Opinion: Role of Rheumatology Nurse Should Be Expanded

In 2012, the European League Against Rheumatism (EULAR) published an evidence-based position paper developed by a multidisciplinary consensus task force that suggested 10 recommendations for the nurse’s role in the management of chronic inflammatory arthritis to “help determine practice, education and research activities.”⁸ Of these, four had an A (best) category strength of recommendations:

1. Provision of patient access to a nurse for education about the disease and its management;
2. Provision of patient access for nurse consultations to improve communication, continuity and satisfaction with care;
3. Nurse participation in comprehensive disease management and outcome activities; and
4. Nurse assessment and intervention for psychosocial issues to reduce the risk of patients experiencing anxiety and depression.

Fewer data were available about assessing rheumatology nursing activities for performing telephone counseling, using care protocols and guidelines, promoting an expanded practice role, assisting in cost control, participating in continuing education and providing patient self-management.

The role of each member of the healthcare team is being evaluated, with focus on efficiency & care coordination.

Since this paper was released, significant clinical research on nursing activities in rheumatoid arthritis has been published, showing the potential positive impact of motivational interviewing, demonstrating that nurses and physicians have good interrater correlation in performing the 28-joint count and showing that nurse-led care in the outpatient setting can achieve comparable or better results than physicians alone.^6,9-17

The time is now to aggressively further investigate and implement the role of nurses in rheumatologic care, not only in rheumatoid arthritis, but also in the other rheumatic diseases.

Let’s do it.

Terence Starz, MD, is a clinical professor of medicine in the Division of Rheumatology at the University of Pittsburgh School of Medicine and is in practice at Arthritis and Internal Medicine Associates–UPMC in the Western Pennsylvania Area. In addition, he is involved in clinical research projects, including rheumatoid arthritis outcome studies, and has participated in classification and intervention studies in fibromyalgia and healthcare utilization in low back pain. He serves on the Board of Directors of the Great Lakes Region of the Arthritis Foundation and the Pennsylvania Rheumatology Society.

Brandon Young, DNP, FNP-C, is a family nurse practitioner who practices in the Rheumatology and Osteoporosis Center for Excellence at North Mississippi Medical Center in Tupelo, Mississippi. In addition, she serves as a sub-investigator in numerous clinical research trials and precepts nurse practitioner fellows interested in rheumatology. She is involved with the Association of Rheumatology Health Professionals and has served on various ACR and ARHP subcommittees and committees.

References

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7. Bureau of Labor Statistics, US Department of Labor. Occupational Outlook Handbook. 2012–13 ed. Registered Nurses.
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