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Joined Apr 4, '11 - from 'Northshore, MA'. BostonFNP is a Primary Care NP. Posts: 4,697 (61% Liked) Likes: 11,397

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  • Apr 24

    I was interested to see the percentage of nurses with a BSN vs. other degrees, especially as I look around and see other healthcare professions such as pharmacy and PT moving to the professional doctorate as the entry to the profession. That has paid off well for them insofar as it has reduced the supply and increased the wages of those practitioners due to demand. Interesting to contemplate if nursing could do the same, but as someone who has been in healthcare for 30+ years, this debate has been going on for many a year.

  • Apr 22

    I think maybe the author misunderstood the Villanova article, Magnet does not actually require 50% or more of staff nurses to have a BSN, it only requirement is for management staff.

    I think it's important when discussing this to understand evidence on outcomes, what steps have been taken since these studies, and the rationale behind the IOM recommendations, all of which are commonly misunderstood.

    The studies that show differing outcomes between Associate and Bachelor level graduates looked at nurses who graduated from these programs in the 70's, 80's, and 90's, and as a result of these studies there has been a shift in Associates programs to adopting BSN curriculum, since that is the presumed source of the differing outcomes. There have been no studies to evaluate the effect of this change, so we can't really say if current ADN grads are likely to produce poorer outcomes in their patients. Assuming the same variations in outcomes still exists despite these changes would be like if you found a patient was hypertensive, so you gave an antihypertensive, then without rechecking the BP just assumed they were still hypertensive.

    The IOM didn't recommend that we no longer utilize ADN programs, and given the negative effect that would have on nursing education that would be counterproductive if our goal is to improve nursing education. They suggested moving towards a more standardized curriculum with ADN programs adopting BSN curriculum, a process which is already well underway. They also suggesting achieving these BSN goals by simply renaming ADN programs as BSN programs (the would also require ADN students fulfill their remaining general credit requirements that their pre-requisites don't cover), in theory this could be done by simply making current ADN programs satellite programs of current BSN granting universities. As it turns out, it's relatively easy make ADN program satellite BSN programs in terms of curriculum, but convincing BSN granting institutions to change from the current RN-to-BSN programs they offer isn't all that easy since this would typically result in a loss of income. But since the differences in outcomes these studies found were likely not due to the three letters that describe someone's education, but rather the substance of the education itself, there hasn't been a significant push to force that issue.

  • Apr 21

    Just want to give you an update.

    Because of your comments re. too many errant student threads in the General Nursing forum and our own observations, we have been investigating and discovered a glitch that affected the topic submission process in the General Student forum and a couple of other forums. This caused threads that were meant for other forums to get posted in General Nursing. That has been fixed now, so hopefully that will solve part of the problem.

  • Apr 20

    That is the better option in most cases, Rocknurse. However, if your overall impression of the rotation with this team is not favorable, I think you also owe it to future students to provide evaluation and recommendation to your program that this might not be a clinical site worth keeping on the list.

  • Apr 20

    Quote from quazar
    I am currently seeing 3 NPs in 3 separate specialties (I have issues....LOL). It never occurred to me to investigate their backgrounds until last week, when I had an issue with one of them making some questionable judgment calls with regards to my treatment. It was then and only then that I investigated her background.

    I always, always, ALWAYS investigate my MDs prior to seeing them, however. All of the NPs I am seeing are the care extenders of carefully selected MDs. I went ahead and looked up the backgrounds of the other two NPs I see. The one I have an issue with went straight from undergrad to graduate school. I have no idea if that affected her lack of proper clinical judgment and not being up to date on the latest evidenced based practice. Of the three NPs I see, she is the "greenest." One NP I see was a physician in another country. The other, who is actually my primary care provider, had 24 years' nursing experience prior to obtaining her APRN. I have never had an issue with the other two providers.

    Anecdotal evidence, yes, however, there it is.
    If not a secret, how exactly you "investigate" your providers, especially if you have no idea whatsoever what did they actually do during their training and no means to check it?

    (contrary to public knowledge, not all medical residencies, as well as not all NP programs are created equal, and the big names may or may not play any role in the process. And if one of my patients suddenly starts to ask questions "to investigate" my past, I'll be happy to refer him to Boards website to see that my clean license, and ask a person running the desk to send the letter informing him that he has 30 days to request his full medical record to present to another provider of his choice).

