House Calls, Addiction Services, Chronic Care Management

Nurse Practitioners Independent Practices Bring Comprehensive, Innovative Healthcare to Communities Across New York State

From the Bronx to Buffalo, nurse practitioners (NPs) around New York State are leading the way in providing comprehensive, personalized care to adults and children in their local communities.   
“As healthcare professionals and as business owners, NPs are creating new models of care to meet changing health care needs,” says Stephen Ferrara, Associate Dean of Clinical Affairs at Columbia University School of Nursing, and Executive Director of The Nurse Practitioner Association New York State.


Manhattan House Calls
In the middle of Manhattan, nurse practitioner Denis Tarrant is literally putting boots on the ground walking from house to house providing primary care to patients in their apartments.  His practice makes about 2,500 home visits per year.


“We meet our patients where they are,” he says, “in their homes where they are most comfortable.  Our goal is to keep people out of the hospital by helping them understand their situation and their environment.”


Most of Tarrant’s patients have complex chronic conditions, including osteoarthritis, diabetes, COPD, and heart disease.  “They are less likely to reach out for care when they need it because they are so debilitated,” Tarrant says. “I sit with them in their kitchens, bedrooms or living rooms and have a conversation while providing care.”    


Tarrant’s staff includes one other nurse practitioner, who also performs house calls, a registered nurse, two managers, and a social worker.  All work from virtual offices.  


“Our patients don’t need or want an actual office, and neither does our staff. With aging in place increasingly becoming a model for older adults and with improvements in the ability to manage chronic conditions, house calls provide convenient, quality and cost-effective care for patients.”
Tarrant, who has a doctorate in nursing practice (DNP), started his house calls practice in 2002, and is an advocate of entrepreneurship.  He says, “One of the greatest things nurse practitioners can do is have a successful independent practice.” 


Child-Adolescent Development in Newburgh
Nurse practitioner Laura Van de Laar, has a busy stand-alone practice treating numerous childhood issues, including autism, anxiety and behavioral disturbances, as well as bipolar disorder and schizophrenia.  Her patients come to her from the local area and from as far away as New Jersey, Pennsylvania and Connecticut.  As the mother of an adult child with Asperger’s, Van de Laar has familiarity and particular insight into providing compassionate care for children and families.  She also makes referrals to other healthcare providers, such as neurologists, endocrinologists and universities that specialize in autism research. 


“My role is to make sure that each child’s deficits and assets have been identified and addressed through treatment,” she says.  “I conduct evaluations, advocate on behalf of children and families, and help them navigate the school system and social services.”  


“It’s not just about medications, I also embrace research-supported holistic resources and supplementation where beneficial,” she adds.
 
Van de Laar encourages autonomy in children and teenagers as well as activities such as hobbies and meditation and continues to treat students after they have gone off to college.  
Nationally certified as a Psychiatric-Mental Health Practitioner, she is a provider in The World Trade Center (WTC) Health Program, which offers care to those directly affected by the September 11 terrorist attacks in New York City and serves all first responders and NYC survivors who apply to the program.  In addition, Van de Laar provides support for foster care placement agencies. 
She talks about how the field has changed over the years.   


“There is increasing acceptance of nurse practitioners by the medical system.  We have gained wider respect and acceptance.  It is professionally and personally very rewarding.”


Palliative Care and Geriatrics in the Bronx
“Nurse practitioners are making a difference in all areas of health care,” says Margaret Nolan, owner of Geriatric Assessment and Support.  Nolan, who has a doctorate in Nursing Practice (DNP), has practiced medicine in critical care settings, nursing homes and outpatient settings.  She now operates an independent practice coordinating care for older patients and those facing the end-of-life.

“As the population ages and people live longer, the need for

health care professionals who can organize and review goals

of care becomes increasingly important,” Nolan says.  “There

is a lot of focus on how sick one may be, but little on the length

of the illness, she adds, “That is my specialty.”


Her service does not provide primary care, rather she provides

consultative services.  She utilizes the phone, the internet, and

may make patient visits if possible.  Her company’s goal is to

and helps patients and families navigate what can often be a

daunting health care and social service system to keep the focus

on the individual’s goals of care.    


