percent were registered nurses, 19 percent were licensed practical and licensed vocational nurses, 3 percent were nurse practitioners, and 1 percent were nurse anesthetists.While most registered nurses (both sexes) left home for work between 5 a.m. and 11:59 a.m. (72 percent), a sizable minority (19 percent) worked the evening or night shifts. The majority of registered nurses (both sexes) worked in hospitals (64 percent). The majority of licensed practical and licensed vocational nurses worked in nursing care facilities or hospitals (about 30 percent each). The percentages for hospitals and nursing care facilities are not significantly different from each other. In 2011, 9 percent of all nurses were men while 91 percent were women. Men earned, on average, $60,700 per year, while women earned $51,100 per year. (article courtesy of Continental Nurse Practitioners) |
| March 28, 2013 | NURSES PUSHING FOR THE RIGHT TO PRAXCTICE WITHOUT DOCTOR SUPERVISION - Nursing groups across the country are pursuing legislation that would allow them to practice without a doctor's supervision. According to a recent report in the Washington Post, the new guidelines being proposed would allow for "tens of thousands of nurses to set up primary-care practices that would be virtually indistinguishable from those run by doctors." Our nurse guests, Angela Golden and Mary Chesney, stressed that they and their non-physician colleagues already carry a lot of the weight in health clinics, and that they are well prepared to do it. "I think what's important for the public to know is that every day, advanced practice registered nurses are making those decisions — deciding on drugs, the dosages, what they're going to do," Chesney said. "And that part of the practice is not supervised." Golden said the country can look to states where nurses already practice independently: "The key here is to remove barriers so that patients have access to a quality health care provider. And in 16 states, that already happens. Our physician colleagues will say they are saying 'no' for safety issues, but we know from those 16 states that safety is not the issue ... the evidence clearly shows that we provide good quality, safe, effective care for those patients across the United States." (article courtesy of Continental Nurse Practitioners) |
| March 28, 2013 | NURSE PRACTITIONERS AND DOCTORS IN TUG OF WAR OVER PATIENTS - Christy Blanco’s health clinic is sitting empty. A nurse practitioner in El Paso, Tex., Blanco says she has all the necessary equipment and a doctorate in nursing practice that prepared her to perform routine physical exams and treat diabetes, asthma, high blood pressure, and many other common ailments. About 50 miles away in Las Cruces, N.M., dozens of nurse practitioners at clinics like Blanco’s are busy caring for patients. The only difference is that in Texas, nurse practitioners are required to contract with a doctor to sign off on medical charts; the physician must also spend 1 out of every 10 days at the clinic. In New Mexico, no doctor is necessary. “I just want to get started,” says Blanco, who’s tried for nearly two years to recruit a physician for her clinic, which will specialize in care for low-income women. “I’m trying to work for the poor,” she says. “I’ve spent thousands of dollars of my own money. I have a waiting list of patients, and I have to tell them I can’t practice.” (article courtesy of Continental Nurse Practitioners) |
| March 27, 2013 | UNIVERSITY OF SOUTHERN MISSISSIPPI FOUNDATION'S COLLEGE OF NURSING RECEIVES GIFT - With a $1 million gift commitment from Joe and Kathy Sanderson of Laurel, the University of Southern Mississippi Foundation’s College of Nursing Building Campaign has exceeded the $5 million mark on its way to reaching its $8 million goal. The campaign began last year with the announcement of a $4 million gift from the Asbury Foundation of Hattiesburg that provided naming rights for the new facility to be known as Asbury Hall. The contribution by Mr. and Mrs. Sanderson will name Asbury Hall’s Clinical Simulation Lab for the family. The Sanderson Clinical Simulation Lab, covering more than 8,000 square feet on the second floor of the proposed building, will feature specialized patient care areas with patient simulators, task trainers, simulated health care records and equipment needed to provide care that will enhance patient safety. Mr. Sanderson is the Chief Executive Officer of Sanderson Farms, Inc., a publicly held poultry company that is one of the leading food corporations in the United States. Mr. Sanderson has held numerous positions in the company since 1969 including the role of President from 1989 to 2004. In addition to his current position as CEO, he also serves as the Chairman of the Board of Directors and is a member of the Executive Committee. (article courtesy of Continental Nurse Practitioners) |
| March 27, 2013 | SENIORS SAVED OVER $6 BILLION ON PRESCRIPTION DRUGS AS A RESULT OF THE HEALTH CARE LAW - As the third anniversary of the Affordable Care Act approaches, Health and Human Services Secretary Kathleen Sebelius announced today more than 6.3 million people with Medicare saved over $6.1 billion on prescription drugs because of the health care law. “By making prescription drugs more affordable, the Affordable Care Act is improving and promoting the best care for people with Medicare,” Secretary Sebelius said.
