Urology APPs: Making an impact during the COVID-19 pandemic

Dr. Caruso is a nurse practitioner at the University of Pennsylvania Health System, Philadelphia. Urology Times blogs present opinions, advice, and news from urologists and other urology professionals. Opinions expressed by bloggers are their own, and do not necessarily reflect the views of Urology Times or its parent company, MJH Life Sciences.

Our country is in a state of national emergency due to the novel coronavirus, which causes the disease known as COVID-19. Advanced practice providers (APPs) across the nation are on the front lines caring for patients. This includes nurse practitioners and physician assistants who have advanced training and education in many areas of need to combat the COVID-19 pandemic. Urology APPs are doing their part!

The World Health Organization declared a global pandemic related to a novel coronavirus. COVID-19 is a respiratory illness with symptoms of fever, cough, and shortness of breath, different than coronaviruses that are already known. The first cases were reported in Wuhan, China in December 2019.

Coronaviruses in general can cause illness in both humans and animals, and it has been suggested that COVID-19 may have been transmitted to humans from bats, similar to SARS-CoV and MERS-CoV. The severity of the illness varies from very mild cases with minimal symptomatology to severe cases resulting in death. Older patients and those with comorbidities or are immunocompromised are at higher risk for developing severe illness (www.cdc.gov).

Highly qualified providers

NPs and PAs are highly qualified providers with advanced training and education and are an essential part of the health care work force. This is especially important to acknowledge as the majority of the nation is facing a physician shortage, and APPs are filling this gap with over 290,000 NPs and 140,000 PAs practicing nationwide (www.aanp.org, www.aapa.org). During this unprecedented time, it is crucial to safeguard access to care while ensuring we all stay safe.

APPs are keeping current with regular review of the full Centers for Disease Control and Prevention COVID-19 Guidance Updates (www.cdc.gov) and as well as the COVID-19 Policy and Practice Updates disseminated by our government agencies, professional association boards, health systems, and private practices. This is quite the task with the plethora of communications on social distancing, personal protective equipment (PPE), ventilator availability, COVID-19 testing, therapeutics including hydroxychloroquine and plasma therapies, and potential vaccine developments.

While keeping abreast of daily updates, these sources adapt and modify treatments as new information becomes available. APPs, along with our physician colleagues, are on the front lines with managing and monitoring the spread of disease, delivering care, and executing treatment recommendations.

Urology APPs doing their part

APPs are an integral part of the urology team and are filling administrative roles in handling the day-to-day divisional and departmental flow in an uninterrupted fashion. Urologist/APP teams are managing care seamlessly. They are providing care on site for those necessary or urgent appointments and procuring telemedicine encounters for necessary but non-urgent visits. Patient access to urologic care is being maintained during this COVID-19 pandemic thoughtfully, guided by evidence and expertise. Acute problems, as well as the bulk of crucial oncologic surveillance and treatment regimens, are being skillfully handled via telemedicine, in both the traditional telephone and virtual platforms.

APPs in urology are part of the “boots on the ground” with this triage process. They are calming fears and alleviating anxiety among urology patients who face postponement of surgical procedures. Amidst this pandemic and anticipating a “peak” sometime soon, many APPs either have been deployed or are preparing for deployment to another area of the hospital, location, or practice area to combat this pandemic. Urology APPs are serving on the front lines.

Advocacy to remove practice barriers

Barriers that limit APP abilities limit APPs’ ability to provide care. APPs are actively advocating for removal of practice barriers at both federal and state levels so they may better serve patients during the COVID-19 emergency. Due to the guidance of President Trump, every state is taking measures to relax regulations imposed on various health care professionals. The American Association of Nurse Practitioners, the largest association representing nurse practitioners of all specialties, is advocating and supporting various legislation to this end. The American Association of Physician Assistants is doing the same.

A recent success on the federal level was the signing of the Coronavirus Aid, Relief and Economic Security (CARES Act) into law by President Trump on March 27. This law strengthens seniors’ access to home health care services and provides needed funding for health care professionals. Most importantly, the law authorizes NPs and PAs to certify and recertify home health care services for Medicare patients, an authorization not previously permitted, strengthens funding for PPE, and secures other vital resources (www.aanp.org; www.aapa.org).

In Pennsylvania, regulations were relaxed, and health care professionals licensed under the Department of State’s Bureau of Professional and Occupational Affairs can provide telemedicine services during the COVID-19 emergency. Patients have access to telehealth and can receive care at home to eliminate the spread to the disease.

APPs are now able to practice telehealth across state lines. Additionally, governors of five states (New York, New Jersey, Kentucky, Louisiana, and Wisconsin) signed executive orders to enact full practice authority for NPs, which includes the removal of the restrictive barrier of a collaborative agreement, and also relaxed regulations for PAs, bolstering their respective health care work forces during this crisis.

Making an impact

Urology APPs are making an impact during this COVID-19 pandemic. Those deployed are using their individualized skillsets to care for patients. APPs with acute care training are taking care of the critically ill inpatients, and those with outpatient experience are posted in triage tents. They are serving regardless of risk to their own health, as are other health care professionals. They are maintaining patient access and managing health care needs. They are protecting patients and guiding them during this crisis.

They are advocating for the removal of regulatory barriers that prevent patient access to care. They are on the front lines and are fulfilling their professional commitment within their department and with deployments to alternate areas of need. I say, thank you to all of those APPs, urologists, and urology teams!

Do you have COVID-19 news to share? Please share your invaluable experiences by sending an email to urology_times@mmhgroup.com.