Content That coast2coast Likes

coast2coast, MSN, NP 7,932 Views

Joined Jul 9, '10. Posts: 405 (42% Liked) Likes: 625

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  • Nov 9

    Our practice act "sunsets" in 2017 so we need to be very mindful and supportive of proposed changes. Here is the latest from ISAPN (IL Society of Advanced Practice Nurses):

    We are gearing up for another big push for full practice authority in 2017. We have a lot of work to do and need all APNs in the state to support our efforts.



    • Change APN to APRN throughout the act and other laws


    RATIONALE - consistency across states and to align with the APRN consensus model

    FOR THOSE PRACTICING AS A CRNA

    • Remove language that references the requirement of physical presence by physicians during the delivery of anesthesia services. Specifically, remove where this language below appears in the Nurse Practice Act or related Acts:


    "and remain physically present and available on the premises during the delivery of anesthesia services."


    FOR THOSE PRACTICING AS CNP, CNM, CNS PROPOSALS INCLUDE:

    • A transition to practice for newly licensed APRNs.
      • After 3000 hours (of practice in Illinois) the APRN may practice without the WCA. They will need to notify the department of that intent.
      • The transition period shall include a written collaborative agreement with a physician licensed to practice medicine in all its branches OR an Advanced Practice Registered Nurse who has five years of practice in the same certification.
      • All currently licensed advanced practice registered nurses may or if desired will be grandfathered as long as they meet the following criteria:
        • Un-encumbered license with appropriate national certification for at least 5 years
        • Notify IDFPR of their intent to practice without a written collaborative agreement


    RATIONALE - National trends show that a transition to practice model leads to successful passage.

    • Increase pharmacology continuing education requirements
      • Total hours will not change 50 hours CE per renewal cycle
      • 20 hours must be pharmacology with 10 of those hours specific to Schedule II


    RATIONALE - National trends show that a transition to practice model leads to successful passage. CE recommendation - To circumvent issues that may occur due to continued conversations in Springfield related to the use of schedule II gateway drugs that may lead to substance abuse (heroin overdose)

    We need to be able to compete in Springfield. We need you to visit your legislator and we need to raise money to support those who will help us get this done.

  • Aug 7

    The socioeconomic and educational level of my patients is pertinent. Less sophisticated people, with poor adaptive skills, are easily swayed by a healthcare system that doled out opiates the past 30 years like candy.

    The healthcare system set these people up for this. Now there is a gnashing of teeth about addiction.

    Enshrining the pain scale as sacred contributed, in my opinion. The most vulnerable members of society were like sheep to the slaughter, lacking coping skills.

  • Jul 16

    Quote from brandy1017
    That is a very sad situation. Why not go back to the NP that was understanding of your mom's need for pain meds and anxiety meds? This is exactly what I feared would happen with the pressure for Dr's not to prescribe narcotics, that people will be left with uncontrolled pain. I see this already with nurse friends who are treated as drug seekers if they need narcotics for an injury or chronic back problem.

    Is there any way you can go back to the NP with her? Otherwise seek out pain management for sure. Sometimes non narcotics can help such as lido patches or a steroid shot, but narcotics should not be withheld from her. Plus she is dealing with anxieity and dementia. The dementia may be increasing the anxiety as she realizes she is forgetting things. I imagine that would be very unsettling.
    During my clinicals, I see pretty often this dynamuc of "the good (cop)/provider" who is "understanding" and "caring" vs. "bad one".

    In my opinion, it is the perfect example of how not to do things. The same story as with a dude who somehow passed NCLEX is glorified as an excellent, caring nurse because she is always chatting happily about life and such while others are effectively doing her job, aka keep her patients alive.

    The NP works under MD license in PA. By "being good" and satisfying patient's wishes, she adds nothing to the quality of treatment and potentially endangers the MD and her own license. BTW, if after TWO years these two put together did not figure out diagnostic workup plan and basically did nothing beyond treating symptoms, I would run for my life outta their practice. 50 y/o female with multiple and increasing neurological symptoms + dementia smells heavily as a systemic problem.

