sserrn 3,807 Views
Joined Feb 27, '10.
Posts: 141 (30% Liked)
it would be helpful to have had an understanding of functional groups and biochem prior to APRN school. If anything at all is to be added it should be that and a basic anatomy course, since regular A and P was pretty distant for most of us.
Everything in medicine is molecule based (really everything in life) and nobody should have prescriptive authority without understanding at least to a fairly basic extent things at a molecular level. Gen chem 100 at the time would not have been enough. A 2 semester integrated gen/ochem/bio chem course would do wonders for our profession. Of course with a medical focus.
acid base chemistry
organic chem functional groups
carbohydrate, fatty acid, nucleic acid, protein chemistry
ions and the like
all that sort of stuff is pretty much left out and would have a bigger impact on patient care than nursing research 101
I think we should indeed keep fighting, and as we demonstrate clinical competence and educational rigor I believe we will better prove our merits. I do not feel that we can go toe to toe against physician lobbyists based on our "3 P's," and I truly do not feel our required education required to become RNs is remotely analogous to the -ologies and training in medicine, i.e. internal medicine, that all physicians get. We do not need total parity in education. We do, in fact, need enhanced education covering the myriad topics that we so badly need to know. For our purpose, we do not need 3+ years of residency or 4 years of graduate education in training, yet if being truthful to ourselves we may all concede that there is little to no uniformity in education and training. For the simple fact that you can study your entire NP degree online never even seeing the host institution and pick a preceptor of your choosing and become a NP, we demonstrate a weakness. We are competing against one of the most educated professions in America who have demonstrated commitment to rigorous study and assessment. I simply think we need to better demonstrate this in our own professional training. My certification exam was largely devoid of clinical content, and even at a state, medical school affiliated NP program I had to find my own preceptors.
I would love to continue sending emails and believe me I've thought about becoming the sacraficial lamb and doing doctoral work to examine the merits of a more biomedical curriculum. Two caveats, I'm not quitting my employment, and I'm not going in debt over it. Give me some funding ideas, and I'll be glad to field the legitimate ones.
Most of the naysayers, such as myself, don't really care so much about the history or theory of nursing (or medicine). I, personally, do read a lot of history and find the history of psychiatry to be rather interesting and something that should be indulged during our training to become psychiatric specialists. How many psych NPs can tell me something about Emil Kraepelin?
A general model for what I feel NP school should include:
1 year biochem if even biochem-lite perhaps even combined with cellular bio, prosected anatomy, physiology in a semester with dedicated training in medical genetics, pathology in a semester, NO combined pathophys junk, some type of combined micro/immuno course, neuroscience and psychopathology even if these latter two are also combined. training in clinical skills, i.e. deductive reasoning, diagnosis, physical examination using the tools of the PE, suturing, splinting, imaging, ECG, and other office procedures.
1 year combined medical training in medicine, peds, healthcare administration/practice management, psychiatry, and specialty focused rotations in OB/gyn, surg, critical care, primary care, neurology, etc based on your desired focus of training (ex, psych might include med, peds, neuro, endo, sleep, a primary care rotation; acute care might be more medicine, neuro, pulm, cards, surg, ID, _CU ), research metholdology and biostats or epidemiology, and journal reviews
1 year of solid training exceeding 1200 hours in your practice specialty during which time you participate in face to face or online presentations regarding your practice specialty (more examples with psych; human development, various psychotherapeutic modalities, psychopharm, forensic psych, child psych, neuro, etc)
That's three years. My master's required three years of coursework although light and fluffy. Most of it could've been compressed into a fall, spring, and summer as well as one semester of full-time clinicals.
We should all be licensed generalists, i.e. generally capable of doing what FNPs are presently trained to do. (The FNPs should get MORE training for that such as dedicated time in ENT, derm, sports med, medicine, et al). We should all be technically prepared and credentialed to prescribe or at least minimally refill anything. We should all have Schedule II prescriptive rights. We should all be able to declare disability, endorse death certificates, authorize emergency holds, admit patients to a hospital, etc. There's way too much state by state mess mirrored by the institution by institution eduational requirements. Whether we do all these things on our own or not isn't really a concern of mine. We could all be collaborative or all be independent. It doesn't matter to me as long as we can do what we're trained to do, and we definitely need more training - all of us.
