Full practice authority--effecting change and improving access to care: the Nevada journey.

PURPOSE: In 2013, Nevada shifted from a collaborative practice model to full practice authority. Given the challenges many states still face, this article provides an outline of the evolution of the "nurse practitioner" (NP) in Nevada. Reviewing the path Nevada took toward full practice authority, we hope to provide insight including lessons learned and opposition encountered to assist other states working toward full practice authority. DATA SOURCES: Literature searches were conducted on PubMed and MEDLINE. Search terms included "autonomous practice," "nurse practitioner," and "full practice authority." CONCLUSIONS: Healthcare reform will require nurse practitioners committed to legislative change. Nurse practitioners have the knowledge and ability to affect the legislative process and improve patients' access to care. With careful planning, full engagement, and team building, making a statute change is possible and should be seriously considered in states still struggling with collaborative relationships. IMPLICATIONS FOR PRACTICE: Nurse practitioners are well situated to provide primary care in the United States. Removing barriers to practice through statute change will empower NPs to effect positive change in our struggling healthcare system.

Interprofessional faculty development: integration of oral health into the geriatric diabetes curriculum, from theory to practice.

BACKGROUND: Health care workforce shortages and an increase demand for health care services by an older demographic challenged by oral-systemic conditions are being recognized across health care systems. Demands are placed on health care professionals to render coordinated delivery of services. Management of oral-systemic conditions requires a trained health care workforce to render interprofessional patient-centered and coordinated delivery of health care services. The purpose of this investigation was to evaluate the effectiveness of an interprofessional health care faculty training program. METHODS: A statewide comprehensive type 2 diabetes training program was developed and offered to multidisciplinary health care faculty using innovative educational methods. Video-recorded clinically simulated patient encounters concentrated on the oral-systemic interactions between type 2 diabetes and comorbidities. Post-encounter instructors facilitated debriefing focused on preconceptions, self-assessment, and peer discussions, to develop a joint interprofessional care plan. Furthermore, the health care faculty explored nonhierarchical opportunities to bridge common health care themes and concepts, as well as opportunities to translate information into classroom instruction and patient care. RESULTS: Thirty-six health care faculty from six disciplines completed the pre-research and post-research assessment survey to evaluate attitudes, knowledge, and perceptions following the interprofessional health care faculty training program. Post-training interprofessional team building knowledge improved significantly. The health care faculty post-training attitude scores improved significantly, with heightened awareness of the unique oral-systemic care needs of older adults with type 2 diabetes, supporting an interprofessional team approach to care management. In addition, the health care faculty viewed communication across disciplines as being essential and interprofessional training as being vital to the core curriculum of each discipline. Significant improvement occurred in the perception survey items for team accountability and use of uniform terminology to bridge communication gaps. CONCLUSION: Attitude, knowledge, and perceptions of health care faculty regarding interprofessional team building and the team approach to management of the oral-systemic manifestations of chronic disease in older adults was improved. Uniform language to promote communication across health professionals, care settings, and caregivers/patients, was noted. Interprofessional team building/care planning should be integrated in core curricula.

The evolution of proton pump inhibitors for the treatment of gastroesophageal reflux disease.

PURPOSE: This article reviews the diagnosis and current treatment options for gastroesophageal reflux disease (GERD) available to nurse practitioners, with a focus on advances in proton pump inhibitor (PPI) therapy. DATA SOURCES: Review of scientific literature and clinical management guidelines for GERD treatment and PPI therapy from the PubMed database, Google Scholar, and other World Wide Web resources. CONCLUSIONS: A number of safe and effective treatment options exist for GERD. Recent developments in PPI technology may begin to address unmet needs in PPI therapy. IMPLICATIONS FOR PRACTICE: GERD is commonly diagnosed and treated by nurse practitioners in the primary care setting. Acid suppression therapy is the primary medical therapy for GERD. PPI therapy provides symptomatic relief of heartburn and regurgitation, as well as effective healing and maintenance of erosive esophagitis. Newer PPIs lengthen the duration of acid suppression and allow for more flexibility in dosing, which may improve medication adherence and decrease episodes of acid breakthrough.

The Genetic Information Nondiscrimination Act 2008: What clinicians should understand.

PURPOSE: To explain the Genetic Information Nondiscrimination Act (GINA), what it covers, and what it does not cover to aid primary care practitioners in advising their patients. DATA SOURCES: Governmental agencies, congressional records, and various nongovernmental agencies, press releases, and journal articles. CONCLUSIONS: The GINA will protect patients from employment and insurance information in multiple ways. However, loopholes exist which will need to be addressed at the next review of the Act in 6 years. IMPLICATIONS FOR PRACTICE: In order to provide accurate information regarding genetic testing, clinicians need to be familiar with key factors about GINA regarding law, practice, impact on patients and their rights in terms of genetic testing.