Skilled Support for Patients and Practices

Kori Dewing, DNP, ARNP, works at the Virginia Mason Rheumatology Clinic in Seattle, has been active in the ARHP, and is an instructor at the University of Washington School of Nursing. In her previous job, she was one of four NPs who saw all new patients for initial workups. The sole rheumatologist refined the diagnoses and developed plans of care, which would be managed by the NPs over time. In her current position, she is much more autonomous, with the ability to see new patients with urgent needs and provide ongoing management of established patients. She also has a special interest in osteoporosis, does injection teaching, and serves as a sub-investigator in clinical trials. Even with all those duties, however, she says that she does have more time with her patients than her physician colleagues do. “My focus tends to be on maintaining wellness and teaching patients what they can do to improve their overall health and achieve their best level of function possible,” she says.

Increase the Numbers?

Studies have validated the value of using NPs and PAs in the rheumatology practice. Nevertheless, Huisinga still detects a bit of “stigma” and misunderstanding about NPs as fully capable providers, even in the VA system, where NPs are widely used. Some of the confusion, she believes, relates to licensure issues and some is related to physician preferences. Dewing believes that, compared with the level of understanding she experienced at her first ACR/ARHP Annual Scientific Meeting nine years ago, there is now more clarity about the role of NPs. She says that physicians can help educate about the NP’s role by appropriate introduction to the practice. (See “Hiring a Nurse Practitioner? Consider This,” above right, for more on introducing an NP into your practice.)

One thing is abidingly clear: following the workforce study commissioned by the ACR, the College supports increasing the numbers of health professionals to help fill the gap between the number of available rheumatologists and the number necessary to meet patient needs.^5,6 That may be easier said than done.

According to a recent study, in addition to the current physician shortage, the United States will also experience a shortfall in the numbers of advanced practice nurses and physician assistants.⁷ As an adjunct faculty member at the Wayne State University College of Nursing, Kerr believes that NPs have a role to play in attracting more NPs to the field. She regularly precepts pediatric NP students and gives lectures on pediatric rheumatic diseases. She also speaks at local and national NP and PA conferences on topics related to pediatric rheumatology. “It’s important for rheumatology nurse practitioners to mentor other nurse practitioners and physician assistants,” she asserts, “to increase awareness of the rheumatic diseases and convey how rewarding a career in rheumatology can be for them.” the rheumatologist