The Affordable Care Act makes Medicare prescription drug coverage (Part D) more affordable by gradually closing the gap in coverage where beneficiaries must pay the full cost of their prescriptions out of pocket. This gap is known as the donut hole. People with Medicare in the donut hole now receive discounts when they purchase prescription drugs at a pharmacy or order them through the mail, until they reach the catastrophic coverage phase. The Affordable Care Act gave those who reached the donut hole in 2010 a one-time $250 check, then began phasing in discounts and coverage for brand-name and generic prescription drugs beginning in 2011. The law will provide additional savings each year until the coverage gap is closed in 2020. In 2013, the health care law increases the discounts and savings to 52.5 percent of the cost of most brand name drugs and 21 percent of the cost of covered generic drugs. Also under the Affordable Care Act, those who choose to enroll in Medicare Advantage and Part D now have access to a wider range of high-quality plan choices, with more four- and five-star plans than were previously available. The Affordable Care Act continues to make Medicare more secure, with new tools and enhanced authority to crack down on criminals who cheat the program. (article courtesy of Continental Nurse Practitioners) |
| March 27, 2013 | MAINE HOSPITAL ASSOCIATION SUPPORTS MEDICAID EXPANSION - The group that represents Maine’s 39 hospitals has come out in support of expanding Medicaid in the state, a move that could provide insurance coverage for about 55,000 low-income Maine residents over the next decade.
The Maine Hospital Association joins two organizations representing doctors, the Maine Medical Association and the Maine Osteopathic Association, in supporting an expansion as Gov. Paul LePage’s administration weighs whether to accept funding available under the federal Affordable Care Act to grow Maine’s Medicaid program. Jeffrey Austin, the hospital association’s vice president of government affairs and communications, confirmed his group’s support for the expansion in a statement emailed to reporters Wednesday afternoon. Austin told the Bangor Daily News last month that the group was seeking more details on the expansion’s financial impact on the state along with assurances that the state wouldn’t continue cutting hospital reimbursement rates to fill budget holes before taking a position. The association has been at the center of a high-profile debate in recent months surrounding efforts by LePage to pay back the state’s $484 million debt to its hospitals using proceeds from a renegotiated state wholesale liquor contract. “Based upon the best information we have available, we are presuming that Medicaid expansion will not cost the state too much money,” Austin wrote in his statement. “Our best information at this time is that for most individuals (but not all) the federal reimbursement will be at the 100 percent FMAP rate for three years and then declining to 90 percent by 2019. We still look forward to the state providing the exact fiscal impact.” The Maine Hospital Association’s support for the expansion comes as LePage, who has long opposed expanding Medicaid, discusses a potential expansion with federal officials. Maine Health and Human Services Commissioner Mary Mayhew last week requested that the federal government cover 100 percent of Maine’s expansion costs for a decade — rather than the three years prescribed in federal law — as a condition for Maine to participate in the expansion. “As we seek to create financial stability for the state’s Medicaid program, it is imperative that we receive greater federal support over a longer period of time,” Mayhew wrote in a letter to U.S. Health and Human Services Secretary Kathleen Sebelius. Mayhew is the former vice president of the Maine Hospital Association. Under the federal health care law, if states choose to expand their Medicaid programs, the federal government will cover 100 percent of costs for newly eligible Medicaid recipients for three years. The 100 percent funding will gradually drop to 90 percent in 2020 and states will have to make up the remaining share. Maine, however, expanded its Medicaid program about a decade ago to many of the people who would otherwise be eligible for the first time under the Affordable Care Act. That means fewer residents in Maine would qualify for 100 percent federal funding. But the federal government is promising to increase its share of costs for states like Maine that have already expanded Medicaid. That means the state would receive more federal funds to provide Medicaid coverage for some people it’s already covering. A recent Kaiser Family Foundation analysis projects that Maine would be one of 10 states to see the amount of state funds it spends on Medicaid actually drop over the next decade — by $570 million, or 3.8 percent — while the federal share of Medicaid expenses would rise by $3.1 billion, or 11.4 percent. The Kaiser analysis also projects Maine’s hospitals would see $348 million more in payments from Medicaid over the next decade if the state expanded the program. Hospitals would also have to provide less care for which they aren’t paid, according to the analysis.While the Maine Hospital Association supports the state expanding its Medicaid program, Austin said that support isn’t unconditional. (article courtesy of Continental Nurse Practitioners) |
