Because so many rheumatic diseases are complex, unpredictable, and chronic, the NP must coordinate everyone involved to achieve control of the disease and optimal patient function. Polling NPs in the field of rheumatology to identify the typical conditions being treated shows that the NPs deal with (in order of magnitude) rheumatoid arthritis (96.8%), psoriatic arthritis (95.8%), osteoarthritis (63.2%), axial spondylarthritis (62.8%), systemic lupus erythematosus (51.6%), and scleroderma (34.7%).3 The same study reveals that the NPs consider the following attributes (in order of importance) to be essential for competence in their field: knowledge of rheumatic diseases and drug therapy, good communication skills, an understanding of team roles, working well as part of the team, patient assessment, teaching, research procedures, organizational skills, and the interpretation of investigations.
In addition to these clinical conditions and the professional skills, NPs may be responsible for managing the business of rheumatology practices—for example, applying services codes to meet Medicare/Medicaid guidelines, assigning Current Procedural Terminology codes for professional services, or determining provider reimbursement based on the Resourced-Based Relative Merit Value Scale. These duties are covered in the Advanced Rheumatology Course.
The Future
The future is here. Specialized NPs have already adopted an independent role in many rheumatology practices and brought clinical, educational, consulting, and business skills to the delivery of rheumatology services. They are managing healthcare teams that integrate patient care and patient education with professional expertise and research. They partner with physicians to eliminate delays in assessment and treatment and to customize patient care. They are part of the solution to the supply and demand gap in the rheumatology workforce now and into the future.
Ann Kepler is a medical journalist based in Chicago.
References
1. Deal CL, Hooker R, Harrington T, et al. The United States rheumatology workforce: Supply and demand 2005–2025. Arthritis Rheum. 2007;56:722-729.
2. APRN Consensus Work Group, National Council of State Boards of Nursing APRN Advisory Committee. Consensus model for APRN regulation: Licensure, accreditation, certification, and education. Published July 7, 2008.
3. Goh L, Samanta J, Samanta, A. Rheumatology nurse practitioners’ perceptions of their role. Musculoskelet Care. 2006;4: 88-100.