NPs and the Management of Chronic Disease

Abstract

Marilyn W. Edmunds PhD, NP D uring discussions and in articles written about recent health care reform, nurse practitioners (NPs) stressed the strengths of the services they provide to patients. This was an important time to emphasize that NPs enjoy being NPs and see ourselves first and foremost as nurses—we just have greater skills and knowledge and more legitimacy in working with patients to do many of the important things that we have always done as nurses—teaching, counseling, and advocacy. But the thing that caught the attention of many legislators was the fact that one of the most important services we provide to patients is care coordination, especially those patients with chronic diseases who may be seeing several specialists. I remember when I was a novice NP and was told, “NPs manage minor acute problems and stable chronic disease,” leaving physicians to care for the patients who had multiple problems and significant health challenges. It did not take me long to recognize that the patients who got shifted to my caseload were often the sickest, elderly patients with numerous chronic diseases, multiple medications, and few resources to help them cope with their family, social, and economic problems. They were often not the patients with stable chronic disease but those who required providers with careful listening skills who would do repetitive teaching and provide intense management of their many illnesses. The medical residents who changed clinic assignments every 2 months couldn’t and didn’t get involved in the problems of these patients, so the sickest, most unstable, and most challenging patients often were in the portfolio of the clinic NPs. I learned early that management of chronic disease is an art form. Our health care colleagues have grown to recognize the increasing contributions of NPs in helping patients deal with chronic disease. Talented NPs enjoy the special relationship that nurses have always had with patients. NPs who incorporate the care integration so essential to nursing into the medical cure dimension continue to practice as NPs and not as physicians or their assistants. NPs should always excel in this dimension of care. This type of nursing behavior must not be lost as students acquire other skills in their new NP role. Management of chronic disease requires patient cooperation, their full participation, and eventually development of self-management skills. How NPs help patients learn to help themselves is an important long-term care objective. The Agency for Healthcare Research and Quality (AHRQ) has recognized the importance of management of chronic disease and over time has established a Health Care Innovations Exchange program to provide tools that NPs can use to help patients learn to manage their own health. The AHRQ’s Web site (www.ahrq.gov) features a variety of innovative programs that provide rich resources to the NP and patient who are working together for more effective chronic disease management.