Ask the Doctor
Questions about kidney disease? Risk factors? Signs and symptoms? Are you concerned about yourself, a friend or family member? Ask Dr. Spry.
by Elaine Go, RN, NP, MSN, CNN
In May, I had the opportunity to join more than 100 nurses, including recent graduates and doctoral-prepared nurses, on a trip to China. We were part of the U.S.-China Nursing Forum, a collaboration between People to People Citizens Ambassador Program, Sigma Theta Tau International and the Chinese Nursing Association.
Some of the goals of the Forum were to observe patient care, the implementation of Traditional Chinese Medicine and modern technology and compare the incidence and treatment of disease. The Chinese are beginning to experience many of the problems faced within the U.S., such as rising health care costs, “empty nest” syndrome and a growing elderly population.
We learned that Traditional Chinese medicine (TCM) is an integral part of treatment. The practice seeks to restore balance to the body and either prevent or blunt the effects of disease. It is composed of five elements—metal, fire, water, wood and earth—each of which applies to a specific organ or system. Acupuncture, herbs and other methods are a major part of TCM. However, evidence-based practice is accepted and encouraged. Chinese nurses actively participate in research and publishing, oftentimes combining both TCM and western medicine.
We visited a premier teaching hospital, The Peking First University Hospital, where we learned that the nurses’ uniform designates their area of employment. In addition, they wear caps with stripes which indicate their rank. We found the equipment and technology to be comparable to that in U.S. hospitals.
Although they have a large peritoneal dialysis program, I had no time to visit the department. However, we saw their 40-bed hemodialysis unit. The dialysis units are staffed entirely by registered nurses and a nephrologist, who is clearly in charge and present at all times. There are no techs or advanced practitioners. They follow KDOQI guidelines and, in this particular unit, had a predominance of fistulas.
The Chinese are extremely hospitable. The language barrier was not an obstacle to excellent service and a welcoming attitude, and the Forum was a great opportunity to discover a different culture’s health care practices.
by Kim Zuber, PAC, MSPS
Members of the CAP Acting Executive Committee are excited about their recent accomplishments. For starters, we have grown our member base, submitted 30 suggestion points to CMS on the Conditions of Coverage and have been asked to work on an NKF program that relates to implementation of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), passed by Congress in July. Let’s take these one at a time…
In September, our determined membership chair, Barb Weis-Malone, notified the Committee that CAP membership had grown beyond the minimum set by NKF for CAP to begin adding new officers to the Executive Committee. At the recent NKF National Committee Meetings in Minneapolis, MN, the CAP Committee was presented to the Board of Directors, staff, Affiliates and Divisions in attendance where we were welcomed with open arms. As CAP continues to grow, we will be adding Executive Committee officer positions, looking for volunteers to serve as Committee Chairs or Committee members and providing access to research funds.
The current Executive Committee was appointed by NKF to assist with developing the CAP. We will have our first ‘official’ luncheon at the NKF Spring Clinical Meetings in Nashville and our first official elections in the fall of 2009. Hope to see you in Nashville!
CMS published the new Dialysis Conditions for Coverage (CfC) in April 2008. However, as we all know, the devil is in the details. Thus, draft interpretative guidelines were published by CMS in August 2008. CAP had five days to review the guidelines. We called in resources and sent a list of ‘unacceptable’ language (mostly omitting NPs and PAs in the area of physician orders). Of the 30 points that we sent in, 30 were accepted and changed! The voices of advanced practitioners were heard, and it was assuring that CMS was so receptive to our suggestions.
The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) was passed by Congress in July over the President’s veto. It includes a new program that allows groups to bill for six (6) CKD education visits for CKD Stage 4 patients covered under Medicare, effective January 1, 2010. While there are a number of good CKD programs out there, NKF is advocating a portable program that would include standardized elements common to all providers. We (the PAs, CNSs and NPs) would eventually be responsible for this program, since we are actively teaching in our practices. In addition, the legislation authorizes advance practitioners to refer Medicare beneficiaries for these educational services. Thus, CAP is on the ground floor and will be instrumental in helping to shape a program that addresses NKF’s implementation recommendations. Look for NKF’s program in your mailbox for review – quick turnaround will be needed, but we want to have your input and opinions.
