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Dembitz 3,383 Views

Joined Mar 5, '09 - from 'New England'. Dembitz is a Nurse Practitioner. She has '4' year(s) of experience. Posts: 52 (40% Liked) Likes: 77

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  • Nov 3

    Quote from Wuzzie
    Nurses, teachers and school administrators are obligated reporters. With children and vulnerable adults we are required to notify the authorities of suspected abuse. It's a little stickier with adults that don't fall into the "vulnerable" category. If we suspect abuse we are required to assess the situation if possible and provide resources.
    Mandated reporters are only required to report suspected abuse that they encounter within the scope of their practice. So no a manager is not required to report to authorities if she see bruises on an employee. Think about it - In the course of daily living I see many thing's that "Just don't seem right" I would be forever reporting everyone if I was required to do so.

    Nor or we "Required to act outside our scope of practice." While most decent people would want to help they are not required to do so.

    As a scenario to show how ridiculous this is imagine walking in a large store and seeing some woman you don't know with bruises on her face. Do you, a total stranger to her, pull her aside and begin to investigate and assess for DV. Do you call the police to come right away before she leaves the store?

    I once was involved in a scenario where I saw an older woman walking down the street with a bleeding head injury, she was walking quickly yelling back over her shoulder at a man who was following her down the street. Concerned that I was witness to a possible crime in action I called the authorities and gave information about the location and followed the pair until the police arrived. I later found out that the woman in question had dementia and had fallen. The man following her was her son and he was waiting for her to calm down enough so he could walk her home and seek treatment for her injuries. Every thing is not always what it seems.


  • Nov 2

    I've said this before...we don't have a medical director so a standing order/protocol isn't available to us to stock epinephrine. I wish we did.

    But my standing order is I answer to a higher authority than state law or district policy so if a child is having an anaphylactic reaction and God put me there to see it and there is no epi on the shelf for that child...I'm grabbing whoever's epipen that is the closest on the shelf, with the correct dosage or next best thing, and I'm using it.

    As a pediatric ER nurse who has handed dead babies to parents to hold for the last time or tried to make dead teenagers presentable for parents to view and hug good-bye forever, and as a parent, I will do everything within my means to snatch a kid from the jaws of death. To Hell with rules and laws and nurse practice acts and district policies...this is where I stand.

    Jen's post hit me between the eye's today as a reminder of how valuable School Nurses are as student and patient advocates and how valuable and functional this SN forum is...after wasting time and energy in participating in the attack thread today that was finally pulled by AN. OMG!! I love you guys like a brother or sister and appreciate what you do...just sayin. Keep on keeping on!!

  • Nov 1

    Quote from SopranoKris
    The hospital I work at simply calls all NPs and PAs "midlevel providers", which to me, makes it sound like we're less educated.
    NPs and PAs ARE less educated than physicians. That does not mean they are lesser providers, but you will never win a "we are just as educated" argument. The numbers don't even begin to add up.

  • Nov 1

    I am also a Direct Entry grad, and feel that RN experience is not related to success as an NP. What is crucial, IMHO, is finding a first position where you have a slow ramp up and have support from a mentor. That is true for any new grad, whether you have years of RN experience or not. As I have said a gazillion times, I rarely use the vast majority of what I learned in the RN portion of my program.

    I'm going to assume you're an FNP as you said you might explore working in the adult arena.I wouldn't want to work in peds as a FNP as we did not get a lot of depth in pediatric clinical and didactic. Peds primary care is tough. I've never seen a peds office, as a NP student or parent, that wasn't crazy-busy and hectic. Perhaps looking at an adult NP job or something like Urgent Care (except if you would be the only provider on duty) might offer you an environment that is more conducive to getting acclimated to this role. I'd look at a large medical group practice where you would have other providers to consult with, and might have a more structured orientation process.

    If you feel you have knowledge base deficits, then hit the books again, and brush up on the areas where you think you need to know more. Don't give up on nursing, or yourself. Not every job is a good fit.

  • Oct 19

    Quote from elkpark
    And, yet, there is Federal law that protects the right of healthcare providers to decline/refuse to participate in procedures/care to which they object on religious grounds (specifically written to protect anti-choice healthcare providers), so there is legal precedent and legal protections in place for individuals who have religious objections to particular aspects of healthcare.

