Transcript 2013-2014 Day in the Life of a Wyoming APRN

2013-2014 Day in the Life of a
Wyoming APRN
Wyoming Center for Nursing and Health Care Partnership
Investigators:
Ann Marie Hart
Mary E. Burman
Matt Sholty
Purpose
• Understand the contributions of Wyoming’s Advanced Practice nursing
workforce to primary and mental health care in Wyoming
• Advanced Practice Nursing workforce = Advanced Practice Registered
Nurses (APRNs)
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–
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Nurse Practitioners (NPs)
Certified Nurse Midwives (CNMs)
Clinical Nurse Specialists (CNSs)
Certified Registered Nurse Anesthetists (CRNAs)*
*Although CRNAs provide valuable anesthesia services in Wyoming, they do not provide primary
mental health care services and were not included in this study
and
Methodology
Population of interest:
Advanced Practice Registered Nurses (APRNs) licensed to practice in Wyoming. In
October 2013, there were 410 NPs, CNMs, and CNSs licensed in Wyoming
Design:
• Electronic survey developed using previous survey by Brown, Hart, & Burman
(2009)*.
– Demographic items related to respondents and their practices
– Items where respondents described a day in their practice during November 2013)
Administration:
– Postcards mailed to respondents with link to survey; reminder postcard mailed 2
weeks later
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•
Link to survey also sent via e-mail to informal WY APRN electronic listserve maintained by Hart
Due to poor response rate from electronic survey, paper copy of survey was also developed and mailed to WY APRNs in March 2014
*Brown, J. Hart, A.M., & Burman, M.E. (2009). A day in the life of rural advanced practice nurses. Journal for Nurse Practitioners, 5, 108-114.
Results
Response rate
• 162 respondents (39.5% response rate)
– Electronic – 71 respondents
– Paper – 91 respondents
• 137 respondents practiced in Wyoming as an APRN
during the past year
• 132 respondents indicated currently practicing as an
APRN in Wyoming
APRNs not practicing in WY
• 25 respondents did not practice in Wyoming during
past year
– Reasons for not practicing in Wyoming during past year:
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Practiced in another state – 12
Did not have a job as an APRN – 3
Took care of home and family – 3
Disabled – 4
Inadequate salary – 5
Attended school – 6
Other – 8
Unless otherwise specified, remaining
slides refer to the 132 respondents who
were currently practicing in Wyoming at
the time they completed the survey
General characteristics of
WY APRN clinicians and practices
Percentage of practice time in Wyoming
over past year?
2%
2%
2%
4%
2%
88% indicated practicing
exclusively (100%) in
Wyoming
100%
75-95%
50-74%
25-49%
5-24%
0
88%
Primary APRN setting in Wyoming
Community
Mental Health
Center
4%
Correctional
facility
2%
Other
4%
Home Health
Home
health 4%
Hospital
7%
Hospital
Emergency Department
Public Health
8%
ED 6%
Ambulatory care setting
Ambulatory care
setting
67%
Public or Community
Health
Community Mental Health
Center
School Health
Telehealth
Inpatient mental health
Employment specialty for WY APRNs
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•
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•
•
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Primary care
Adult health /family health
Psych mental health/substance abuse
Women’s health
Pediatric/neonatal
Acute/inpatient care
Maternal/child health
Oncology
Palliative care
Home health
Telehealth
Other:
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–
–
–
33
24
24
15
5
5
2
1
1
1
1
Cardiology
2
Dermatology
3
Urgent care
3
1 each for Pulmonary, prison health, Podiatry/wound care, Orthopedics, Pain Management, Gastroenterology, ER, ENT, diabetes,
neurosurgery, OB/GYN
Wyoming Practice locations
• 22 of Wyoming’s 23 counties – excluding Johnson
County
– 57% practicing in communities with populations >
20,000, including Cheyenne, Casper, Laramie,
Gillette, Rock Springs
– 16% practicing in communities with populations
between 10,000-20,000, including Evanston, Green
River, Riverton, and Sheridan
– 27% practicing in Wyoming’s least populated
communities
• 17% practicing in communities with populations between
5000-9,999, including Jackson, Cody, Lander, Torrington,
Powell, Douglas, and Worland
• 10% practicing in communities with populations < 5,000,
including Wheatland, Newcastle, Thermopolis, Pinedale,
Afton, Ft. Washakie, Basin, Moorcroft, Dubois, and Baggs
WY communities served by APRN respondents
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Alpine
Bondurant
Big Piney
Buffalo
Burns
Carpenter
Chugwater
Etna
Guernsey
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Meteetsee
Midwest
Rock River
Saratoga
Sinclair
Thayne
Wamsutter
Woods Landing
etc.
