For Janice Miller, CRNP, MS, CDE, a big advantage of her job as a nurse practitioner is the 40-minute block she spends with diabetes patients to educate them about managing their condition. As the only nurse practitioner along with 12 physicians in a Philadelphia internal medicine practice, Janice meets with the diabetes patients to discuss diet and nutrition, review exams of their eyes and feet, evaluate and order lab tests, start insulin regimens, prescribe medications and chart progress.
“I can do a lot of teaching with a patient,” says Janice, a diabetes educator who instructs third-year medical school students for Thomas Jefferson University, with which her Jefferson Internal Medicine Associates is affiliated. “I like having some autonomy and feeling the things I do impact people and can change the course of their health.”
Janice sees many more patients with other chronic conditions, such as congestive heart failure, arthritis, kidney disease and sickle cell anemia, who need comprehensive treatment plans and care coordination to avoid costly hospitalization. Her practice focuses on preventive care and uses electronic health records to determine how to improve the quality of care.
“I like getting to know the patients in an ongoing care setting,” says Janice, who worked as a critical care nurse and a pulmonary researcher before becoming a nurse practitioner. “They really open up and you get to know things about their lives that aren’t readily apparent when you meet them. A sense of mutual trust develops.”
Janice recently has become engaged in political advocacy, talking with her congressional representative about removing barriers to APRN practice and writing to Pennsylvania state legislators in support of bills. “I’m trying to raise consciousness about the role of nurse practitioners in health reform and in increasing access to care, quality of care and cost savings. As a group, we need to be more vocal.”