I'm terribly disheartened when NPs suggest we get "enough" training.
What about the IO route?
It is a growing medical problem -- patients whose habitus, anatomy, medical and social histories and/or disease processes mean they have very poor venous access. You may recall recent state execution attempts hampered by venous access issues which were widely covered in the media.
I personally would probably not participate in continuing to stick this individual, if his access is already that poor. I continually teach my patients who get regular blood draws or infusions that the problem with repeatedly accessing the "go-to" vein is that it WILL eventually sclerose ... and then what do you have? On that fateful day when the patient becomes hypotensive, hypoxic, dysrhythmic, suffers trauma or some other EMERGENCY ... to have compromised their chance of successful resuscitation by sclerosing accessible veins without good reason is just not something I'm comfortable with.
Is he dry? Perhaps you should suggest lots of water prior to the visits?
My goodness, this patient needs a midline, a PICC or a port - STAT. Have these been considered?
Needless to say, this reminds me of several incidents that I encountered with the nursing staff that I managed and had to let go on my previous facility. Having said that, one in particular comes to mind a nurse on the 7-3pm shift no matter how many times I had a chat with her regarding coming to work on time, she would always walked in around 9:am or 9:30am. However, she would leave on time. Therefore, I change her shift to accommodate her schedule, since she was a single mother of 3, but she still manage to come in late after that. Then she began to miss work all together, so I had to let her go. Consequently, a month later she gave my name as a reference to a clinic nearby that was hiring
When I managed an apartment complex back in a previous life, a tenant I'd evicted for non-payment of rent (among other offenses) actually had another apartment manager call me for a reference! I couldn't believe it---this woman had trashed her unit, left a bunch of rotting food in the fridge, and let her teenager 'tag' the fence behind the apartment. She also left a scrapped car in the tenant parking area and refused to move it when she left.
Well, you can bet your bottom dollar that I gave him a string of reasons why no one with even an ounce of interest in their property would rent it to her......luckily there were no rules at the time saying that I couldn't do that.
I understand your concern regarding the patient's subsequent development of SVT. But I'm not understanding the initial hesitation about giving it, if the patient was without other history that made him particularly susceptible to lidocaine toxicity. This is an approved use of lidocaine -- if I was going to question the physician's order it would be for a specific reason.
SVT is not associated with lidocaine toxicity. Your patient likely has an EP issue.
But then again, I suppose a lot of us are capable of obtaining a nursing degree, but far less of us are capable of being NURSES. Here's some advice, if you are tired of trying to draw IV's on us "regulars", maybe it's time for you find a new profession.
Whoa, 53 units? What was the outcome?
And BTW, thank you everyone who responded! I didn't know about the rapid infuser.
How do you like the ED?
Thanks for everyone's responses! It gave me a lot to think about. I talked to my manager this morning & she said she understood. She even asked if I wanted to stay prn so in case things don't work out, I could always come back! I honestly think this is just too good of an offer to pass up. I mean how many times do you hear hospitals telling you they'll pay off your contract & pay for you to get your masters (I forgot to mention that earlier). I won't be quiting right away, that way my manager has time to find a replacement and train her. Thanks for everyone's input!
You made a deal. You signed the contract. There is a certain honor/maturity involved in owning up to ones responsibilities. If you do break the contract, even though the facility offering to pay for you to leave..... will never forget you broke your promise. The facility you left will not forgive you for reneging on your promise.....I am sure they will not give you a good reference nor will you be up for rehire.
Have you asked to move within the facility or department? That you want to learn all aspects and would LOVE to work the L/D area or NICU/nursery? Have you asked to go to the ED at the facility where you are?
If the working conditions were unsafe or you were in danger without a doubt...leave. Because you are bored? Not so much...... Sometimes as professionals we need to own our responsibilities then move on.
I wish you the best.
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