Nurse practitioners (NPs) play an increasingly large role in delivering rheumatology care and services. Their specialized knowledge and skills help both rheumatology patients and rheumatologists to create an interlocking network of patients and medical professionals.
An NP is a registered nurse (RN) who acquires advanced credentials to expand his or her scope of responsibilities in the workplace. After completing an accredited graduate-level (master’s or doctorate) educational program and passing a certification examination that signifies advanced knowledge and skills, an NP often works either as an independent provider or as part of a care team. Every U.S. state board specifies the scope of practice for NPs, and many states allow NPs to establish their own practices. According to Angela K. Golden, DNP, FNP, and president of the American Academy of Nurse Practitioners (AANP), “Seventy to 80% of NPs stay in primary or family care, while 20% to 30% go into a subspecialty. Either way, NPs bring their nursing education and experience and advanced practice education to the care of patients and fill the need for more providers in clinical settings.” In fact, rheumatology practices are increasingly turning to NPs to fill the gap between the demand for and supply of rheumatologists. Spanning this gap is becoming a long-term goal for clinicians entering the rheumatology workforce.1
Advanced Training
Building on the undergraduate RN training, the NP program requires courses in health assessment, physiology, pathology, treatment protocols, pharmacology, and research methodology. State laws regulate the licensing of NPs, and NPs in all 50 states have prescriptive authority. NPs specializing in rheumatology now can enroll in the ACR’s Advanced Rheumatology Course (ARC), an online course that offers a three-track (adult, pediatric, and combined) curriculum designed to provide in-depth information and advanced skills. A participant who passes each module within the selected track receives a Certificate of Participation. Golden, a professional leader in the AANP, says that the ARC meets important educational criteria. “The course is comprehensive and offers expertise in such a way that the participant can verify and document knowledge,” she says. She notes that the ARC “has a strong educational approach while emphasizing care based on patient participation in his or her treatment.”
What an NP Does
The NP delivers health care from the initial assessment through diagnosis to continuing management of chronic rheumatic illness. This includes taking health histories, performing physical exams, interpreting tests, and developing a treatment plan.2 Throughout the process, patient education and communication are key components to building a team partnership with the patient and health professionals.
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.