  • Jul 16

    Dear OP,

    while I totally understand your frustration, I must say that your former doctor was very much correct in his tactic, although not in his actions.

    As I get it, your mother is in her early to mid 50th. She has chronic pain and tremor, both of unknown origins, some dementia-like symptoms, personality changes and now new pelvic symptoms. It is a description of a complex patient who was, as far as I get it, never was worked up and has no working diagnosis. It is up to your mother to refuse testing, but it doesn't mean that she should be given meds with high addiction potential for this and that symptom just because she likes how they work on her. Your doc was absolutely right in attempting to transfer care, get specialists on board, etc., Sudden changing meds was not appropriate, but he was correct in refusing to escalate dose without proper diagnosis.

    Regarding pelvic exam, it is up to provider to determine who is more qualified to do which type of assessment in practice setting. Pelvic exam #1 on difficult diagnostic case needs to be done by whoever knows better, not by whom the patient likes more. Unless the NP was specializing in women's health, she might have very limited experience with abnormal pelvic exams.

    Regarding passing info, I can assure you that it is what happens in 100% of cases. No provider in his or her right mind would transfer care without communicating every single detail to accepting care office. Transferring a patient with even traits of "risky behavior" which might affect one's licensing status (even non-compliance, refusing to test, missing appointments, etc) and not telling about it is seen as extremely unprofessional behavior and can kill physician's career.

    I do not say that your mother is addicted, but there were several things in your post pointing on developing of at least tolerance. She absolutely should not be treated in primary care setting, it is not safe for her on the long run and you need to understand it. She should be referred to specialists and get diagnosed before making any changes in her meds. As the very least safe step, she should take the same meds in the same doses, but there should be no increasing doses before we know what is really going on.

    I have to work on regular basis with highly dependent and escalating patients suffering from chronic neurologic diseases from MS to Alzheimer, and it is incredibly painful, in all senses of the word, for everyone involved. I hope you would be able to convince your mother to get diagnosed and find a capable physician for her.

  • Jul 12

    Quote from NurseGirl525
    Be careful with going into a direct entry program. You may have a difficult time finding a job afterwards with no bedside experience. I'm not sure who hires Nurse Practioners with no actual nursing experience.
    40+ people in my cohort were hired with little to no bedside experience. Employers were much more concerned with lack of NP experience than lack of bedside experience. Bedside experience does not necessarily make a better NP. Are you an NP or currently in an NP program?

  • Jul 12

    Quote from NurseGirl525
    Be careful with going into a direct entry program. You may have a difficult time finding a job afterwards with no bedside experience. I'm not sure who hires Nurse Practioners with no actual nursing experience.
    This is repeated all the time but often time is not the case.

  • Jun 1

    Quote from sailornurse
    As a new graduate NP you need to be in the supportive environment.
    But why? Why shouldn't we come out of school prepared to practice independently to the full scope of our license? Although a supportive environment would be ideal I don't think it should be expected. I have concerns the unreasonable expectations of extended orientations for new NPs hurts our credibility with physicians who expect us to be ready to practice. We have one, not even new just new to our specialty, who calls the physician before ordering a multi vitamin its embarrassing.

    To the OP please reconsider accepting poor wages or working conditions due to an obligation to your patients. Very few men or physicians fall into this codependent trap. Make your requirements known before you start a new job and handle your business like what it is, a business.

  • Jun 1

    There's no data to support the idea that "bioidentical hormones" are any safer than synthetic ones- nor are they actually more "identical" than synthetically produced hormones.

