Posted on Dec 17, 2015 7:02:00 AM by Leslie Wooldridge, GNP-BC, CUNP, BCIA-PMD

Nurse Practitioner Competencies in 3rd Line Therapy for OAB

 Nurse raises both arms in excitement for approvalI have frequently written about the role of the nurse practitioner in chronic care within a urology practice. When it comes to treating OAB patients, what better focus than for the NP in the practice to assess, treat, evaluate and re-evaluate these patients for adequate and proper treatment.

In a CNE article titled “Competencies for the Nurse Practitioner Working with Adult Urology Patients,” which appeared in the September-October 2015 issue of Urologic Nursing, the authors were spot on with their assessment of the future of urology. They discuss the “increasing demand for urology services in the U.S. and the decline in available urologists, combined with restrictions on resident work hours and changes to primary care training requirements at a time of decreasing reimbursement for graduate medical education, have created an opportunity for NP’s.” This discussion focused on competencies for the Urologic Nurse Practitioner at 3 levels of experience from Level 1 the “expert” urologic NP to Level 3 the “newly graduated and/or new to urology NP.”

All of us have been at Level 3 at some point in our career when we started to determine that urology was the place for us. As we have practiced over the years and as technology and research have guided those careers, we have been able to expand our expertise in clinics across the world to be able to offer better and in-depth care to our patients. Even as nurse practitioners, some of us have chosen to sub-specialize in a growing field of need for our practices and our patients within the urology world.

Overactive bladder treatments have blossomed over the past 20 years since I first came into urology from offering a couple of drugs to an assortment of medications in multiple preparations to the success of pelvic floor therapy and on to even more success for our refractory OAB patients with 3rd line therapies. The major organizations who guide treatment of these patients, ICS, AUA, AUGS, SUFU and SUNA have also developed and endorsed simple-to-use guidelines for all practitioners in offering the best, most advanced and appropriate treatment for our patients. As nurse practitioners developing our practices from that novice, new practitioner to the expert, we can carve a niche for ourselves in areas that can compliment our fellow urologists who so generously give of their time and expertise in making us good at what we do.

I will never forget my first urologist collaborating physician, or my current, for the knowledge they have bestowed upon me to help me become the practitioner I am today. In 3rd line OAB treatment, I have been given the freedom, education and training to help the patient choose among Urgent PC, Botox, and Interstim therapy. I have grown a very large practice of these refractory patients and have made Urgent PC the major contributor for these patients as they have moved forward. Yet, I also do insertions of PNE’s for Interstim and assist with Botox injections. I would consider myself a “cheerleader” for my patients with OAB as they know we never give up evaluating their success and offering the best treatment options available to them in each individual situation. 

I urge all nurse practitioners, physician assistants and yes urologists, uro-gynecologists and gynecologist to read the article, as it is a superb guideline for developing the practice of the advanced practice practitioner within your own practices. Let’s think outside the box. As these authors state, “These urology-specific competencies take that groundwork (basic NP education) and focus the primary care skills toward GU care and management. Many GU conditions benefit from episodic but long-term medical management, which is a role well-suited to the urology NP.” Are you offering treatments best suited for your OAB patients? Think first of Urgent PC as the least invasive, nearly side effect free therapy for that hard to treat OAB patient.

Quallich, S., Bumpus, S, Lajiness, S. (2015) Competencies for the nurse practitioner working with adult urology patients. Urologic Nursing. 35(5), 221-230.

Botox and InterStim are registered trademarks.

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This blog post reflects the opinions and experience of Leslie Wooldridge, a long-standing user of the Urgent PC Neuromodulation System, and was produced under a paid consulting agreement with Cogentix Medical.

Urgent PC is indicated for the treatment of Overactive Bladder and associated symptoms of urinary urgency, urinary frequency and urge incontinence. Treatment with Urgent PC is contraindicated for patients with pacemakers or implantable defibrillators, patients prone to excessive bleeding, patients with nerve damage that could impact either percutaneous tibial nerve or pelvic floor function or patients who are pregnant or planning to become pregnant during the duration of the treatment. Most patients don't experience side-effects. If side-effects occur, they are typically temporary and include mild pain and skin inflammation at or near the stimulation site. Caution: Federal law (USA) restricts this device to sale by or on the order of a physician. For complete instructions for use, storage, warnings, indications, contraindications, precautions, adverse reactions and disclaimer of warranties, please refer to the insert accompanying each product or online at Models are for illustrative purposes only. Urgent is a registered trademark of Cogentix Medical © 2016 Cogentix Medical. All rights reserved. 

Leslie Wooldridge, GNP-BC, CUNP, BCIA-PMD
Leslie Saltzstein Wooldridge, GNP-BC, CUNP, BCIA-PMD, is Director of the Adult Bladder Control Center, Mercy Health Partners, Muskegon, Michigan USA. Ms. Wooldridge received a Master of Science degree in nursing administration, critical care nursing and postgraduate certification as a Geriatric Nurse Practitioner from Marquette University, Milwaukee, Wisconsin. In 2015, she was honored with the Women’s Health Foundation Activist Award. She is also the recipient of the 2009 National Association for Continence Rodney J. Appell Continence Champion Award. Ms. Wooldridge has published in multiple refereed journals. She authored the Genitourinary chapter in The Nurse Practitioner in Long Term Care: Guidelines for Clinical Practice (2007). She has lectured throughout the United States on geriatrics, urology and clinical practice.
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