Are there NP run programs that help patient with chronic conditions get off their medications?

Oldmahubbard · Jun 7, 2019

Your target market is that 2% of people somewhere that are motivated enough to lose 50 pounds, possibly more, and keep it off. There are already thousands of such nutrition and fitness gurus trying to make a living this way.

As an NP, you would differ from most of them in that you can actually order labs, and monitor metabolic parameters.

Aside form bariatric surgery, the medical community has had relatively little to offer the obese. So far, telling people to move more and eat less has had almost no impact. Pharmacologic treatments have also been disappointing.

It could be there is a market out there for this type of service offered as an NP. It would generally not be covered by insurance, so this would be an out of pocket thing. Essentially limiting it to the well off.

But most obesity in the US is among the lower middle class and the poor.

Just my thoughts

**blushpink, BSN, RN** · Jun 11, 2019

Hello! I also wish to be able to provide what the original post, @NurseLissie wants to do, and make a living. However, I agree with @Oldmahubbard. Unfortunately, our healthcare system appears to be more reactive than proactive/preventative. I’m currently working in a specialty where most patients do not want to get better on their own and want their healthcare providers to “fix” them.

InfxPrev · Jul 4, 2019

Consider this: hospice RNs. I am serious, here. I did this about midway through my career--was looking for "something" but wasn't seeing it in the usual acute hospital rush. First thing that a hospice RN does when onboarding a new patient is a detailed physical exam and a review of all medications--to see if there are conflicting meds, duplicated medications or meds that could be delivered in a better way (inhaler vs nebulizer is an example). Then there is education about the patient's condition based on the exam, home nutrition, management of symptoms. I found back then that unless the patient had an invasive cancer AND the referring physician waited till the last minute to tell them "sorry, can't help you anymore, here is hospice's card--call them" I could make such an enormous difference in the patient's life that easily 20-25% of them "graduated" from hospice and we were no longer needed because they became healthier--sometimes for months, sometimes for years before their chronic conditions started impairing their lives again. This wasn't just me, across the board hospice care nationwide has the same percentages. How was this accomplished when a physician had deemed them with less than 6 months to live? Because hospice RNs take the time to do the the things that needed to be done--med reconciliation, diets specific to conditions, pain management (not just opiates or NSAIDs but taking in the whole picture and the interactions of body/mind and spirit) exercise (yes exercise for those patients who would benefit and/or wanted to do that) education of the caregivers and families--all of these things are aimed not only to ease suffering like most people think, but to give BACK to the patient their lives and allow them to live fully for the time that they have.

You are in a rut now--stuck on the hamster wheel of acute care hospitals that give you so many patients, so little time to take with your patients. You can do for your patients NOW what hospice RNs do at end of life. You have to somehow find that time--it will be hard at first but remember that there are others on your team who would likely faint dead away in delight if you asked for their help if you found concerns (dietitians and pharmacists are cute that way). The attending physician is a great resource though often they are rushed too. Physical therapy, respiratory therapy, occ therapy, case managers, all have specific areas they are experts on (again, big picture of the patient and how all systems interact). You are starting up in your career as a nurse, utilize the rest of your team--learn from them so the next time you see similar in another patient, you will recognize something that they or you might be able to help. Go to your interdisciplinary meetings or team rounds! The whole idea of a hospital is to bring back health, not for patients to keep going in/out of our doors as seems to be the case nowadays. If you are in a hospital that you do not learn at least one new thing regularly about conditions, medications or therapies from physicians and other team members and you aren't making any headway getting involved with them---find a new hospital. They are out there, sometimes though you bounce a couple times till you find one. Acute care should be the drive to address conditions before they become chronic--otherwise what are we doing for our patients?

NurseLissie · Jul 15, 2019

@InfxPrev Wow! Thank you so much for this advice! You make some very valid points.