mammac5 9,172 Views
Joined Nov 10, '09.
Posts: 735 (30% Liked)
Well, I'll jump in here and say that you will get a whole host of responses to this question, but there is no "rule."
Some will say the RN should work for 2 years or 5 years, and I'm not saying there's anything wrong with that view. I will say that there are a whole of us that did not work as nurses (or hospital nurses, anyway) but went directly into an NP program and have done very well.
Some experience can be very valuable, and others maybe not so much. For instance I talked to someone who had worked for a year or so in a skilled nursing facility with elderly folks...and was in a midwifery NP program.
This is your own anecdote and does not represent NPs or even nursing as a whole. Not feeling respected or feeling respected has more to do with where you are working versus what you are doing.
Similarly, just because your hospital system is not respectful, doesn't mean all are that way. My anecdote is that NPs at my hospital are treated as providers and afforded all the privileges of physicians, including premium parking, physician lounge access, etc. I personally don't know an NP in my area that doesn't feel valued and respected. The ones that I know that have felt that way got new jobs.
My mother completed an RN program several years ago and was not taught how to draw blood...then she accepted a job in an outpatient pediatrics clinic a few years later. I taught her how to draw at my kitchen table so she'd know by the time she started her job!
Lots of inpatient settings use phlebotomists from the lab to get all their draws; they use IV teams to start lines. Not all nurses do these skills so many of us are not learning them in school.
Many programs teach access for insertion of IVs and/or drawing from central or peripheral lines, but not venipuncture in the "outpatient" sense of the word. You can learn this at a hospital or local CC that has a course...usually short.
I learned as a Certified Med Assist, but nurses don't usually learn this until on the job, or never.
A & P is important; we assume everyone knows where the parts are located (the A) but many people get through basic courses without really knowing how everything works AND how it all works together (the P).
I would review the autonomic nervous system function, renal function, and all the chemistry that is in the A & P text. Chemistry is vital for learning about acid/base balance, appropriate fluid maintenance, and understanding how drugs work.
The program I'm in is an accelerated one, so everyone's experience is going to be different. I'm a pretty good student and not new to the world of healthcare, but I can say that the areas that have been the greatest challenge to me are acid/base, fluids & electrolytes, and hemodynamics. All of those require understanding of chemistry and memorization of lots of numbers.
Best of luck and hold onto your enthusiam!
Pts should not NEED a snack. If snacks are routinely needed, the insulin dose is too high.
I like NPPs in primary care, particularly nurse practitioners. I realize many here will not agree with me, and that's fine, but let's not fight about it!
There have been studies that show NP care is equal to (in some cases superior to) physician care, particularly with management of chronic illnesses. NPPs are likely to have more time for chronic disease management and that's the role they would fill in the PCMH model. Frankly, no one needs a physician to diagnose or manage diabetes, hypertension, obesity, etc., since these diseases are diagnosed by numerical value guidelines and managed (in the majority of cases) by published disease-specific guidelines. NPPs work so well in this area since what chronic disease requires is TIME to talk with patients, listen to their concerns/barriers to self-care, help them set goals, assist them in managing all that comes with living with a chronic disease, etc. My personal opinion is that NPs are great here because the focus on communication that comes with nursing education, as well as education in theory which includes helping patients make important changes in their lives.
In addition, NPPs are more than qualified and very skilled with providing preventive care (also guidelines-driven) which will soon be covered under Obamacare for millions more than currently have access to these services.
Now, if I'm having a mysterious constellation of new symptoms that signify a new and possibly serious disease process, I may prefer to have a physician who has spent years honing diagnostic skills and looks for zebras. But for routine care and maintenance of the human, I prefer an NP.
I work in both inpatient and outpatient DM mgmt. There is theoretically no limit to the doses of basal insulin...no upper safe dose to prescribe the way we think of meds like METFORMIN. Having said that, I normally will have pts split a large dose into 2 injection sites for better absorption...say, if they are injecting 80 units total I would have them inject that into two sites, but they can do so at the same time.
Patients who require 200 or more total daily units of insulin may do much better with U-500 insulin since the volume injected is much smaller and seems to be better absorbed/assimilated. I live/practice in an area of the country with high insulin resistance and actually use quite a bit of U-500. We still use NPH for some patients, as well. Especially since it is dirt cheap at Walmart pharmacies...not as great a basal insulin as LANTUS or LEVEMIR (which usually should be dosed BID) but cheap = the only way to go for many patients.
Appropriate to hold the insulin in an elderly patient with CBG of 75 but if your institutional policy says you must notify the prescriber when you judge that the insulin should be held, then you should follow that policy.
Giving the insulin and then offering the patient a milkshake would frustrate the CRAP out of me, as a prescriber! What is the point of that? Why would anyone give a milkshake to a diabetic patient? Sheesh.
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