As a conclusion to Wyoming's 2013 "Nurse Practitioner Week" it seems appropriate to reflect on this year's May 23rd visit from Dr. Loretta “Lee” Ford, co-founder of the nurse practitioner profession. Dr. Ford, a nurse, along with Dr. Henry Silver, a physician, envisioned the nurse practitioner (NP) role and offered the world’s first NP program at the University of Colorado in 1965. Similar to today, the 1960's experienced a shortage of primary care physicians. However, Ford’s and Silver’s vision for the NP role did not evolve because of a shortage of physicians. Rather, the NP role was developed to improve the health of children and families, and the physician shortage created a unique opportunity to implement this new role. 2013 is a replay of that 1960's situation: not only do we have a growing shortage of physicians in primary care and in rural areas, but we also have a unique opportunity to meet the complex healthcare needs of the people in the United States and in Wyoming’s own rural communities.
Dr. Ford was invited to commemorate, recognize, and encourage the inaugural cohort of 12 students in the new University of Wyoming Fay W. Whitney School of Nursing’s (UW FWWSON) Doctor of Nursing Practice (DNP) program. The school already had a successful master’s level Family Nurse Practitioner program, but was propelled to phase out that program and institute a DNP program to address (1) Wyoming’s rural healthcare needs noted above; (2) the projections of future primary care shortages, and (3) the call from the American Association of Colleges of Nursing (AACN) to move the level of preparation necessary for advanced nursing practice roles from the master’s degree to the doctorate level, to better equip practitioners to deal with the varied and complex health issues prevalent in this country and in this age.
As it was a bold gesture in the 1960's to start a nurse practitioner program, it is an equally bold gesture today to start a DNP program. Current DNP student Kristi Trefren said after listening to Dr. Ford, “It was motivational to understand the amount of struggles that have been overcome to pave the way for the current NPs, and it is helpful in building up my self confidence that I can overcome similar challenges facing the new standard of having a DNP.” The struggles of the early NPs have resulted in such positive outcomes. The American Association of Nurse Practitioners (AANP) reports high patient satisfaction with the unique approach NPs take to healthcare: “NPs are quickly becoming the health partner of choice for millions of Americans. …With almost 600 million visits made to NPs each year, patients report an extremely high level of satisfaction with the care they receive.” We can be hopeful that the DNP will have a similar success.
During Ford’s time in Laramie, she participated in a public interview with UW’s Distinguished Emeritus Professor Pete Simpson, who relayed the DNP students’ questions to Ford regarding the history of the NP movement and her vision for health care delivery. The faculty coordinator of the University of Wyoming’s DNP program, Ann Marie Hart, lists below several issues that Dr. Ford addressed at the interview on the 23rd that either resonate already with the DNP program curriculum, and/or inspire the faculty and students with ideas for caring for the health of our modern-day populations:
Dr. Ford emphasized that the NP is not a physician and does not “practice medicine”. Yes, NPs can diagnose and treat disease. But NPs need to be experts in “primary health” with the emphasis on health, said Ford. “With the ‘baby boomers’ coming of age, there is more chronic illness today than ever before. NPs need to be able to help people stay healthy and assist those who already have chronic illnesses to maintain their health and prevent further disease and disability.”
The American Association of Nurse Practitioners (AANP) web site reflects Ford’s philosophy with its description of the unique approach NPs take to healthcare: “What sets NPs apart from other health care providers is their unique emphasis on the health and well-being of the whole person. With a focus on health promotion, disease prevention, and health education and counseling, NPs guide patients in making smarter health and lifestyle choices, which in turn can lower patients' out-of-pocket costs.”
“NPs should not practice in isolation,” stressed Dr. Ford. “Integrated care delivered by a team of professionals who have differing areas of expertise is crucial to good primary health.” Ford continued, “The NP role is strongly rooted in public health. ‘Big picture’ thinking and understanding how outside factors (e.g., national policies, economics, culture, etc.) impact health is critical to the NP’s role, as is advocacy. NPs need to be advocating for individuals and communities, as well as for policies that promote health.”
Ford stressed that NPs should be experts in genomics and help patients utilize their own genetic make-up to prevent disease and maximize health. “The human genome project has afforded us a wonderful opportunity to improve health,” noted Ford. “NPs need to embrace genomics and help patients navigate their personal genetic make-up. In the same vein, future NPs will be more apt to use an individual’s unique genetic data than general data obtained from randomized-controlled trials."
“Innovation is the name of the game,” said Dr. Ford. “NPs need to embrace and lead in this area. The tools we are currently using in primary health care (exam rooms, stethoscopes, EKG machines, etc.) are rapidly becoming extinct and are being replaced by handheld and video technology.” To get a better since of these innovations, Ford recommended Eric Topol’s book “Creative Destruction of Medicine” (2012).
“Loretta was really excited about the potential for nurses in a health care world that has been transformed by technology, e.g., patients in the home with blood pressure or glucose monitoring devices,” noted UW School of Nursing Dean Mary Burman. “Her forward-thinking fits with what our UW nursing faculty did when envisioning a curriculum for the DNP program. Faculty discussion was focused on patients and their needs and then figuring out what role the NP could play.”
“NP practice needs to be reflective. Our practice can improve quite a bit by dedicating time each day to thinking and reading and writing about what we have experienced in practice. Regularly talking to other providers is another good way to reflect and learn,” concluded Ford.
The students in the School of Nursing’s DNP program will be using the State of Wyoming as their campus. The first cohort of DNP students has completed their first year of intensive didactic courses, including coursework in pathophysiology, pharmacotherapy, evidence-based practice, professional writing, behavioral change, and theories of advance practice nursing. They now transition from the classroom learning to experiential learning in clinical settings. Although these students will continue to have some didactic coursework, the primary focus for the remainder of their program is experiential; the students will be doing clinical rotations for the next 2 ½ years. And their program is based on rural health, so Wyoming’s rural clinics will be the perfect settings for educating these NPs who hope to make a difference in the health of the people they treat.