One-way mileage traveled by patient who lives the
farthest away
• 1-500 miles
• Eliminating lowest and highest entries, average one-way
distance was 107 miles
In your WY practice____
• Do you see non Englishspeaking clients?
No response
4%
• Do you see non-citizens (such as
documented or undocumented workers)?
No
response
1%
No
27%
No
50%
Yes
69%
Yes
49%
In your WY practice, do you _
• interpret X-Rays independently?
– Yes – 32 (24%)
– No - 100
• interpret your own EKGs?
– Yes – 54 (41%)
– No - 78
• use telehealth?
– Yes – 33 (25%)
– No – 99
What other health professionals are in your
WY practice?
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RNs – 72%
Primary care physicians – 52%
NPs – 52%
Specialty physicians – 52%
Physician assistants (PAs) - 39%
Counselors/mental health professionals – 30%
Pharmacists – 26%
Clinical nurse specialists – 0.05%
Certified nurse midwives – 0.05%
Do you own or co-own your APRN practice in WY?
Co-own
1%
Own
17%
Do not own or co-own
82%
Data Regarding APRNs’ Chosen Day
On your chosen day, how many total hours did you
work?
13-14 hours
5%
11-12 hours
10%
9-10 hours
37%
24 hours
1%
< 4 hours
2%
4-7 hours
14%
8 hours
31%
On your chosen day, how many hours did you
spend seeing patients?
> 9 hours
20%
< 4 hours
8%
4-6 hours
31%
7-8 hours
41%
On your chosen day, how many patients did you
see?
• Range: 0-46 patients/day
• Total for 132 respondents: 1750
• Average: 15 patients/day/NP
On your chosen day, how many patient visits
were____?
Well child
2%
Prenatal/postpartum
2%
Other
16%
Mental health
7%
Chronic illness
22%
Wellness
17%
Episodic illness
34%
On your chosen day, on average, how many
minutes did you schedule to spend with each
individual patient on the following types of visits?
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New acute
Established acute
New chronic
Established chronic
New health promotion
Established health promotion
New mental health
Established mental health
New acute (n=64)
> 60 min, 2
60 min, 6
35-45 min, 4
21-30 min, 25
20 min, 8
15 min, 11
up to 10 min, 9
0
5
10
15
20
25
30
Established acute (n=75)
minutes
> 60 min, 2
60 min, 3
45 min, 1
25-30 min, 17
20 min, 14
15 min, 26
up to 10 min, 12
0
5
10
15
20
25
30
New chronic (n=51)
60 min, 13
40-50 min, 6
25-30 min, 20
20 min, 4
15 min, 5
up to 10 min, 3
0
5
10
15
20
25
Established chronic (n= 73)
minutes
60 min, 3
40-45 min, 5
25-30 min, 33,
minutes
20 min, 10
15 min, 15
up to 10 min, 4
0
5
10
15
20
25
30
35
New health promotion (n=60)
60 min, 9
40-50 min, 17
25-30 min, 22
20 min, 4
15 min, 6
up to 10 min, 2
0
5
10
15
20
25
Established health promotion (n= 56)
minutes
60min, 5
35-45 min, 13
25-30 min, 23
20 min, 4
15 min, 5
up to 10 min, 3
0
5
10
15
20
25
New mental health (n= 40)
minutes
60 min, 13
40-50 min, 4
30 min, 8
20 min, 5
15 min, 2
up to 10 min, 3
0
2
4
6
8
10
12
14
Established mental health (n=51)
minutes
60 min, 3
40-45 min, 3
30 min, 20
minutes
20 min, 9
15 min, 8
up to 10 min, 3
0
5
10
15
20
25
On your chosen day, how many patients did
you
see at each of the following locations?
Telehealth 2%
Hospital 9%
Patient home
1%
Office or clinic,
87%
Other
1%
On your chosen day, how many patients ___?
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Had labs ordered? – 530 (30%)
Had imaging ordered? – 178 (10%)
Were referred to other health care providers? – 130 (7.4%)
Were referred to a specialist? – 116 (6.6%)
On our chosen day, how many patients
received___?
No couseling or
prescription
2%
Counseling only
28%
Counseling and
prescription
64%
Prescription only
6%
On your chosen day, how did patients pay for their
visits?
