Supply and Demand

College of Health Professions Assistant Professor Andréa Sonenberg discusses how the anticipated increases in the number of insured will affect the already short supply of primary care providers.

“We’re going to see about 32 million newly insured people on our rosters, most of which will be on the Medicaid rosters,” says Andréa Sonenberg, DNSc, WHNP, CNM, an Assistant Professor in the College of Health Professions. “The potential problem being projected is that we won’t have enough primary care providers to service this newly insured population.”

With the Supreme Court’s decision on the Patient Protection and Affordable Care Act (PPACA) taking place this past June, and with the outcome of this year’s Presidential Election, it is expected that the PPACA will progress to full implementation over the course of the next two years. In an effort to seek out ways to improve access to care for the newly insured, Sonenberg and Dyson Assistant Professor of Public Administration Hilary Knepper, PhD, teamed up with Joyce Pulcini, PhD, PNP-BC, FAAN, FAANP, of George Washington University to examine the role of regulatory policies on the practice of nurse practitioners and the health outcomes of would-be patients throughout the United States.

“Our premise is that regulatory policy impacts the ability of nurse practitioners to practice to the full extent of their education and scope of training,” asserts Sonenberg, who goes on to say that the Institute of Medicine recommends the expansion of the scopes of practice for nurse practitioners, who studies have shown to have clinical outcomes that are at least as good as physicians, and who’s patient satisfaction rates are oftentimes significantly higher than physicians.

“Nurse practitioners are a high-quality, cost-effective solution to the primary care shortage,” Sonenberg says, “Not to mention that they’re highly sought after by patients.”

Currently, many of the regulations governing scope of practice within the country, which vary from state to state, are very restrictive. The restrictions typically come in three areas: legislative, which regulatory body decides what the scope of practice for nurse practitioners can be; reimbursement policy, the percentage of the service fee Medicaid or a private insurer is willing to pay a nurse practitioner for providing the same service as a physician; and finally prescriptive authority, which gives nurse practitioners the right to prescribe medications independently of physician supervision.

“We look at how many nurse practitioners practice in a particular state, what percent of the services under Medicaid are delivered by nurse practitioners in that state, the population health outcomes in the state, and whether or not there is any correlation of those variables to the regulatory policies within the state,” she says.

States with more stringent restrictions on scope of practice for nurse practitioners may be less likely to attract nurse practitioners, which potentially impacts the patient population’s access to care within the state. If nurse practitioners are only earning 85 cents to the dollar as compared to a physician delivering the same service, or if a nurse practitioner is able to diagnose a patient’s health issue but must send the patient to a physician to receive a prescription for medication, access to care becomes even more strained.

“I think it’s so important to do this work collaboratively and intercollegially,” says Sonenberg. “I think it expands our perspectives and viewpoints as scholars. For example, working with our colleague in Public Administration has offered a different perspective than solely the health care outcome perspective. And working with a researcher from George Washington University gives us a new geographical outlook, which is especially important when looking at policies that vary depending upon location.”

 

The Professor Is In: Q&A with Elizabeth Berro

College of Health Professions Professor Elizabeth Berro discusses The Walking Dead, what she values most in her students, and more in the latest Professor Is In.

College of Health Professions Elizabeth Berro, RN, PNP, gives insight into how her enthusiasm for education over the years has influenced her. Her love for nursing is evident and transcends to the classroom where she teaches classes from pharmacology to “Pathophysiology in Entertainment Media.” Professor Berro began her nursing career as staff nurse in a pediatric intensive care unit at The New York Hospital and has been a full-time faculty member since 2006. You can find her on the Westchester Campus in the classroom, or advising her students and helping them pursue their personal and professional goals in nursing.

What was your favorite class as a student? Least favorite?
Not surprisingly, my favorite class was biology. I love science—well, not all sciences. I really enjoy life sciences. My least favorite class I’d have to say was chemistry so I can really empathize with students who dislike chemistry, not because of the didactic portion of the class but because of the lab. I actually had to retake chemistry in school because of the lab portion of the class. I took a chemistry class where a graduate student taught the lab portion and he gave me a C I think because he thought that would be considered a passing grade so I wouldn’t have to retake the lab. In my nursing program though, you needed a C+ as a passing grade so little did he know, I’d be back to take the course over again.

