Coronavirus in Context: A Nurse Practitioner’s Perspective

Hello. I'm Dr. John Whyte, Chief Medical Officer at WebMD. And welcome to Coronavirus in Context. Today, we're going to talk about the role of nurse practitioners in battling COVID-19. And my guest is Dr. Sophia Thomas. She is President of the American Association of Nurse Practitioners. Dr. Thomas, thanks for joining me today.

Oh, I'm happy to be with you.

Now, I understand you're in New Orleans. What's happening in the city?

I tell you what, it's been very difficult these last few weeks. We've obviously put a stay at home order in. It's going on three weeks now. Louisiana is up to over 5,000 cases in a very short period of time. Just two weeks ago we had 92. And we're up to 239 deaths, unfortunately. So the cases are spreading very, very quickly. Our numbers are on a trajectory very close to northern Italy.

Now, the media has been covering the role of physicians, even nurses. But they haven't always covered the role and experience of nurse practitioners. And you have a survey up on your site where you've been encouraging nurse practitioners to share their experience. What have you been hearing?

Well, we have. So we have 290,000 nurse practitioners in this country. And AANP represents about 105,000 members. And throughout this crisis, we wanted to hear back from our members to know what types of problems they're having, what they're seeing, what are some issues.

And the things we're hearing are obviously, the lack of PPE. We're also hearing that some people have been furloughed or laid off because some outpatient clinics are running out of low census now. So some nurse practitioners have been let go from their positions.

The problem with this is, nurse practitioners can't just go and practice in another location and help out on the front lines during this crisis because in 28 states, nurse practitioners are required to have what's called a collaborative practice agreement to practice with -- it's an agreement with a physician that just says, this is our collaborating physician if we need anything. As we know, nurse practitioners are educated and trained to assess, diagnose, treat, and prescribe for patients of all ages across the health care spectrum. And in 22 states plus the District of Columbia, nurse practitioners are not required to have this written collaborative practice agreement. They have what's called full practice authority.

So this is becoming a problem right now because in these other states, very much my own state in Louisiana, if a nurse practitioner is furloughed or laid off because of low census, she can't just go practice in another area.

But also, we're having a lot of physicians that are getting sick and unfortunately passing away. And if our collaborative physician passes away, that case is also the same. We can't just go and practice somewhere else because we don't have that written collaborative practice agreement.

Are you pushing governors to remove these restrictions? What's kind of the status of that? Given, you know, we're removing restrictions on, on telehealth. Where are we in terms of kind of the ability of nurse practitioners to kind of have that solo practice?

Well, absolutely. As I said, 22 states plus the District of Columbia, as well as a couple territories and the VA, the Veterans Affairs Association, does have full practice authority. Last week, I wrote a letter to the National Governors Association asking, asking them to loosen these regulatory requirements that are really archaic and outdated regulations. We really need to modernize our practice environment right now.

So we wrote the letter to the National Governors Association. Secretary Azar, HHS secretary Azar also wrote a similar record. And actually, President Trump in his executive order, Medicare executive order last October said in section 5 that providers need to be practicing to the top of their education and training.

Since I wrote that letter to the National Governors Association, for example, Governor Andrew Cuomo in New York has loosened those requirements. And immediately, we had 2,400 nurse practitioners step up to, to volunteer to help on those front lines. So we know if this bottleneck is, is released and governors would modernize their health care practice environments, we'd have many more NPs stepping up to help. Because we want to serve. We want to care for our patients.

And we've been talking about surge capacity and the ability to have enough providers. But then there's also discussion about the role of telehealth. So how do we remove kind of an influx of patients coming into the office, coming in to the hospital for non-COVID-19 problems? How have nurse practitioners been involved in providing telehealth services?

Well, many of our offices have converted to telehealth, and my office included. And this goes along with our practice of social distancing right now. The only thing that's going to stop the spread of this virus is for every, everyone to be on board with social distancing.

But telehealth goes hand in hand with that, because people still need health care. And there are many things that can be taken care of through telehealth services that patients don't have to come into the office for. And it's really been an asset and a tool as we continue to provide primary health care services to patients who don't need to be leaving their house for routine things.

There are, as you know, there are so many things, diabetes, hypertension, urinary tract infections, routine coughs and colds, injuries that can be handled over telehealth. And so it's been a blessing that telehealth has been increased. And I think this is going to be a new way for us to continue to provide health care in the future. It's a new model. And this is, this COVID-19 crisis is really putting it to the test. And I think we're going to find that it's going to be very successful. Do you think this epidemic, this pandemic is helping patients understand the role of nurse practitioners?

Absolutely. I think that, you know, we've been practicing for 50 years. And we're practicing in all medical specialties out there. I don't think there's a clinical area out there that you wouldn't find a nurse practitioner practicing.

So I think this is definitely giving more of an awareness about the scope and practice of nurse practitioners, what we do. We follow the same national guidelines and standards as our physician and PA colleagues do when we're treating various diseases and diagnoses. So I think this is definitely giving more of an awareness about nurse practitioners.

Now, we've been hearing hospitals had been potentially cracking down in terms of what nurses and doctors and nurse practitioners are saying to the public. Have you been hearing that from your members? Not necessarily a gag order, but trying to restrict their ability to show what's going on?

I haven't heard that from my nurse practitioner colleagues. But I can tell you that my nurse colleagues, speaking with them through this COVID-19 crisis, there are many that have many stories to share which are compelling and eye opening. But they are afraid to talk because they, they know that they'll be fired from their institution.

Do you feel we're having more collaboration now between physicians, nurse practitioners, even pharmacists? As you know, sometimes we've all been siloed in the past. What are the lessons that we're learning from managing this pandemic?

You know, I think what we've learned is that A, we need all health care providers practicing to the top of their education and training. We're all part of the health care team. The patient is the center of that team. And every one of us plays a part in this.

I think the lesson to be learned from this is right now, we need the patience to be the MVPs of our team and to stay at home, practice social distancing, listen to the experts. Because again, that's the only way we're going to be able to prevent the spread of COVID-19 is for, from everybody doing their part.

And here in New Orleans, even though we've had our social distancing order on for about three weeks, we're still having people that are having second lines in the streets and going out in their boats and things like that. We're very lucky that the polices are breaking these, these --

Yeah.

-- get togethers up. But we need everybody across the country, if they're watching, listen to the social distancing laws.

What gives you optimism, though? Is anything that you're optimistic about? We hear a lot of doom and gloom stories. And we need to hear those stories. But what gives you optimism?

Well, I think, you know, at the end, I think this is actually going to pull our country together. We're all in this boat together. The other thing is, I think as far as health care goes, people are seeing that health care can be provided in other ways, through telehealth and things like that.

And if anything, I think this is going to make everybody aware of what life would be like without vaccines and the importance of vaccines and you know, taking the vaccines for vaccine preventable illness. Hopefully next year, we'll have an uptake on the number of people who get their flu vaccine.

You know, as you know, so far this year, more people have died of flu in, in the United States than of COVID-19. But those numbers look grim and, and it's, if Anthony Fauci has a crystal ball and he's predicting um, up to 200,000 deaths, certainly that's scary. So I hope there's more of an awareness about the importance of getting vaccines every year.

Well, and you're right. We want to become aware but we don't want to become scared.

Right.

Thank you, Dr. Thomas, for the work that you do, for the work of nurse practitioners, and as well as for taking the time today from what I'm sure is a busy schedule to talk.

Oh, absolutely. It was a pleasure speaking with you.

And I want to thank folks for watching Coronavirus in Context. I'm Dr. John Whyte.