  • Apr 7

    Quote from BostonFNP
    or c) preceptors refusing to take students without a relationship with the academic program.
    That. And for those of us not affiliated with anyone, I think it is or obligation to refuse to participate in this. It’s not a matter of “remember how you started, give someone else a chance”, it’s a matter of making sure our profession continues to provide high-quality.

    I worked with a cardiologist years ago who was a trained obstetrician. He wanted to become a cardiologist, so another cardiologist provided him OJT. He actually acquired privileges in 3 different hospitals for cath, intervention and pacemaker implants. His work was mediocre, at best. As new cardiologists came along who were fellowship-trained, his work was called into question. Eventually, the hospitals were forced to rescind all of the privileges except cardiac cath, and he could only do heart caths when an interventionalist was present in the hospital. This stopped his practice, but many, many patients had ill-placed stents before that happened.

  • Apr 6

    Quote from ModernRN
    Please nurses, stand up for yourselves and the patients! Healthcare is evolving to the physicians doing hardly anything and putting all responsibility on the nurse. I feel the shift is for the doctor to spend less time with patients so they can see more pt's which only equals more money for doctors. Conflict of interest in my opinion.
    More money for whom?

    I take it you haven't been watching this situation evolve for very long!

    These physicians of whom you speak - are they employed, or in private practice?

    Man, it is depressing to hear a nurse comment about this situation using the same verbiage as a completely uninformed lay person.

  • Apr 4

    So, for some reason the quote feature just will not work for me (certain I am doing it wrong) but this response is clearly in reference to the OP's claim that my practice of suggesting, accepting and carrying out verbal orders is somehow practicing beyond my scope.

    Have you actually worked in a real, busy teaching hospital for more that a month? Seriously, sorry for the sarcasm, but please don't spread these unrealistic expectations to new nurses. Our docs work 14-40 hour shifts with no sleep and get paid the equivalent of 6$/hr for the first 3-4 years of residency. They have ratios of up to 20 patients PER RESIDENT, and as much as you, the OP hate to admit it, have and EXPONENTIALLY higher level of responsibility, accountability, liability and intellectual input for EACH patient than we do.

    I might get some flak for writing this, but we all know, deep down, these 1st year residents have more medical knowledge and (medicine, NOT nursing) critical thinking than any of us will after 20 years of nursing. Again, I was the one who insisted we are a TEAM - and we are, but for the love of Pete, to blast a doc who has 3x as many patients, is covering up to 8 other teams' patients, admitting in the ED and managing other specialty services...and refuse to suggest and take verbal or phone orders? You are out out of line, my friend. You really, really are.


    I don't know if I have ever meant this as strongly as I do now: YOU DO NOT KNOW WHAT YOU DON'T KNOW.

    If ANY of you have that level of disrespect, misunderstanding, lack of compassion, inability to be a team player...I'm just glad we don't work together. Cause that self centered, "i'm the only one who works hard, knows what's going on, is doing it right..." crap would never fly when I'm in charge.

    Docs must treat nurses with respect when I'm in charge. Nurses are held to the same standard.

  • Apr 4

    Quote from ModernRN
    What I am saying is that the physician should know their patients and write the orders accordingly. We have enough on our plates keeping the sick alive and having to question the physicians orders is absurd in my opinion.
    You don't believe that part of your job is advocating for your patient? Then you're not doing your job. Keeping the sick alive is a collaborative process between multiple health care disciplines. All this anger about what physicians are or are not doing and are or not being disciplined for doing or not doing it seems unhealthy for you AND your patients.

  • Apr 3

    1. Physicians still giving verbal orders - this has been noted as a national patient safety issue. So why can't the physicians protect patients safety? Are doctors truly concerned with pt's safety? If they are ignoring pt safety goals then I'd say no they aren't.

    This will need a culture change within your organization. I work as an NP in a university hospital and no nurse will ever enter a verbal order anymore and I don't blame them. In this age of EMR's, any provider can enter an order himself or herself in any location of the hospital that has access to a workstation (even call rooms for providers). Older providers who trained before the age of EMR will have to keep up and learn or quit.

    2. Why are nurses now responsible to make sure certain medications or therapies ordered such as Metoprolol or VTE prophylaxis? Nurses are getting burned because physicians aren't capable of being thorough enough to make sure they have ordered what is appropriate for their patient. This is just lousy of physicians in my opinion.