Self pay
10%
Unknown
11%
Other
14%
Medicare
14%
Private insurance
34%
Medicaid
17%
On your chosen day, how many of your patients
were___?
Hispanic/ Latino
American
8%
Indian/Alaskan
Native
3%
Mixed ethnicity
2%
Black/African
American
2%
White
85%
4 (0%) Native Hawaiian/ Pacific Islanders
On your chosen day, how many of your patients
were male/female/transgendered?
Transgendered
0%
Male
40%
Female
60%
On your chosen day, how many of your patients
were in the following age ranges?
> 65 yrs
12%
< 5 yrs
7%
5-12 yrs
7%
13-18 yrs
8%
51-65 yrs
19%
31-50 yrs
19%
19-30 yrs
28%
On your chosen day, please list the procedures you
performed:
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Suturing
Splinting
Casting
Cryosurgery
Colposcopy
Infant delivery
Joint injections
Nail removal
Nasal cautery
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Nerve blocks
Skin biopsy
Endometrial biopsy
Skin allergy testing
Skin lesion excision
Assisting with C-section
I & D abscesses
IUD insertion and removal
Implanon and Nexplanon
insertion/removal
percent was done independently (without
consultation)?
• Range - 60-100%
• Average - 97.33%
In terms of the number of patients you saw on
your chosen day, how typical was this day
compared to other days?
typically see
MORE patients
28%
pretty typical day for
me
65%
typically see LESS
patients
7%
Respondent Demographics
(applies to all respondents)
How many years have you been practicing as an
APRN?
• 0-40 years
• Mean 11.36 years
What type of APRN are you? National
certification? Prescriptive authority in WY?
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Nurse Practitioner – 179*
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Clinical Nurse Specialist – 8
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FNP – 112
Adult psych mental health – 15
Women’s health – 15
Family psych mental health – 12
Pediatric – 5
Acute care – 4
Oncology – 4
Gerontological - 4
Adult – 3
Other – 4
Neonatal 1
5 Psychiatric mental health
3 Other
Certified Nurse Midwife (CNM) – 6+
Are you nationally certified?
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Yes – 160 (98%)
No - 3
Do you have prescriptive authority in WY?
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Yes – 157 (96%)
No - 6
*Respondents may have been certified in
more than one area; 10% NPs certified in more
than one area
+One CNM also prepared as an NP
What type of nursing degree/credential
qualified you for your first U.S. Nursing
license?
LPN/LVN,
Diploma in Nursing,
5%
4%
Doctoral research
degree - nursing,
1%
Master's
nursing,
16%
LPN/LVN, 6
Diploma in Nursing, 9
Associate in
Nursing,
22%
Baccalaureate –
Nursing,
52%
Associate in Nursing, 35
Baccalaureate - Nursing, 85
Master's nursing, 26
Doctoral research degree - nursing,
1
What is your highest level of education?
Doctorate, nursing research
2%
Clinical doctorate
6%
Doctorate, other Non-graduate degree
2%
5%
Masters, other
6%
Non-graduate degrees
• Diploma – 2
• ADN – 1
• Associate degree, non-nursing
–1
• BSN – 3
Masters, nursing
• Baccalaureate degree, non79%
nursing - 1
Where did you receive your initial APRN
education?
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University of Wyoming, 61 (37%)
University of Colorado, 13
University of Northern Colorado, 3
University of Nebraska, 2
Montana State University, 2
University of Utah, 2
South Dakota State - 1
University of North Dakota - 1
Frontier School of Nursing - 3
In which of the following categories is
your annual income from nursing?
60
50
40
30
20
10
0
What is your race/ethnicity?
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White, non-hispanic (97%)
Black/African American – 1
Hispanic/Latino – 1
American Indian/Alaskan Native – 1
Mixed ethnicity – 1
Other - 1
What is your current age? Gender?
• Age - 26-72 years, mean - 49.45 years
• Gender
– Female – 150 (93%)
– Male – 12 (7%)
– Transgendered - 0
Limitations
• 39.5% response of 410 APRNs licensed to
practice in October 2013
• Survey only reflects data of APRN respondents
(not all APRNs in WY)
• As of late October 2014, there 705 NPs licensed
to practice in Wyoming!!!!
Conclusion
• Considering Wyoming’s small population, APRNs
are providing a LOT of primary and mental
health care
• As Wyoming continues to seek ways to provide
better health care services to its citizens, it
needs to consider APRNs in the equation and
APRNs need to have a prominent seat at the
“table”