| March 27, 2013 | STATE BOARD REJECTS LINDENHURST PLAN - The state health facilities board voted down a plan by Vista Health System to build a new $131 million hospital in an affluent area of Lake County, the second time such a plan has been rejected in five years. The Illinois Health Facilities and Services Review Board, which reviews all health care construction projects to avoid a duplication of services, voted 6-0 against a proposal by Waukegan-based Vista to build a 132-bed hospital about 13 miles west in Lindenhurst. Vista, a subsidiary of Franklin, Tenn.-based hospital company Community Health Systems Inc., was opposed by rival hospitals in Lake County and by a group of religious leaders and community activists, who said a new hospital would divert badly needed health care resources from Waukegan. (article courtesy of Continental Nurse Practitioners) |
| March 27, 2013 | TOP 25 HIRING HEALTHCARE WORKERS IN FEBRUARY 2013 - According to the U.S. employment outlook report released by Simply Hired, these are the thirteen healthcare providers among the top 25 hiring healthcare workers in February:
1. Atlanta, Georgia: Northside Hospital - 837 jobs
2. Boston, Massachusetts: Massachusetts General Hospital - 1,165 jobs
3. Charlotte, North Carolina: Carolinas Healthcare System - 1,934 jobs
4. Dallas, Texas: BayI havelor Health Care System - 2,985 jobs
5. Denver, Colorado: HealthONE - 1,342 jobs
6. Houston, Texas: HCA Healthcare - 736 jobs
7. Minneapolis and St. Paul, Minnesota: UnitedHealth Group - 1,819 jobs
8. Orlando, Florida: Adventist Health System - 725 jobs
9. Phoenix, Arizona: Banner Health - 1,220 jobs
10. Sacramento, California: Sutter Health - 568 jobs
11. San Francisco Bay, California: Sutter Health - 1,382 jobs
12. St. Louis, Missouri: Saint Louis University Hospital - 393 jobs
13. Tampa and St. Petersburg, Florida: BayCare Health System - 1,283 jobs (article courtesy of Continental Nurse Practitioners) |
| March 27, 2013 | SENATE APPROVES BILL TO LET DENTISTS, PHARMACISTS LICENSE THEMSELVES - The state Senate voted 45-8 to remove licensing of dentists and pharmacists from the duties of Secretary of State Brian Kemp – but not before Sen. Renee Unterman accused her fellow Republicans of growing government and of being unduly influenced by campaign contributions. “Let your money do your dialing through the state Senate,” Unterman said, after a slide presentation in which she declared that chamber leaders had accepted $142,400 from dentists and pharmacists in the last two years. Gasps could be heard from lobbyists watching the proceedings outside the Senate’s heavy wooden doors. At issue was H.B. 132, a bill that would allow dentists, dental hygienists and pharmacists to regulate their own professions under the auspices of the Department of Community Health. Currently, they are a minority of the 430,000 professionals – plumbers, CPAs, barbers, hairdressers, nurses and a host of others – whose twice-a-year licenses are handled by the secretary of state’s office. Kemp has complained that licensing fees meant to fund his operation have been siphoned into the state’s general funds, to be point that licenses are often delayed. Further, he has said, the state’s new illegal immigration law, which requires license applicants to submit paperwork proving citizenship, has bogged down the operation even more. (article courtesy of Continental Nurse Practitioners) |
| March 27, 2013 | CONTINENTAL TELEHEALTH OFFERS NURSE PRACTITIONER CONSULTATIONS - Health care reform in the United States is an ongoing challenge. All health care reform solutions, whether it be the current Patient Protection and Affordable Care Act (PPACA), or variations thereof being proposed, will have the basic fundamental objective of providing high quality health care for all the people at an affordable cost. While there may continue to be much debate regarding how these objectives can be best achieved, there is little argument that pure population figures challenge the existing physician practice model to optimally satisfy these objectives. As a result, opportunities to further explore the scope of practice of the Advanced Practice Registered Nurse or "Nurse Practitioner" are growing throughout the Unites States. Examples of the increased role of the Nurse Practitioner as part of health care reform come not only from the Federal Level - as demonstrated through federal funding to support the development and operation of Nurse Managed Health Clinics (NMHCs) - but also from the individual State Level - as several individual states have already recently made legislative changes loosening Scope of Practice restrictions for Nurse Practitioners to allow for health care support to a broader patient population. Myrtle Beach based Continental Nurses has long been working with nursing professionals to supplement the staffing of health care organizations all across the US for over 25 years. The company is now launching its new brand, Continental Telehealth, a service that will provide patients with an opportunity to engage a Nurse Practitioner, via Telehealth, to discuss their health care concerns. Telehealth, the use of technology to delivery of health care or health information remotely, has shown tremendous potential. Through Continental Telehealth, contact