As you can see from the above, things are REALLY moving fast and furious in CAP. Thanks for all the comments on the listserv. I love learning from everyone else!
by Jane Davis, CRNP, MSN
Barbara Weis-Malone, BSN, RN, MSN, CFNP
Barbara Weis-Malone frequently refers to a person’s passion for a topic or area of interest. Her personal passion is service to others, and that has been a dominating quality in her life. Barb is known among her peers as one who is always ready to go the extra mile for others as well as for ideas she believes in.
After graduation from the University of Virginia in Charlottesville, Barb and a friend packed a Volkswagen and headed for Denver, CO, where she has stayed for more than thirty years. While in Denver, she obtained her certification as a Family Nurse Practitioner (FNP) and Masters degrees in both Healthcare Organization Systems and Nursing.
Until 2001, when she joined the renal division of the University of Colorado Health Sciences Center, Barb held a variety of positions providing care to low income American Indians, uninsured populations and underserved populations. Her work earned her a commendation from the Denver mayor. While practicing as a FNP, Barb also has been a preceptor for medical, nursing and pharmacy students and a volunteer at local health fairs. She has been a clinic instructor at the University of Colorado for more than ten years.
Barb has the ability to believe in possibilities and is the motivating force behind the establishment of CAP. It is because Barb did not accept that PAs, NPs and CNSs could not come together in one organization that CAP came to be. Her passion for giving to others earned her the Nightingale Award for Nursing Excellence and she was named “Hero of the Uninsured” by the Colorado Medical Society.
She is equally at home teaching classes relating to both children and adults and to students on both the undergraduate and graduate levels. When not in clinic, Barb loves the outdoors, particularly downhill skiing, horse back riding and tennis.
Elaine Go, RN, NP, MSN, CNN
If you want to catch Elaine, Continuing Education Co-Chair for CAP, you have to get up early in the morning. You might want to first try the beach in Orange, CA, where you can spot her riding her adult tricycle. If you miss her there, you may find her seeing patients in clinic or dialysis. If it is during the summer, you might find her as a nurse volunteer either at the NKF Pediatric Hemodialysis Summer Camp or Muscular Dystrophy Camp.
Born and educated in the Philippines, Elaine came to California in 1980 and worked as an ICU nurse for five years before finding a home in nephrology. In Manila, she worked in the recovery room and as a supervisor. She received her master’s degree in nursing from California State University, Long Beach.
In addition to seeing patients, Elaine provides ongoing educational activities for ICU staff for both St. Joseph Hospital and Children’s Hospital of Orange County. She is active in many professional organizations and has also served as president of her local American Nephrology Nurses Association (ANNA).
Elaine draws on her experience of developing and presenting education programs in her area while serving in her current position with CAP as CE Co-Chair.
by Laurie Benton
Several years ago, sessions for advanced practitioners at the NKF Spring Meetings were few in number. Attendees went to physician or nursing programs. Gradually, the number of offerings increased and we now have a full schedule devoted solely to advanced practitioners. The topics are popular, as evidenced by the large attendance numbers at the 2008 sessions in Dallas. We had originally underestimated, and extra chairs had to be brought in for nearly every program attended by all specialties.
In addition to the scheduled meetings, NKF 2007 Spring Clinical Meetings in Chicago marked the first Nephrology 201 course. This is a full day, covering advanced practitioner-specific topics of interest which has also proved to be extremely successful.
NKF 2009 Spring Clinical Meetings and Nephrology 201 will live up to and most likely surpass previous offerings. The planning committee, headed by Laurie Benton and including Elaine Go, Tricia Howard and Jeanne Thacker, has already been hard at work developing topics and lining up speakers.
CAP is offering professional educational stipends of up to $500 to assist you in attending the NKF Spring Clinical Meetings, March 25-29, 2009, in Nashville, TN. You can earn more than 30 hours of CEUs or CMEs plus pharmacology credits.
Topics offered, as requested by CAP members, include reading the renal ultrasound, Restless Leg Syndrome, transplant meds and many more, all presented by stellar, “in the trenches” faculty. A unique aspect of the Spring Clinical Meetings is the ability to attend physician, dietitian, social worker and nurse/technician presentations in addition to advanced practitioner sessions.
Each day of the conference offers unique opportunities to network with your fellow NPs, CNSs and PAs and discuss relevant issues to our profession. There are breakfast, lunch and dinner symposiums on a variety of subjects, which helps the food budget as well. We are a new Council and this is our yearly opportunity to meet with CAP members and explore how CAP can help you and show how you can get more involved with CAP. See you there!To qualify for the professional educational stipend you must be a member of CAP. Apply here by December 1, 2008.