“With Joyce Carlone and her skills, we were able to then get involved in a number of NIAMS [National Institute of Arthritis and Musculoskeletal and Skin Diseases]- and pharmaceutical-sponsored studies in rheumatoid arthritis and then lupus. She helped recruit, educate, and supervise … other research nurses,” says Dr. Conn of their enterprise.
Providing a cohesive link between patient care and clinical trials, Carlone uses her assessment skills to obtain clinically useful data and helps patients maneuver through a potentially overwhelming healthcare system. “I have become well acquainted with the majority of the early arthritis clinic patients and act as their liaison between their doctors, the clinic, and the hospital,” she says. “Grady [Memorial Hospital] is very large, and it is difficult for patients to navigate the system.”
She has subsequently broadened her administrative responsibilities to include 2004 chairperson of the ARHP Meeting Planning Committee. A strong advocate for rheumatologic training at all levels, she endorses adding more mid-level training opportunities to the curriculum of the annual scientific meeting, and her endeavors have evolved into a one-day Clinical Focus Course for NPs and PAs.
Teamwork on Quality
In the non-academic setting, a mid-level provider–physician collaboration may have different goals. Leslie McDowell, ANP, MSN, and Dr. Queen focus on efficiently delivering high-quality care to a large patient population. The result of their collaboration has been the steady growth of Dr. Queen’s practice—she has seen an average of 20 new consults a week for the past 10 years—as well as the development of a computerized medical record. Dr. Queen credits McDowell with finding new ways to deal with the challenges of a busy practice. “She helped me understand things that she could do to lighten my load, and she did free me up in a lot of ways to focus on other challenges,” says Dr. Queen.
Currently, McDowell sees about 15 patients a day, orders labs and diagnostic studies, performs arthrocenteses and joint injections, and teaches patients about DMARD therapy and teriperatide self-injection. She rarely sees new patients and does not initiate DMARD therapy without Dr. Queen’s consent. “It is terribly important that the two individuals have a collegial working relationship and similar philosophies,” says McDowell. “Unless there is mutual respect there will not be success. Communication between providers is also essential. Patients need to know that you are a team in order to have confidence in their care.”
Experience and Certification
The road to becoming an NP may start with a nursing degree, but most NPs have many years of nursing experience before completing the graduate-level NP training program. Their training focuses on learning basic assessment skills, distinguishing normal from abnormal findings, and understanding the limits of one’s own clinical judgement. There is also a clinical component in which student practitioners shadow physicians or certified NPs and assist with history taking, physical exams, and decision-making. NPs must maintain not only state nursing licensure, but also NP recognition. National certification exams are given based upon specialty, and most of these certifying bodies require continuing education or periodic re-examination.
