ADVANCED PRACTICE NEWSLETTER
September 2020
Ivette Becerra-Ortiz, DNP, NEA-BC, CPNP-PC Associate Chief of Advanced Practice &
Shelley Gierat, CRNA Chair of APP Advisory Board Communications Committee
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Loretta Ford, EdD, PNP, FAAN, founder of first NP program (1965) |
Sister Mary Bernard, first recorded example of a nurse anesthetist ( 1877) |
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First graduating class of Physician Assistants |
Mary Breckinridge, the first to bring nurse-midwifery to the United States (1925) |
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CELEBRATING
NURSE PRACTITIONERS
NURSE ANESTHETISTS
PHYSICIAN ASSISTANTS
NURSE MIDWIVES
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IN THIS ISSUE
Highlighting APP Practice at UCSF Health
Annette Carley DNP RN NNP-BC PPCNP-BC
Clinical Professor
Associate Director DNP Program
UCSF School of Nursing
Annette Carley DNP RN NNP-BC PPCNP-BC is a Clinical Professor in the School of Nursing and current Associate Director of the Doctor of Nursing Practice (DNP) Program. Her clinical background is in neonatal and pediatric care, and she was previously part of the Neonatal Nurse Practitioner group in the UCSF Intensive Care Nursery. Dr. Carley joined the UCSF School of Nursing in 1995 as part of the neonatal/pediatric faculty and assumed the role of Specialty Coordinator for the Advanced Practice Neonatal specialty from 2015-19. In 2012 she embarked on a journey in leading task force efforts to create a DNP degree program at the school. She shepherded the program through campus and system approvals to become the first DNP program offered in the UC system. The program admitted its first students in spring 2018 and was successfully awarded national accreditation in fall 2019. Several UCSF Health APRNs/nurses are among its alumni and current students, and collectively they continue to contribute quality improvement and other scholarly works to benefit nursing and UCSF health practice.
Dr. Carley maintains her connection with UCSF Health as a member of the AHP Board as well as advisor and DNP Project Chair for students undertaking their DNP Projects.
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Dear Colleagues,
I’m pleased to announce that for the 13th consecutive year, UCSF Health has been named an “LGBTQ Healthcare Equality Leader” by the Human Rights Campaign (HRC) Foundation, the educational arm of the nation’s largest lesbian, gay, bisexual, transgender and queer (LGBTQ) civil rights organization.
UCSF Medical Center was the first major hospital in the nation to participate in HRC’s annual Healthcare Equality Index (HEI) and is the only hospital that has done so every year since the HEI’s inception. Well before other health systems and the HEI, UCSF Health extended foundational discrimination protections to LGBTQ individuals, providing nation-leading training in LGBTQ health needs and developing policies and practices to optimize care for LGBTQ people. You can read more about the HEI, UCSF Health’s LGBTQ-centered medical services, and the new UCSF Center for Sexual and Gender Minority Health here.
High-quality care is built on trust between a provider and patient in a safe, welcoming environment, and I am immensely proud of our track record. I also know that we must continuously do better, which is why last year I asked consultant Shane Snowdon, who from 1999 to 2012 was the first full-time director of the UCSF LGBT Resource Center, to initiate a comprehensive review of how UCSF Health could improve LGBTQ health care here and nationwide.
To assess the current landscape, Shane interviewed 80 health care administrators, providers, and LGBTQ individuals within UCSF, at neighboring hospitals, and across the Bay Area. Under her leadership, the UCSF Health LGBTQ Practices Improvement Committee was created and charged with developing and helping implement by year’s end a wide range of changes to improve care for LGBTQ patients and their families, including:
- a UCSF Health webpage with a wealth of LGBTQ-related information
- expansion of the online “Find a Doctor” system that will allow LGBTQ patients to find UCSF Health providers who have identified themselves as LGBTQ
- policies to improve care for transgender patients
- guidance for UCSF managers and other employees around transgender workplace needs
- processes for collecting and responding to LGBTQ patient feedback
- initiatives to strengthen UCSF Health’s relationships with LGBTQ individuals and groups in the Bay Area
Health disparities, including those rooted in factors such as race, ethnicity, socioeconomic status, sexual orientation, and gender identity, are preventable. We have made health equity an integral theme across Vision 2025, UCSF Health’s strategic plan, and I recently shared some of our efforts in to address health disparities caused by racism in this message. Achieving health equity is important not just for patients at UCSF Health; we also are encouraging our network of affiliates to participate in the HEI.