    I'm surprised at how many people here have posted that, if the OP has religious objections to some aspects of providing care, and his religious beliefs don't permit him to provide care for everyone, then he has not business going into healthcare. When anti-choice people come here to say that they want to go into healthcare but they have religious objections to abortion and are unwilling to participate in abortions, no one tells them that they shouldn't go into healthcare -- people practically line up here to assure them that they will be fine, there is law that protects their beliefs, they can't be compelled to participate, and all they have to do is work in a setting that won't involve abortion. That is all the OP is doing -- asking for suggestions about healthcare settings that would not conflict with his religious beliefs and observance.
    Yes, and it's a Federal Law to which I am vehemently opposed. As for your assertion that "When anti-choice people come here to say that they want to go into healthcare but they have religious objections to abortion and are unwilling to participate in abortions, no one tells them that they shouldn't go into healthcare -- people practically line up here to assure them that they will be fine, there is law that protects their beliefs, they can't be compelled to participate, and all they have to do is work in a setting that won't involve abortion.", au contraire, I don't believe they should go into healthcare either, and that would be my position if I ever read a post regarding the issue. Abortions are a part of women's healthcare and one shouldn't be able to pick and choose for whom they provide care, particularly based on supernatural beliefs.

  • Oct 19

    Just as I don't believe that pharmacists should be able to refuse to sell Plan B due to religious beliefs, I don't believe health care providers should be allowed to pick and chose for whom they provide care based on religious beliefs. (That includes Catholic hospitals if they're getting government funding, but that's another issue, I suppose.) If your religion requires you to shun half of the population because of what does or does not dangle between their legs, you need to stay out of healthcare. Time for everyone to evolve.

  • Oct 18

    I'm a Direct Entry graduate who worked for many years in a non-nursing health care profession before I went back to school. I have not worked bedside as a RN. I graduated 8 years ago and had no trouble finding a job at that time...No one cared about my lack of RN experience; employers were more concerned about my lack of NP experience. I don't think not having bedside RN experience has hindered me at all. I use very little of what I learned in the RN portion of my program.

    If you choose to go this route, select a reputable school with a competitive program. You don't want to go to a school that has low admission standards. Be willing to go over and above the minimum clinical requirements, as the more clinical time you can get, the better. Sadly, also be prepared to hear a lot of negativity from nurses who cannot see how DE grads can be successful NPs. Work hard, do your absolute best, and let your performance speak for itself.

  • Oct 5

    Quote from scuba nurse
    Can you get a note form your OB saying it is against her medical advice at this time that you receive it?
    But it's not. A PPD is not contraindicated during pregnancy. So I would be very concerned about any OB who would do so.

    I think asking for a quantiferon, and paying for it out of pocket if necessary, would probably be the best option.

    Good luck on the ultrasound tomorrow, OP!

  • Oct 5

    My sister has endometriosis and goes to a gynecologist that suddenly decided to stop prescribing birth control, no matter what the condition. I would also like to clarify that this wasn't part of a religious healthcare system, it was just because of his personal beliefs. My sister is non-medical and liked/trusted him while he offered her "other alternatives" and suffered for so long before (thankfully) having her first child. I just couldn't understand somebody going into that field and not offering such a major service. It still gets under my skin. I felt like it was unethical in a way - like a previous person said, as a provider its your job to lay out all of the options and give your patient the choice if they understand the risks.

    If you feel strongly against the CDC vaccine schedule, I would suggest finding a job where that wont be part of your duties. I'm just not sure what your response is if you are ever questioned by a lawyer about why a child died of meningitis or epiglottitis or pneumonia because they were not given the HiB vaccine when indicated, especially if you were following your own schedule and the parent didn't know it wasn't CDC guidelines.

    In general, I have a lot of difficulty understanding a provider that puts their personal beliefs ahead of research or patient autonomy. I feels like it crosses a line and makes me feel uncomfortable. I wouldn't want my physician to withhold treatment from me or slant their "speech" about treatment options and leave out certain ones based on personal beliefs. If they disagree because of experience or research, thats totally justifiable. But patients put their faith in you as a provider to guide them. If you have personal beliefs that aren't backed up by evidenced based practice and practice guidelines, I would really just suggest finding a job where those beliefs don't conflict with your job.

    All this is said with respect and isn't a personal attack, I promise. It really is just to give you perspective from the other side.

  • Sep 22

    One way to look at this is to consider the numbers:

    By graduates/education:
    The number of NP graduates between 2010-2013 is about 52,000.
    The number of RN graduates between 2010-2013 is about 144,000.
    The number of NP graduates in 2010 was 11,000 and in 2015 it was 20,000.

    By workforce data:
    In 2011 there were about 100,000 NPs and that increased to 128,000 in 2014, a 28% increase over 4 years.
    Between 2003 and 2014 the total number of nurses in the workforce increased from 2.44million to 3.04million, a 24% increase over 12 years.

    It shows that the number of NPs is increasing exponentially but the number of NPs compared to the number of RNs remains a small fraction of the total RN workforce.