can be increased between a patient and the medical system and additional expertise can be provided to reach out to patients while they are at home, saving time and money for both practitioners and patients. Continental Telehealth is the first company to offer Nurse Practitioner consultations all across the US. "We are excited to provide input to the health care reform solution through the successful outcomes of our services. Individual states have demonstrated their interest in further exploring the scope of practice for Nurse Practitioners and recently several states have adopted new legislation that will allow Nurse Practitioners to provide services without a Physician Collaborative Practice Agreement in place. As a result, access to health care is more accessible to the patient population in these states." says Scott Vansant, Program Manager for Continental Telehealth. South Carolina remains among the approximate 20 individual states that continue to have restrictions requiring Nurse Practitioners to have written documentation in place of physician involvement in order to provide their services. Scott Vansant further says, "Being based in South Carolina, we are hoping to have an opportunity to reach out to our home state to share our outcomes to help educate legislative leaders involved with defining the scope of practice for Nurse Practitioners. South Carolina alone has about 3,000 Nurse Practitioners. There is tremendous opportunity here to further engage Nurse Practitioners as part of the health care reform solution in South Carolina." Additional information can be obtained at www.ContinentalTelehealth.com. (article courtesy of Continental Nurse Practitioners) |
| March 26, 2013 | TEXAS NURSING HOMES PLAN MAJOR CHANGES IN RESPONSE TO BUDGET CUTS - Budget cuts impacting Medicare and Medicaid will leave Texas nursing home providers no choice but to scale back on staffing among other changes, the communities say. Nursing homes in Texas say state and federal funding cuts to are presenting a “dangerous strain” on their ability to care for older, more medically complex patients. In a survey of 100 nursing homes representing 10% of the state’s nursing home population, the Texas Health Care Association found more than 65% have made staff changes, more than 72% have reduced staff hours, wages and benefits, and 60% have canceled or postponed facility improvements already in response to Medicare and Medicaid cuts. “The so-called ‘Medicaid expansion’ discussion in Austin is coming at the expense of a closer legislative look at how Texas nursing home patients are increasingly put at risk by the state’s own lack of Medicaid funding adequacy,” said Tim Graves, THCA president. “So far, the Texas Legislature has not come close to adequately addressing seniors’ state Medicaid funding requirements, and far more focus is warranted. Local seniors are at risk, and the Legislature needs to act.” The cuts are putting increasing pressure on senior care within the state, the survey finds, with the majority of providers anticipating measures such as freezing wages, deferring facility improvements, and reducing staff benefits to accommodate the change. More than 30% say they are considering staff layoffs in 2013. (article courtesy of Continental Nurse Practitioners) |
| March 25, 2013 | SHORTAGE OF NICU NURSES - A surprising number of the nation's neonatal intensive care units (NICUs) have too few nurses, a new study by researchers from the University of Pennsylvania and the University of Medicine and Dentistry of New Jersey (UMDNJ) has found. Infants in understaffed units were more likely to get infections, which decrease the chance that these fragile babies will survive, the study also found. Infections also increase costs. An added wrinkle is that Medicaid, which pays for the care of 42 percent of preterm and low-birth-weight infants, no longer reimburses hospitals for expenses associated with infections acquired in the facility. Eileen Lake, an associate professor of nursing and health policy at Penn, said most infections -- staph bacteria are the most common culprit -- stem from the tiny catheters that give these immature bodies fluids, nutrition, and medicine. She suspects that overworked nurses may have less time to devote to catheter hygiene. The babies, she said, "are a uniquely vulnerable group." The study, published last week in JAMA Pediatrics, looked at staffing in 560 of the nation's 900 NICUs in 2008 and 2009. The group included a disproportionate number of magnet hospitals for nursing. That designation certifies that those hospitals provide high- quality nursing care, but it does not consider staffing ratios, said Lake, a coauthor. The research team compared staffing levels to those recommended by the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the Association of Women's Health Obstetric and Neonatal Nurses. These are guidelines, not regulation or law. Lake said some hospitals might have had trouble interpreting the guidelines. Her inter- disciplinary team, she said, has created clearer definitions for what kind of patient needs a particular level of staffing. The study found that NICUs were understaffed for 32 percent of their patients. Staffing was inadequate for 68 percent of high-acuity infants, or the sickest 8 percent. (article courtesy of Continental Nurse Practitioners) |