What one thing or person made you passionate about your current career?
It wasn’t really a person but more of an experience—a clinical experience—that made me passionate about my career. I was part of a nursing school that had a “diploma program.” It was a three year program and I was able to work directly with patients almost immediately. I really benefited from my clinical experiences working with patients in a hospital environment.

What quality do you most value in your students?
It’s an intellectual curiosity. That if they hear something they don’t know, or are learning something that they’d be curious about it and want to learn “why.” That is what made my clinical practice interesting. I asked myself “why” I was doing something, and why it worked like that. Whether it was the human body and why someone felt a specific symptom or whether it was a piece of equipment I worked with I always asked “why?” I worked for a long time in intensive care so there was a lot of equipment and I was always curious about how it worked and why it worked that way. And that is what makes my job interesting. Sometimes I feel like a three year old asking “why?”, “why?”, “why?”, but that’s what has made my experiences interesting.

What’s your advice to students to make the most out of their time in college?
I think there is a balance between making sure you’re having a good time, meeting people and also [deciding] if nursing is what you want and making sure that you succeed in reaching your academic goal. Keep your eye on the ball, decide what you want, and make sure you get that accomplished and establish and create a support [network] to do that. Often that entails surrounding yourself with a lot of other nursing students— and that is helpful— but I also think you should make sure you are exposed to people who are not in the nursing program. That’s a nice thing to do because people in the nursing program tend to be insular because they tend to study all day long and for [many] hours. It’s hard to get out of that circle or group of people and so I think trying to extend friendships and support outside that group is something I would recommend. I also think taking advantage of both our campuses is important. We also have a wonderful New York City Campus. Take advantage of both campuses and enjoy both environments.

If you had to do it all over again and took another path, what profession would you like to attempt? What profession would you not like to do?
I’m not exactly sure what the profession would be but I think I would like to have done something that involved more travel—maybe a nursing career that involves more travel. Those opportunities are there for people who want to travel. I’d like something that involves seeing a bit more of the world. I think anything solo is very difficult. Being a novelist I think would be a very difficult. It requires so much discipline and solitary work. Writing is a tough profession to begin with, a tough task that requires so much revision and to be so detail oriented. Authors who work on their novels for three, four, five, ten years… it seems like such a long, arduous process, and such a lonely process, and I don’t think I would want to do something that is so lonely.

What is your favorite book/TV show?
My favorite book is A Prayer for Owen Meany by John Irving.

I have two favorite TV shows. One is not running anymore but it’s House. One of my favorite classes I teach is called “Pathophysiology in Entertainment Media,” where we look at different diseases and how they’re presented in the media, TV, movies and plays and they can be presented in any way. Sometimes we look at House. I am a bit of a House Junkie. I just consulted on a play to make sure that it is relatively consistent with being accurate. That whole issue of trying to portray diseases and disorders in an accurate way is very intriguing to me. There are times when they are [portraying diseases incorrectly] because they need to move the plot along so the disease will move along more quickly or more slowly or they’re emphasizing a symptom for the plot. I can understand and appreciate it. Sometimes when they’re just wrong that annoys me. When they could have just as easily used a different disorder to get to the same end does get aggravating.

My current favorite show is The Walking Dead. It gave me nightmares last season and I swore I wouldn’t watch it again and I’m back to watching it. The nightmares have not started up again.

What would you do if you had an extra hour every day?
I have to admit right now I would end up working. It’s been a really busy semester catching up after the hurricane. Our students are a little behind and our classes are a little behind. We’ve been doing some simulations which use high-tech mannequins to create an environment for our students like a real clinical setting and we’ve used a lot more of that this semester compared to other semesters in the past so we have taken on a big project. That combined with the backlog of work because of the hurricane has made this semester a little trying. So I would take the extra hour and play catch-up and make sure I was available for the students.