She says, “Patients come to me via word of mouth, referrals from providers, and other professionals.  Much of my work has been devoted to care of the geriatric patient and it’s gratifying to be able to help these patients and their families during what can be a challenging period.” 


Family Practice on Staten Island
Nurse Practitioner Efrat LaMandre always knew that she wanted to open up her own practice “It’s been very rewarding being able to drive patient care in the way that I think it should be driven,”

she says.  

Her practice, EG Healthcare, focuses on pediatric and adult

medicine, offering “modern healthcare with a community feel.”

  Complete physical evaluations and social assessments are a

priority.  Every patient is not only examined physically but also

screened for depression, food scarcity and substance abuse. 

Patients are then connected with necessary resources on Staten

Island.  


LaMandre emphasizes inclusivity and education in her practice. 

“We extend ourselves to populations who have often been

considered underserved,” she says.  “We reach out to local

churches and organizations to provide patient education and

information about health care concerns.”  Her practice also

prides itself in being a safe environment for the LGBTQ community.


As the owner of an independent, autonomous practice, LaMandre has a two-pronged approach: She actively promotes her own practice, and also takes time to promote the larger role of NPs as health care providers in the community.  She serves on the Regional Board of the Nurse Practitioner Association in her area, and in that capacity coordinates educational programs for Nurse Practitioners of Staten Island.  She also serves on the Staten Island University Hospital Foundation Board of Trustees.  In addition she serves on the board of the Staten Island Pride Center.
She says, “I am, of course, a huge advocate for nurse practitioners, however, I also strongly believe in integrating myself and our role in the medical world and in working closely with physicians, physician assistants, and other health care professionals to help shape policy and maximize patient care.  Ultimately it’s all about the patient.” 


Pediatric House Calls on Long Island
Back in the day, newborns and sick children didn’t leave the house for medical care, the care came to them.  In a throw back to that earlier time, but with a modern twist, Mary Beth Koslap-Petraco, who has a doctorate in nursing practice (DNP), is providing pediatric house calls on Long Island.  Koslap-Petraco runs a busy practice in Nassau and Suffolk County offering in home newborn visits and sick visits.  She also does school visits.  In addition, she teaches at Stonybrook University’s Pediatric Primary Care Nurse Program (PNP).

During newborn visits, she sees many parents who have never

interacted with a newborn before and have many questions. 

“I discuss baby safety, vaccines, and bathing, for instance, and

I address any concerns they bring up as new parents.”  She also

advises them not to be afraid to leave the baby with a trusted

family member or friend, so they can have some time for

themselves.  


“It’s really all about empowering the mother,” she says. 

“I offer encouragement, tell her how well she’s doing, and

give guidance about breast feeding.  I stay for as long as it takes

to make her comfortable, and I give her my cell number so she

knows I’m always available.”  


Most of the sick visits are for children with asthma. For them, it’s important to discuss when and under what circumstances an asthma attack started and review the appropriate use of their inhaler, she says.  


As someone with 27 years experience as an NP, Koslap-Petraco, offers some words of advice for NPs who are thinking of setting up a business.  “Get a good attorney.”  She emphasizes getting the right business guidance from an attorney who is completely familiar with the laws governing nurse practitioners in New York State.  


She advises people who are starting their careers as NPs to get a lot of clinical experience, build relationships with other health care professionals, and develop critical thinking skills to make the transition from registered nurse to nurse practitioner.  


 “I see more independence for nurse practitioners in NYS than ever before.  It is no longer mandatory for us to have written practice agreements, for instance.  And, I see NPs moving toward being the main primary care providers for patients.  This is a great time to be a NP.”

The Nurse Practitioner Association New York State

Nurse Practitioners (NPs) are registered nurses who have completed advanced education, at a Master’s or Doctorate level, plus additional clinical preparation.  These professionals are authorized to independently diagnose illness and physical conditions, perform therapeutic and corrective measures, order tests, prescribe medications, devices and immunizing agents, and refer patients to other health care providers.  The Nurse Practitioner Association New York State (The NPA), the only statewide professional association of nurse practitioners, promotes high standards of healthcare delivery through the empowerment of nurse practitioners and the profession throughout New York State. For more information, visit: www.TheNPA.org.