  • Aug 30

    Interesting thread. This topic has been debated vigorously on the APRN and NP forums.

    All available evidence indicates that NPs without RN experience are as likely, or more likely, to succeed in MSN programs. In addition, some studies indicate NPs without RN experience have superior clinical skills as evaluated by NPs and MDs. Not one single study has demonstrated that NPs without RN experience have worse patient outcomes. In addition, I fail to see how RN experience in an acute care setting helps in the primary care arena. Many primary care and outpatient specialists have told me they have no interest in hiring an NP or PA who only has acute care experience. Finally, ironically, this is similar to the MD vs NP debate. We all get frustrated with MDs arguing against full practice authority for NPs even though over 100 studies have shown NPs provide the same, or better, quality of patient care. So now we have RNs and NPs arguing that RN experience is necessary to be an NP, but without any supporting evidence.

    I do believe we should have NP residency programs for new grads and the AANP, ANNC, and state level NP organizations should lead the way in helping us with policy, legislation, and funding to support this. It would be great if there was funding for residencies in underserved areas and NPs choosing this route could get tax breaks or some student loan forgiveness.

    Online programs deliver didactic content online. Clinicals with preceptors are still required. There are many reputable online programs such as Frontier Nursing University.

    With regard to online courses – if it is just lecture, then who cares? In fact, the advantage of an online lecture is you can listen to it as many times as you need, whenever you want. The only value to an in-person class is if there is substantial class participation and Q&A. Only a few of my MSN classes had that, and I went to a top school. There are online learning platforms that do provide for real-time student participation and allow the instructor to call on individual students. Online education is the future of education.


    El-Banna MM, Briggs LA, Leslie MS, Athey EK, Pericak A, Falk NL, & Greene J. (2015). Does prior RN clinical experience predict academic success in graduate nurse practitioner programs? Journal of Nursing Education, 54(5):276-80. doi: 10.3928/01484834-20150417-05.

    Rich, E. R. (2005). Does RN experience relate to NP clinical skills? The Nurse Practitioner, 30(12), 53-56.

    Rich, E. R., Jorden, M. E., & Taylor, C.J. (2001). Assessing successful entry into nurse practitioner practice: A literature review. Journal of the New York State Nurses Association, 32(2).

  • Jun 22

    Quote from Jules A
    But the real problem, imo, lies with the schools telling her and a bazillion others "absolutely just pony up $50,000 and you too can be a NP." It will be interesting to see how this all shakes out a decade or so down the road. Remember Alina Health's ad?

    "Allina Health does not hire new grads from all academic institutions. Many proprietary on-line schools do not meet Allina Health’s standards due to the minimal oversight of the student’s clinical experience, the high faculty/student ratio, and the lack of focus on national certification standards in the curriculum."

    Ruby Vee will you be sharing your concerns with the CCNE? There is only a few days left for the survey.
    Not all schools will take any paying customer. Some are like that, but there are respectable programs who do adhere to national standards and have a rigorous admission policy. I know of several who accept less than 10% of applicants. So, you can't make sweeping generalities.

    Jules-I've also seen you disparage the so called "Mommy Hours" in several posts. What's wrong with wanting to have a balance between life and work? Not all of us want to be at work either physically or mentally 24/7. You can be an excellent provider and keep up with new advances without trying to mimic a resident's schedule. Those that want their lives to be all work may be better off at medical school.

  • Dec 20 '16

    I am a dyed in the wool liberal who doesn't live under a rock, and has no issues with anyone legally owning a gun, nurse or not.

    Sweeping generalizations are usually inaccurate, Annie.

  • Dec 6 '16

    This was more common back in more sensible times. The patient is obviously a daily drinker and needs his maintenance dose.

    My late husband got wine with meals in the hospital to help his appetite thanks to a very caring dietitian to whom I'm forever grateful.

    America is still puritanical regarding alcoholic beverages. But with 5% of the world's population we consume 70% of the world's prescribed pharmaceuticals. We are one of 2 nations allowing direct to consumer advertising of drugs. Yet we get nervous at a daily glass of wine or 2.

  • Sep 8 '16

    Quote from nurse0614
    Recently I heard our hospital will be forcing everyone to get a flu shot or they will have to wear a mask for their entire shift. I have had a reaction to it and usually just boost my immune system during flu season and this works well. I was told that even if we have had a reaction in the past and still don't get it, we wear a mask. This does not sit well with many of us at the hospital. Was wondering if others have experienced this and what they did.
    I am not sure how you boost your immune system but your facility probably won't accept it as effective immunity, so will need a mask. It protects both you and the patient, good all around.