What is your favorite journey/experience?
This past summer I went with my husband and my two kids to London and that was a fun event. My kids are 19 and 16 so they are great ages and everybody could fully appreciate the trip. We all were busy the whole time and everyone went places they really wanted to go. It was a perfect trip.

What is your favorite saying/words to live by?
One thing I say that sometimes gets me into trouble (but probably gets me out of trouble more than into trouble) is “action is better than inaction.” So when I’m doing something or when I’m worried, I try to do something about it. Sometimes it gets me into a little bit of trouble because I sometimes do things without thoroughly thinking them through, but a majority of the time I end up in a better place, rather than sitting, and worrying and thinking about it. I’m a person who wants to get up and do something. “Action is better than inaction” in almost anything.

If you could have any five people, living or dead, imagined or real, as guests at a dinner party, who would you choose?
I think I would have all of my closest friends from different points of my life all together at dinner. I would have my closest grade school friend, my closest high school friend, my closest college friend, my closest friend from when my children were infants, and my closest friend now. That is who I would have all together.

Written by Pace student Sarah Aires ’14

Silver Surfers

Jean F. Coppola and her nationally recognized collaborative and multidisciplinary research team study older adults, computing, and what happens when the Internet Age and the Golden Age collide.

Jean F. Coppola, PhD

“Someone at that age is sometimes scared that they’re going to break the computer,” says Jean F. Coppola, PhD, of the senior citizens she works with. “But they don’t want to be left behind. They want to learn.”

Coppola, an associate professor of Information Technology at Pace’s Seidenberg School, is also one of the lead researchers in a nationally recognized collaborative and multidisciplinary team studying older adults and computing.  The Gerontech Team, which is led by Coppola and Lienhard Professors Lin Drury, PhD, and Sharon Wexler, PhD, comprises several Westchester County administrators and professors from both Pace and other institutions, is currently working with several community partners and Pace students to improve the quality of life—emotionally, cognitively, and socially—for older adults learning about technology.

A few years back, Coppola was called on by the Westchester County Department of Senior Programs and Services to participate in Take Your Grandparent to Work Day. Due to the logistical limitations of the request, Coppola and her students brought their work to the senior citizens. “We had support from IBM—we had laptops with a network—and we taught the seniors to make photo greeting cards using their photos of family and friends,” she says. “After that experience I knew we had found something special.”

Afterwards, Coppola co-developed a service-learning course called “Intergenerational Computing,” which was first offered to Pace students in spring 2006. This small class was the first formal incarnation of what Coppola and her students are researching today. The students, who also learn about social gerontology and technology in action, go through sensitivity training so that they are better able to understand the needs of senior citizens.  The training, which is conducted by Drury and Wexler, involves students using everything from wheelchairs, walkers, and leg weights to experience limited mobility, to glasses and earplugs that simulate vision and hearing impairments, to popcorn in shoes to create a feeling like arthritis. This creative and necessary part of training helps ensure students have a new awareness of their senior citizen pupils and instills in them a patience that is necessary when working with senior citizens.

The course has expanded and evolved since its introduction in 2006. Coppola’s gained new community partners including nursing homes, adult day care centers, and centers that cater to people living with cerebral palsy. In addition, the research team has partnered with Telekin.com for the donation of touch-screen computers and CogniFit.com, which has donated 1,000 licenses for their brain fitness software.

As words like Google, Twitter, and wiki enter our everyday lexicon, seniors are increasingly eager to learn about computing and technology. Through Coppola’s research program, Pace is helping provide seniors with the tools they need to use a computer, navigate the internet, and participate in social media.

“Just the other day I had one of the [senior] ladies come up to me and say ‘I think you really can teach an old dog new tricks,’” says Coppola.

For more information about Jean Coppola, PhD, and the work of Pace University Gerontechnology Program, click here.

Editor’s Note: Since publication, The Los Angeles Times featured Pace’s gerontechnology program headed by computer science professor Jean Coppola, PhD, and nursing professors Sharon Wexler, PhD, and Lin Drury, PhD, on March 20, 2012. The same day, Coppola was honored by Cerebral Palsy of Westchester which declared the day “Jean Coppola Day” for the work she does teaching technology to older adults.