New Opportunities for Nurse Practitioners in Tough Economic Times
Source: Peggy Kaplin
Lourdes Santoni Reddy, PhD, APRN-BC, CPP, FAAPM, has spent the last seven years as a Nurse Practitioner specializing in Addiction, Behavioral & Pain Medicine. Her practice at the North Philadelphia Health System’s Girard Medical Center and St. Joseph’s Hospital in Philadelphia, Pennsylvania has allowed her to manage patients who are indigent or with minimal health insurance coverage. Dr. Reddy strongly believes that serving the healthcare needs of the underserved is one of the major reasons why she became a Board Certified Nurse Practitioner and Credentialed Pain Practitioner. In her Addiction Medicine role, she delivers care to patients who, for a variety of factors, have become dependent on drugs and or alcohol. Her population is complex because of dual diagnoses with Psychiatric Disorders or Multiple Co-morbidities such as Hepatitis, HIV, Diabetes or Pain Syndromes.
Dr. Reddy attended Queens Vocational High School in New York City and started her career as a Licensed Practical Nurse. She moved to Philadelphia to become a Registered Nurse as many New York Schools of Nursing were overcrowded at the time. Upon graduation she practiced as a Critical Care Nurse for several years and paused long enough to start a family. Her strong desire to care for others led her to pursue and obtain Graduate Education and Nursing Degrees. Her letters include a Bachelor of Arts in Science from Penn State University, a Bachelor of Science in Nursing from Graceland University, a Master’s of Education from Holy Family University, a Master’s of Nursing from Drexel University and a Doctorate from the University of Integrated Studies. She is a Fellow in the American Academy of Pain Management and is a member of several advanced practice nursing associations. She is Board Certified as an Acute Care Adult Nurse Practitioner and has held faculty positions at several Schools of Nursing.
“The Nursing Profession was very valued and important,” recalls Dr. Reddy of her training. “That respect gave my peers and I the incentive required to advance our careers. When you practice in an environment where Nursing is recognized for the profound difference it makes towards the care of patients, you obtain a stronger desire to be the best. Nursing Excellence was what we were striving for with the goal focused on our patients.”
Dr. Reddy found the changes in healthcare to be impersonal and she wanted a role in the provision of care to those who were at a disadvantage. Deciding to practice within the urban setting from which she came was simple enough, but she never imagined that where there was the most need, would one day be a place where healthcare positions would be minimized.
Dr. Reddy says, “During my clinical training, most of my preceptors were physicians, so I came to learn the medical model well and merged it with the nursing model.” The fact that she has a strong clinical background makes a difference in how she manages patients but that does not seem to be enough in today’s changing economy.
The changes have produced challenging scenarios, but have served to advance her career in unexpected ways. She says, “Institutions are forced to down-size or face closure especially those which serve the poor. I was laid off on September 5th 2008 and, although I continue to practice on the same unit, I now have no healthcare benefits. My new title is that of a consultant and I am compensated per patient seen versus a salaried staff position. I continued to fill in the gaps of care on a pro bono basis but have recently decreased this behavior because of circumstances.”
“I see others trying to practice in this manner and forced to move along quickly so that they can generate a better income…volume/time becomes an important factor, but this was not how I was trained. Upon reflection, I often think that we dishonor the oath taken as a student and then again at graduation, where we committed ourselves to our patients and vowed to do no harm.”
“Hospitals have to battle insufficient reimbursement, rising costs, litigation and a myriad of things that keep the debt incurred in the millions of dollars. For a Community Hospital the loss is felt at many levels, but when staff layoffs take place as a cost saving measure, this has a direct, negative impact on patient care services. Hospitals try to merge or close for business, which again burdens the very patients who need us.”
Dr. Reddy has taken this rough economic climate as a chance to further her independence and to extend and re-invent herself. She says, “The physicians where I practice were unaware I was laid off as they saw me day in and day out. Upon the discovery, several realized that they could use my expertise and I now collaborate privately with the hospital and the attending physician staff. I see patients independently versus being part of a department or team. My practice has evolved to include more autonomy and decision making. Instead of having one collaborating physician, I have several as each practice is separate. This diversity provides the opportunity to communicate and facilitate better care for my patients. I have been able to learn the nuances of private practice from my attending physicians. I cross cover Addiction, Behavioral, Geriatrics, Primary Care, Occupational, Pain Medicine and Women’s Health. Being laid off was traumatic and worrisome, but it has opened options I might not have attempted. I had to change with the changing times and market myself within an unstable environment. I realized that my skills can cross boundaries and I practice in the acute care setting, private office, healthcare clinic and corporate world.”
Mid-level providers include Physician Assistants and Nurse Practitioners but they are NOT interchangeable. Nurse Practitioners are credentialed and socialized very differently. Dr. Reddy says, “As more physicians take note at the scope of Nurse Practitioner practice they realize that we can relieve them from many duties and deliver care at a superior level. Trust is a major cornerstone in the building of a relationship between providers. Physicians acknowledge Nurses who, as a profession, have been prominent along with them at the bedside. Today’s Advanced Practice Nurse is credentialed at the highest level holding a Doctoral Degree and multiple certifications in many areas of both medicine and surgery.”
Because of the autonomy that Nurse Practitioners possess, they are able to fit into many different roles. They have a tremendous impact on the patients they treat as they have traditionally been and remain the patient advocate, caregiver and educator. Dr. Reddy maintains diversity in her practice after noting that other providers tend to send patients home with a prescription as opposed to addressing the other facets of their illness, including psycho-social components.
Reddy says, “A certain percentage of drug addiction cases include failed pain therapy. A patient who has had lumbar surgery, for example, continues to have pain. They are put on medication and eventually their provider, unable to help them, stops management. These patients have no other recourse than to go doctor shopping to see who will provide Vicodin, Percocet, or Oxycontin. Now dependent on opioids and without a provider to prescribe for them, they find their way to the street to buy their medication. Those medications have a higher street value than heroin and cocaine put together, so eventually they begin taking something less expensive that will manage their pain and prevent withdrawal symptoms. Soon they are entangled in the social scene that exists among drug dealing neighborhoods, causing them to lose their jobs, families and further risk their health. I’ve had patients from all walks of life who fall into that population. Many are well educated and are not the stereotypical drug addict society recognizes.”
Patient education is a given in healthcare as it reduces anxiety and produces better informed decisions. Physicians often lack the time required to teach patients and may not discuss the fact that they can make the pain better but may be unable to eradicate it. Other modes of therapy which may be beneficial may not be disclosed by a busy provider. Many pain patients may also be depressed and that needs to be addressed simultaneously. Dr. Reddy points out, “Patients who are genuinely interested in getting well and receive the best possible care do succeed.”
The Detox Unit at St. Joseph’s Hospital includes a dedicated staff that enjoys their practice. They are, as a whole, founded on providing care to its community. Even in tough economic times there is hope…providers like Dr. Reddy will continue to use their knowledge, skills and resources to do whatever they can to help those in need.
Lourdes “Cindy” Santoni Reddy, PhD, APRN-BC, CPP, FAAPM, practices in Philadelphia, Pennsylvania, at CIGNA Corporate Health, Girard Medical Center, North Philadelphia Family Medicine, and St. Joseph’s Hospital.
Peggy Kaplin is a freelance writer from New York City and is on the editorial staff of NEWS-Line for Nurse Practitioners.
comments powered by Disqus