It is our responsibility to deliver equitable care to everyone in need and to ensure every employee, faculty member and learner feels valued and respected. Academic medical centers also play an important role in advancing care equity by equipping future health care providers with the training necessary to offer competent, sensitive care to LGBTQ patients and their families. We have a solid foundation of work in this area, and it is critical that we continue to identify and build on our successes, as well as serve as a role model for health organizations locally and nationally.
As always, thank you for all that you do for UCSF Health and the patients we are privileged to serve.
Mark R. Laret
President and CEO
UCSF Health
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Sent on behalf of Josh Adler, MD and Ivette Becerra-Ortiz, DNP
Dear Colleagues,
The UCSF Health LGBTQ+ Practices Improvement Committee was created by Mark Laret and charged with developing and helping implement by year’s end a wide range of changes designed to optimize care for LGBTQ patients and their families.
One initiative of the committee is to expand the online “Find a Doctor” system to allow LGBTQ patients to find UCSF Health providers who identify themselves as LGBTQ+. This is one of the most common requests of LGBTQ+ individuals seeking care at UCSF Health.
We are looking for providers who self-identify as LGBTQ+ to participate by providing information on identity and pronouns, which will be placed on your UCSF Health Provider profile along with the following logo and statement.
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Advanced Practice Provider Advisory Board
Organizational Chart
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VERY EXCITING NEWS
NP’s and CNM’s in California state
AB 890 (NP practice authority bill) and SB 1247 (CNM practice authority bill), which would allow NPs and CNM’s to work without physician supervision, passed the Senate Business & Professions Committee in July and on 09/01/2020 we were notified that both bills have passed out of their respective houses and are on their way to the Governor’s desk for signature.
STAY TUNED...
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2020 UCSF HEALTH EXCEPTIONAL APP AWARD
CALL FOR NOMINATIONS
Submissions are due no later than
Friday, October 23rd, 2020
UCSF Health will recognize its Advanced Practice Providers (APP) with the Exceptional APP Award at the 2020 Annual Honors and Awards Celebration in November. APPs will be chosen for their demonstration of UCSF Health’s PRIDE values: Professionalism, Respect, Integrity, Diversity and Excellence.
FAQs
Who is eligible?
Any practicing UCSF Health Nurse Practitioner, Physician Assistant, Nurse Anesthetist or Nurse Midwife, who has not been a past recipient AND whose primary site of practice is UCSF Health, may be nominated for this award.
Who can nominate?
Any UCSF Health employee may submit and/or second a nomination. All nominations must be seconded. Multiple nominations for individual APPs is acceptable
Please note, submissions are due no later than Friday, October 23rd, 2020.
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DELINQUENT OPEN ENCOUNTERS
Friendly reminder that notes need to be signed/completed ideally within 24 hours of the encounter and no later than 14-days from the encounter.
For providers who have open encounters that go beyond 14 days, your Medical Staff privileges will be suspended
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This is to remind those applying for NPIII classification, that the due date is Wednesday, September 30th by 5pm.
If you have further questions or would like to speak to someone regarding the application process please click here
The purpose of this role is to encourage nurse practitioners to become nursing leaders by participation in clinical care, research, education and service to the medical center. Click here for access to the application packet and an exemplar application packet and job description for review.
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UCSF HEALTH ADVANCED PRACTICE WEBSITE |
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ADVANCED PRACTICE GRAND ROUNDS
Moved to October 22nd and will be virtual with breakout rooms.
WATCH FOR NEW INVITE or use link to APP Events page below.