    I don't see a problem in specializing in hormone replacement therapy, per se. I do a lot of it in my practice, and as long as you are adequately trained it is well within NP scope, barring local regulatory silliness. I do, however, feel a little bit alarmed whenever I hear NPs espouse pseudoscientific health beliefs, especially ones that actually have potential for harm. Bioidentical hormones are largely produced by an industry that is just as profit driven and susceptible to corruption as Big Pharma, and who also benefit from a lack of outside oversight. Actual amounts of hormone in a pill can vary widely from company to company, and even batch to batch.
    http://www.menopause.org/docs/defaul...F.pdf?sfvrsn=2
    Bioidentical Hormones << Science-Based Medicine

  • May 15

    Meh, if you can't beat 'em, join 'em.

    "Well, the g-d Fentanyl didn't do s***, let's try some ******* Dilaudid."

  • Apr 23

    Since when is it "news" that opioids cause constipation?

  • Apr 23

    This is new?

    Not trying to be sarcastic. This has always been a recognized issue.

    Is this perhaps a "sponsored" article?

  • Apr 9

    "I have had a similar situation. I had a bad virus infection (as I thought) for more than a week. Progressively, it became worst and I went to see my PCP. Paid $20 co-pay by a check. My PCP was on vacation and the covering bit$& (a female) refused to prescribe any antibiotics. She did not even suggest that I do any lab tests! Frustrated, I stormed out, and went to the walk-in clinic affiliated with CVS, and walked out with my meds. Two days later my infection went away. But, I stopped the payment on my check to my PCP's office. They sent me a bill plus $25 for the stopped payment they had to pay. I responded with a copy of my bill from the walk-in clinic and a copy of prescription bottle, with two questions next to the balance due of $45 - for medical mal-practice? Failure to diagnose? Never heard again from my PCP again."

    To me this displays something that is all too common these days, a very low distress tolerance, and this attitude of entitlement, that if they pay to be EVALUATED and assessed by a professional, that it entitles them to be prescribed whatever they want. I actually had a patient who wanted her money back after an 1.5 hour Psych Eval because I wouldn't recommend a stimulant. "But why won't you give me Adderall, I paid for this appointment". Ugh....

  • Apr 9

    I think canceling a check for service provided is wrong. Just because you don't like the diagnosis you got doesn't mean you shouldn't pay for the work that was done. And no, no lawyer is going to call such an episode "malpractice."
    Lab test is not necessary for a URI unless strep throat is suspected. Obviously this is all theoretical since I didn't see you personally, but in general if the cold went away within 2 weeks (with or without antibiotics) it is safe to say it was a viral infection. That's what evidences show. So you can't attribute the fact that you got better when you took the antibiotics to the good work of antibiotics. You were on your way to getting better and you happened to take an antibiotic so you think that's what made it better. Again, that's if the whole thing lasted 2 weeks or less and all in theory.

  • Mar 29

    Quote from LadyFree28
    Genetic testing is offered when considering having a child, as well as during pregnancy; one can test for Fragile X syndrome, which is a leading gene in ASD.

    My GYN offers genetic testing for fertility, as well as genetic testing for most genetic carrier disorders; albeit my GYN is a part of health system that has been researching genetic testing for most carrier disorders for some time, and now offer pts the ability to undergo testing.
    Autism is a behavioral diagnosis. Fragile X is a genetic diagnosis. When kids are diagnosed with an ASD, we usually do genetic testing to see if they have any genetic disorders. Fragile X is but one genetic disorder associated with autism. (The National Fragile X foundation website confirmed this also).

    Kids with disorders such as Down Syndrome and Tuberous Sclerosis also have a higher incidence of autism, but not everyone with autism has Fragile X, Tuberous Sclerosis, or Down Syndrome.

    I will add that many insurance companies have now balked on paying for some genetic tests for kids with developmental delays or disabilities citing testing will not change the treatment or the outcome.

  • Mar 29

    I work for Big Pharma (commence terrified screaming!!!!!!!) and just want to let you know that yep, we are actively trying to kill every single person on this planet. Oh, and Big Foot exists, aliens crash landed at Roswell, and 9/11 was an inside job.

    NOW YOU KNOW THE TRUTH

    *rolls eyes and heads off to get popcorn. gonna sit back and watch the flamessssssssss*


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