Management of Lipid Disorders: Multidisciplinary Teams



Lynne Braun, PhD, CNP: Everything you’re talking about with our role as nurse practitioners reminds me to restate the way we started our conversation today. We, as nurse practitioners, are such an important part of the health care team. We work with our physician colleagues, the pharmacists, exercise specialists, and the so-valuable dietitians. The patient is in the center of how we work, so it’s all very important.

From a legislative standpoint, nurse practitioners have a variable amount of autonomy throughout the country. Some states have granted full practice authority to nurse practitioners. Other states require that we have a collaborative agreement or are supervised by a physician. Nonetheless, it’s all a team. When physicians work together, they consult one another, and there are certain things that we are better at based on how we’re educated. We were educated with the nursing model as opposed to the medical model, and it had more of a biopsychosocial focus.

We’re probably better at lifestyle counseling and counseling our patients in behavior change because we’ve learned that. We’ve learned the scientific basis for that, and our physician colleagues recognize that and refer patients to us for that. Not that we’re not prescribers as well. I believe in all states now, nurse practitioners have prescriptive authority. We do prescribe as necessary, but even when I fully intend to prescribe a medication, I like to talk about lifestyle first because that that is so important. That’s in the guideline.

I was so happy that as a nurse practitioner, I was able to represent nursing in the development of the latest guidelines. I’m grateful to the Preventive Cardiovascular Nurses Association [PCNA] for asking me to represent it on the guideline-writing committee. Because you and I both, as past presidents of PCNA, know wonderful work in terms of clinical care and education that the organization brings. It was a gift to me to be able to represent PCNA along with nursing and nurse practitioners on the guideline.

Joyce L. Ross, CRNP: I’m happy that you brought that up, because I was sitting here thinking to myself—we’ve given a lot of information out, Lynne. We’ve talked about our clinical experience, the availability of new things. We’ve painted a really good picture of the world of nurse practitioners in dyslipidemia. But what about what we need to offer? How do our fellow nurse practitioners, who are listening to us today, get started being more sophisticated and understanding this better? You mentioned PCNA, which we love and have been part of for many years, as a way of getting information, education, and more—the collegial attitude and togetherness with other like-minded people. The same applies for the National Lipid Association [NLA]. Just as you were able to step forth and break that glass, so to speak, in the guidelines with your association with PCNA, I was the first nurse practitioner who ever was president of the National Lipid Association.

Lynne Braun, PhD, CNP: I know, and I loved it.

Joyce L. Ross, CRNP: I’m still blown away, because I think of all the wonderful people I know who graced me with that opportunity.

Lynne Braun, PhD, CNP: You were wonderful.

Joyce L. Ross, CRNP: Talk to me about what you’re going to recommend to a nurse practitioner who wants to be a clinical lipid specialist as we both are.How do you steer them in the right direction?

Lynne Braun, PhD, CNP: First, the NLA, as well as other organizations like PCNA and AANP [American Association of Nurse Practitioners]. But the NLA in particular—because they’re all about lipids—provides a great deal of education. They offer the certification of being a clinical lipid specialist. Nurses have to have a certain level of academic formal education, but also they need a fair amount of education in lipids. There’s a certain amount that they are required to have, either through self-study or through attending the various NLA Clinical Lipid Updates and scientific sessions where they earn continuing education credits. It’s always best to mingle with your colleagues when we can do that again.

To be a specialist, someone who would be the recipient of referrals from other providers—primary care providers, cardiology, endocrinology—that route would be through the more formalized training and certification that the NLA offers.

That’s where I would start. But we can talk about that through our involvement in other professional organizations, such as the American Association of Nurse Practitioners and the Preventive Cardiovascular Nurses Association. For me, I’ve spoken often at the Nurse Practitioners in Women’s Health meeting because I’ve always had a lot of women as patients, so I can add that dimension. That’s what they’re interested in there. The more we get involved with our organizations, the more we network with nurses, the more we offer ourselves to be consultants to help the next generation get to where we are—that is critical.

Joyce L. Ross, CRNP: That’s why we’re blessed.

Lynne Braun, PhD, CNP: Yes.

Joyce L. Ross, CRNP: We know that we get by with a little help from our friends, and we know that we didn’t get where we are by ourselves. We’re at least leaning on the shoulders of many others. For nurse practitioners who might want to consider a little more knowledge, whether they want to be certified or not in the lipid field, going to specifically the PCNA and the NLA offers them not only education but tools to use with their patients, areas of discussion for our chats, and other opportunities to learn. What’s more important is that we feel good about ourselves and that we embrace our traditional role in where we want to go with our treatment for our patients. We’re the specialists in that field. We need to confidently hold that and bring that to our patients.

When our patients know that we’re certified clinical lipid specialists and have increased knowledge, it makes them feel safer. It makes them feel more assured about what they’re getting. What we didn’t touch upon is that we really encourage our patients to understand research. Who would have thought that nurses would do that? Well, of course we do, because we base everything we do on our research. That’s how we hang our shingle up: We don’t do anything that we don’t believe is research based, as you already brought up. We know that it says something to the other providers in our systems too. For an internal medicine doctor or another provider, they may say, “Lipids are beyond my ilk, beyond my specialty, and frankly not what I’m really interested in. Let’s send them to a nurse practitioner, with that experience and that level of education, who will be able to work with that patient and get them where they want to be.”

We have talked so much about a team. We’ve talked about our progress as becoming more professional as we’re going along and how we’ve gotten where we are. We’re both very cognizant of that all the time, that in terms of a team—whether it’s a team of nurse practitioners, pharmacists, social workers—psychologically we have to deal with so much. We haven’t even talked about the psychological ramifications of a man having a heart attack at the age of 45 and with children to raise. We have to think about what we need to know from our psychological community. What’s out there for those patients to be assured? We know that people who have high stress levels, when they’ve had a recent MI [myocardial infarction] or something like that, are higher risk for another if they are depressed or have other things. It’s a team, and it’s always going to be a team.

Lynne Braun, PhD, CNP: Always with the patient in the center.

Joyce L. Ross, CRNP: I’m honored to be part of this team and have a little chance to have some dialogue in the conversation. We’ve probably used up our time today, and I know you and I could talk for hours about lipids. We love it, we love our work, we love what we do, and we love our feeling. I’m so grateful that you’ve joined me today for this conversation, Lynne.

Lynne Braun, PhD, CNP: Thank you, Joyce. I wish we could be face-to-face in the same room.

Joyce L. Ross, CRNP: I know.

Lynne Braun, PhD, CNP: At comfy chairs looking at each other.

Joyce L. Ross, CRNP: And a glass of wine.

Lynne Braun, PhD, CNP: That’s right.

Joyce L. Ross, CRNP: We have solved so many problems in life with these relationships, just by settling down and having a good old conversation.

Lynne Braun, PhD, CNP: Yeah.

Joyce L. Ross, CRNP: Again, Lynne, thank you so much for joining me.

Lynne Braun, PhD, CNP: Thank you, Joyce. Thank you for the invitation. I’m so grateful.

Joyce L. Ross, CRNP: Thank you all for joining us. We sincerely hope this helps you feel more involved and interested in the field of dyslipidemia and that there are many avenues for you to go. We’re always available online to talk to. You can always go to the NLA and PCNA and get further information. Again, thanks very much.

Many thanks to all of you out there who joined us today for this educational program on “Optimal Management of Lipid Disorders and the Expert Nurse Practitioner Perspective.” It’s really important that we share this information with one another, and we hope to talk with you again soon.

Transcript Edited for Clarity

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