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Topic: Climate Change and Impacts on Health
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Co-sponsors: Office of Sustainability and Education Committee of the UCSF Health Advanced Practice Advisory Board
Topic: Climate Change and Impacts on Health Speaker: Barbara Sattler, RN, MPH, DrPH, FAAN Professor at the University of San Francisco and an international leader in environmental health
advancedpractice.ucsf.edu
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One continuing education credit can be earned by attending Nursing Grand Rounds, which are free to attend.The upcoming schedule is as follows:
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Sept. 11, New Language Guidelines for Diabetes: Presented by Maureen McGrath, MS, PNP-BC, BC-ADM. Meets from 2 to 3 p.m. in OPC Auditorium
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Nov. 9, Nursing Grand Rounds: Presented by Alicen Kershaw, NP (topic TBD). Meets from 8 to 9 a.m. in OPC Auditorium
AND
UCSF School of Nursing Research Seminar
On Sept. 18, University of Virginia professor Randy Jones will present a talk on mhealth interventions as part of this research seminar series. It is open to anyone at UCSF. Here’s the event listing:
ALSO
Pediatric Emergency Medicine (PEM)
will be hosting a virtual CME course on
pediatric urgencies and emergencies on October 16-17, 2020
Almost all of the speakers will be PEM faculty from San Francisco-based group and the Oakland-based group and we'll be talking about how to manage common pediatric urgencies in outpatient
We are offering a $50 rebate on the registration fee for any of our DEM APPs (any site). Please email me at: carol.chen@ucsf.edu if you are interested in registering or with any questions.
Please check out the website below for more information.
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The UCSF Health Office of Advanced Practice Academic Stipend
15 Academic stipends are offered each fiscal year to offset the cost of APPs presenting at a conference in their specialty. Podium/poster/panel presentations will be eligible. Other requirements listed in link below.
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UCSF DNP PROGRAM
Applications are open from July 1, 2020 through Nov. 15, 2020 for
Spring 2021 entry
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Join us in Celebrating
NATIONAL MIDWIFERY WEEK
OCTOBER 4, 2020- OCTOBER 10, 2020
"Midwives For Equity"
National Midwifery Week (#NMW2020) was created by the American College of Nurse-Midwives to celebrate and recognize midwives and midwife-led care. It's time to display your pride in the hallmarks of midwifery that you deliver every day; this week is for you and about you.
This year's theme is "Midwives for Equity." Midwives play a key part in enhancing equity among all populations. Midwives believe every person has a right to equitable, ethical, accessible, quality health care. The midwifery model of care empowers individuals and communities, creates compassionate partnerships, and personalizes care based upon each individual’s life experiences and knowledge.
https://www.midwife.org/National-Midwifery-Week
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AMBULATORY PROVIDER SELF-CODING |
Sent on behalf of Josh Adler, MD, Susan Smith, MD and
Ivette Becerra-Ortiz, DNP
Thank you for your commitment and tirelessness in providing outstanding care for our patients.
We are writing to ask for your partnership on a new initiative designed to improve the transparency and feedback of our coding process, and to support UCSF’s financial recovery.
Because CMS has simplified the coding rules for in-person visits effective January 2021, and for video visits effective immediately, UCSF has decided to implement self-coding for Evaluation and Management (E&M) codes. This change will align UCSF with most AMCs and enable us to substantially reduce the cost of external coding. Key program components are outlined below.
1. During Fiscal Year 2021, all FPO physicians and APPs will transition to E&M self-coding.
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Phase 1: E&M 2021 Guidelines (CPT Level/Family – level of service, new vs. established, prolonged visits, consults), Diagnosis coding, Modifiers, HCC
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Phase 2 considerations: In-clinic procedures and/or Inpatient subsequent care days
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Out of Scope: All OR, Inpatient admit day, discharge day, and critical care coding
2. The Steering Committee prioritized practices based on criteria such as simplicity of CPT code sets and current coding accuracy. We will begin transition to self-coding in September 2020 with the initial practice.
3. A standard education, auditing and provider feedback model will support this transition.
- Providers will attend an initial training and then begin self-coding; all charges will be reviewed by a coder until a Compliance audit is cleared with >90% accuracy
- Each provider will receive a report outlining audit findings
- Ongoing education and auditing will support the provider experience
4. We will track financial, quality and provider experience metrics and evolve the program based on feedback from our providers, operations teams and learnings from peer AMCs.
Please take a couple of minutes to complete this questionnaire so we can better understand your current experience with coding and any concerns.
Thank you for engaging with this important effort – we welcome your questions and feedback.
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New flu vaccination requirement for UC student, faculty and staff |
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To support the health and well-being of UC students, faculty and staff and our communities, the University of California, in consultation with UC Health leadership, has issued a systemwide executive order requiring all members of the UC community to receive an influenza immunization before Nov. 1, 2020.
