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Nurse practitioners (NPs) are valued members of the health care team, and their numbers are growing each year. The volume of literature demonstrating the impact on quality, safety, patient satisfaction, and access measures is substantial and growing. There is a significant lack of measurement methods and outcomes related to NP contributions to organizational productivity. The construction of strategy for measurement of NP productivity is a prerequisite for studies focusing on impact. Models that are being used to measure physician productivity are available to be examined in terms of their applicability to the NP work force. In 2005, the Deputy Under Secretary for Health for Operations and Management directed Veterans Healthcare Administration (VHA) to develop a productivity-based model for physicians using the Medicare Resource-Based Relative Value Scale, which was created in 1992 to provide guidance on determining payment for physician services. In 2015, the VHA set out to set standards for productivity measurements for NPs, physician assistants, and clinical nurse specialists, and in doing so, the physician productivity model was adapted for the NP workforce. The work of adapting the model will be presented in this article. The specific steps in the process of measurement, operational definitions for work activities, and calculations are provided. The article concludes with a discussion of lessons learned and next steps.Transgender individuals have a long-standing history of honorable service in the United States Military. However, politics have had an impact on their ability to openly serve in uniform as policies continually change rapidly with each new administration. This article describes the shifting political landscape of policies related to whether (or not) transgender individuals can serve in the military, and how this has affected the health care experiences of transgender individuals and the ability for nurse practitioners to provide quality health care to the transgender population serving on active duty.It is estimated that almost half the general population has a headache disorder. The majority of these are considered tension-type headaches. Migraines and chronic daily headache (CDH) are not as common but are much more debilitating. Although CDH/chronic migraine (CM) occurs in about 3% of the population, it has been found to be 20% or higher in the post 9/11 combat Veteran population. Data from the Veterans Health Administration show that more than 380,000 Veterans, younger than 50 years, received care for a headache in 2017. Approximately 75% of the headache care was from a primary care provider. The purpose of the article is to review physical examination for the veteran with a history of a headache disorder, discuss contributing factors and comorbid conditions, as well as give an overview of current treatment options, with a focus on the post-9/11 combat Veteran who has CDH/CM.

An increased incidence in hygiene-related urogenital infections (bacterial vaginitis, vulvovaginal candidiasis, and urinary tract) has been reported in female warfighters serving in austere environments with decreased availability of water and sanitation resources, and when personal safety outweighs concerns for hygiene. Selleck LY3473329 Knowledge and access to an innovative kit designed for the female warfighter to self-test, self-identify, and self-treat common urogenital symptoms is critical to force health.

The purpose of this descriptive, cross-sectional, exploratory qualitative study was to explore female warfighters' 1) confidence in seeking sex-specific health care in field and deployment environments and 2) acceptance and willingness to self-test, self-identify, and self-treat urogenital symptoms and infections.

Qualitative data for this thematic analysis were collected during administration of the Military Women's Readiness Urogenital Health Questionnaire. Participants provided open-ended comments associated wecomes available for female warfighters, NPs are the model healthcare provider for educating women on their use.The US Department of Defense (DoD) recognizes the importance of warfighter brain health with the establishment of the Warfighter Brain Health Initiative and Strategy. For a warfighter, also known as a service member, to perform at their highest level, cognitive and physical capabilities must be optimized. This initiative addresses brain health, brain exposures, to include blast overpressure exposures from weapons and munitions, traumatic brain injury (TBI), and long-term or late effects of TBI. The DoD's pursuit of maximal strength hinges on the speed of decisions (neurocognitive) and detection of brain injury when it occurs. The strategy creates a framework for deliberate, prioritized, and rapid development of end-to-end solutions for warfighter brain health. Through this strategy, DoD is addressing the needs of our service members, their families, line leaders/commanders, and their communities at large. The implications of this initiative and strategy are noteworthy for practitioners because the DoD Warfighter Brain Health construct lends itself to nurse practitioner engagement in clinical practice, patient education, policy development, and emerging research.As a recently retired Army Nurse Corps officer with almost 30 years of service to my country, I want to ensure that my fellow nurse practitioners (NPs) are aware of their role in ensuring high quality and safe patient care to all veterans who are accessing care outside of the Veterans Health Administration (VHA). Specifically, NPs who work outside the VHA have an opportunity to participate in patient safety efforts aimed at reducing veteran suicide. On June 6, 2018, Congress passed Public Law 115-182 or the Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act. A goal of the MISSION Act is to ensure that veterans have access to health care by streamlining eligibility criteria for community care. A veteran who drives more than 30 minutes or waits more than 20 days for a primary care or mental health appointment may be eligible to be sent to a community care provider such as an NP. Therefore, NPs and other providers who work in community settings have an obligation to know more about the mental and physical health care needs of veterans as well as the resources that have been developed by the VHA to assist them.