By Ericka Waidley, MSN, RN
January 27, 2000

Q: As an NP student about to enter the market as an FNP, I wonder what kind of position an NP could be in if the group of physicians with whom he or she practices decides to bargain collectively for contracts with HMOs. Where would this put the NP on issues of reimbursement, collaborative practices, and equal pay for equal work? What should we consider when looking at this issue?

A: Your concerns are well founded. According to the American College of Nurse Practitioners (ACNP), this is a dynamic issue on Capitol Hill. As with most legislative issues, however, it could take a while for anything to be resolved. This is a good time for you to get involved in professional organizations. The ACNP is hosting a Year 2000 Summit in Washington, D.C., in February, which will focus on these types of issues and will include a meeting with several senators and representatives. Even if you can’t attend, you will want to stay on top of the outcomes of this summit and ACNP legislative initiatives.

In regard to physician unionization, ACNP President Mary Knudtson, MSN, FNP, PNP, RN, said "it is premature to know what effect, if any, physician unionization will have on nurse practitioner practice." She said she is not aware of any state or federal legislation that specifically addresses physician unionization at this time.

My advice to you, as you begin interviewing for jobs, is to address these issues and concerns during the interview process. The response you get will help you decide the best, and most secure, job opportunity for you. Also, make sure that you understand the business hierarchy of the physician group (Is there a higher level, maybe even a distant, corporation involved in the business?) and the business plan and vision of the practice.

The role of the nurse practitioner is being strengthened by current research, such as the study published in the Jan. 5 issue of the Journal of the American Medical Association. Briefly, this New York study reported that whether treated by physicians or nurse practitioners, patients had consistent short-term health outcomes. Although the study has its limitations, it opens up the door for further research and analysis of practitioner roles, reimbursement issues, and patient outcomes. I encourage you to continue your interest in these practice issues and investigate membership in professional organizations both at the state and national levels. Good luck as you begin your career as an FNP!

Q: I recently received a copy of a community education calendar and was stunned to read this listing: "CPR & AED: Cardiopulmonary Resuscitation & Automated External Defibrillator Training." This class is open to anyone who cares to take it—and does not require a medical background. Is it legal to teach anyone how to use a defibrillator, and more importantly, is it legal for them to use it?

A: This issue has been in the limelight for several years. As early as March 1996, Rep. Gerry Studds, D-Mass., introduced the Cardiac Arrest Survival Act (HR 3022), which recommended making automated external defibrillators (AEDs) more accessible to professionals who regularly respond to emergency situations. From that proposal, there has been a push to expand this concept to include all "first responders" to emergency cardiac situations. Such first responders can include EMTs, firefighters, police, security staff, professional medical personnel, and trained laypeople. One endorsement to increase public access to AEDs is from the American Heart Association (AHA), which recommends special effort be made to extend bystander-initiated defibrillation in rural and congested urban areas where resuscitation strategies have had little success. An AHA report from April 1998 says that greater availability of public-access defibrillation (PAD) may save as many as 24,000 lives per year. Other studies put the number as high as 50,000.

The American Association of Critical-Care Nurses (AACN) also endorses the Cardiac Arrest Survival Act. But according to Janice Weber, MSN, RN, public policy specialist for the AACN, the group recognizes "the need for further research to address training issues such as the length of training, frequency of retraining, and content." Along with training programs comes the need for more user-friendly defibrillators in public places. Many cities are placing AEDs in sports stadiums, theaters, supermarkets, airports, and casinos.

A 1999 study of AEDs by researchers from the University of Washington School of Medicine in Seattle found that the majority (95 percent) of those suffering cardiac arrest outside of a hospital die. They blame this statistic on lengthy response time and a lack of available equipment. The study looked at the training needs of laypeople in learning how to use AEDs. Researchers recruited 15 sixth-graders and gave them brief instructions about the safe use of the AED and placement of the paddles. They found that it took the sixth-graders an average of 90 seconds to complete the defibrillation compared to an average of 67 seconds for EMTs/paramedics.

Each new study seems to support increased training and availability of this equipment to the public. If you want to help assure that the training is appropriate, I would encourage you to become an instructor for these community courses.