The executive order is an important proactive measure to help protect members of the UC community — and the public at large — and to ameliorate the severe burdens on health care systems anticipated during the coming fall and winter from influenza and COVID-19 illnesses.
In addition to protecting those on campuses and the surrounding communities, this requirement is designed to avoid a surge of flu cases at health care facilities across the state during the unprecedented public health crisis caused by the coronavirus pandemic.
According to the Centers for Disease Control & Prevention (CDC), flu vaccination is a safe and effective way to prevent millions of illnesses and thousands of related medical visits every year. In recent years, flu vaccinations have reduced the risk of flu-associated hospitalizations among older adults on average by about 40 percent. Flu vaccinations also protect those around us, including those who are more vulnerable to serious flu illness.
The executive order requires the vaccination for all faculty and staff who are working at a UC location. The university already has a clear policy on immunizations for students, and this action adds influenza to existing vaccination requirements for them, and extends the requirement to faculty and staff beyond those which presently exist for all UC health care workers.
A process will be put in place for faculty and staff to request medical exemptions. Requests for disability or religious accommodations will be handled through the interactive process consistent with existing location policies and procedures.
All UC medical plans which cover faculty, staff and students include coverage for flu vaccinations at no cost to those covered by the plan. In addition, for those without group health care coverage, all ACA-compliant health plans also cover flu vaccinations as part of a preventive care package that includes no copay.
More information about the implementation of UC’s requirement, and when the flu vaccination for 2020-21 is available, will be shared in the coming weeks.
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You have taken care of our patients, now let us take care of you
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Caring for the Caregiver program |
UCSF Health has developed the Caring for the Caregiver program to ensure that providers and staff are emotionally supported through the experience of patient care. Approximately 50% of clinicians are involved in an adverse event each year, which leads to decreased morale and lack of productivity—the “second victim” phenomenon. Through the Caring for the Caregiver program, UCSF Health hopes to better coordinate support for providers and staff when they are involved in stressful patient care experiences. In addition to already existing resources such as FSAP and Spiritual Care Services, Caring for the Caregiver has established a peer support team to provide one-on-one, emotional first aid for all care team members at UCSF Health. If you are experiencing a normal reaction to a stressful event or outcome (also called “second victim”), we can help.
Our goal is to help care team members understand what normal reactions to stressful events look and feel like, and the resources available to them. The program is available to all health care team members at UCSF Health hospitals and clinic sites.
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NEW CRNA PROVIDERS
Please welcome these new APP professionals
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I am originally from South Korea and received my BSN from the Armed Forces Nursing Academy of Korea. I served in the Korean military as a nursing officer. After moving to the United States, I worked as an ICU and OR nurse at NYU Langone Medical Center for almost 8 years. I attained a nurse anesthesia degree at Georgetown University and worked at Memorial Sloan Kettering Cancer Center in New York as a CRNA. I am very excited to live in the west coast and start a career at UCSF. |
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Darlene Fields-Ba MSN, CRNA |
I graduated from USF in 1993 and Samuel Merritt in 2002. I served in the US Army Reserves and deployed to Germany in 2004. Prior to UCSF, I spent 18 years at Kaiser as a CRNA and provided anesthesia in a private practice setting. I enjoy spending time with family, skiing, traveling, hiking and bike riding. I am also a pet lover. |
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SOME ARTICLES ARE RELEVANT TO ADVANCED PRACTICE. YOU CAN SUBSCRIBE IF YOU WISH. |
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For more information, contact
Ivette Becerra-Ortiz, DNP, NEA-BC, CPNP-PC
Associate Chief of Advanced Practice
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ALL APP STUDENTS AT UCSF HEALTH FACILITIES |
All preceptors are required to ensure all students from ALL educational institutions have been vetted by UCSF prior to any educational activities, including employees. UCSF has many parts of the organization involved in this process. Their school needs an affiliation agreement with UCSF, they need health screening to be completed, they require online training for Health and Safety and APEX, and sign a HIPPA form. |
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WANT TO SHARE YOUR EXPERTISE WITH APP COLLEAGUES ACROSS THE STATE, THE NATION, OR THE WORLD? |
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I am here to support and advocate for APP's
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Senior Operations Analyst |
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