    Again, this is an institutional variation. Non APN's are not providers and their scope does not cover writing orders for VTE prophylaxis and beta blockers for whatever indication. You facility is taking a short cut to keep up with regulatory standards by making nurses take care of these issues instead of making providers accountable for this particular part of their role. This is not something nurses decide on where I work.

    3. Nurses having to get physicians to renew 24 hour restraint orders and foley cath orders. If your physician does not know the pt is in restraints or has a foley catheter that requires a new order then they are not fully aware of the pt they are managing care for and is not professional.

    You as the bedside nurses know more of the hour to hour the changes that happen to a patient. I wouldn't know if you're still concerned about patient safety, hence, the need for restraint. I don't feel restraints should be treated in an "auto pilot" way and nurses and providers should collaborate on their use. For that reason, I prefer being told that I need to renew restraint orders. Same with Foleys, I actually have had conversations with nurses who prefer their input prior to DCing indwelling catheters.

    4. Physicians are not giving report of their patients when another physician is taking over call. Calling a physician for help with a pt issue and the MD has no clue who you are talking about is poor physician management in my opinion and is a safety issue.

    It's hard to comment on this. Providers do give hand-offs to each other when they switch. I know we do as NP's in the ICU. However, I don't necessarily respond well to a call from a nurse saying "Mr. S PCO2 is 68". Give me a little bit of background so I can get a perspective of why you're calling me.

    Also realize that in some situations, a provider is carrying the pager for a large number of patients some of whom they only got a one liner about in terms of patient info. During hand off, a lot of the times we get sign out on what to expect as problems that may arise but I'm sure other issues will pop up unexpectedly. That's where SBAR or whatever system you use help.

  • Apr 3

    Quote from TheCommuter
    Life is not fair, isn't it? Physicians are not paid for what they do; instead, they are paid for what they know. The sooner people figure this one out, the less time-wasting rumination about "physicians hardly doing anything" occurs.

    This is one of the benefits of attaining a professional doctorate: being paid for abstract knowledge and consultative services while those with less years of educational attainment deal with the array of busy hands-on tasks. It is what it is.
    Reminds me of the frequent complaint of the nursing aides, the care techs, who insist that they do "all the work and the nurses just sit there at their computers doing nothing". Yes, that's exactly it, the educated and licensed nurses do nothing and the aides do it all. Breaking news!

  • Mar 25

    I am a Direct Entry grad who has been practicing as a FNP since 2009. I had a lengthy career in another health profession, but really wanted to be involved in direct patient care. I have no regrets about obtaining my NP through a direct entry program. I worked harder in this program than I ever had in my life. I was only able to work a limited number of hours per week, as school took precedence and the volume of work was high. My program's standards were high, as they should be. It was stressful, but I never felt that I couldn't handle it or that I had made a mistake. Maybe that's a benefit of going back to school as an older adult. I worked in a community health center for a few years, which was very stressful due to lack of support and resources. I'm now in a private specialty practice, and I don't find it to be very stressful. I'm paid well, I'm good at what I do, I have a great work-life balance. Oh yeah...I also really help my patients.

    If you choose to go the DE route, make sure you choose a reputable program with stringent admission standards. Do not settle for a for-profit school that will admit anyone willing to pay. I personally chose a 100% brick and mortar, no online component school. I felt that being in a classroom and working with other students was a better way for me to learn. I also liked meeting with faculty face to face and being able to ask questions in real time. I think it's also important to find a program that will help you find preceptors for your clinicals.

    Best of luck to you.

  • Mar 24

    I think a doctorate can come in handy for a future role in teaching so I'm considering it but I'm in a state that doesn't offer a great selection of DNP programs that I can attend in person. I'm also considering the cost factor and don't want to spend a lot of money on a degree. I never had loans for my Master's and want to be able to do the same for DNP.

  • Mar 24

    I think you should consider a few things while making your decision: where do you want to be in 5 or 10 years? What are your other goals- professional @ personal? Also, for me, at least, age is a factor.
    I am 53 years old & have been a nurse for 32 years; nurse practitioner for 16. I really like what I do & hope to remain in my current position for at least 5 more years, but I'm tired! If the opportunity arose, I would probably go part time. Obtaining a DNP at this point is just not something I want to put time, effort & money into. It would not help me in my current position & I would not make any more money.
    You, however, may be much younger & plan to work a lot longer than I will. You may just want to bite the bullet & get it over with. Just another hoop through which you will have to jump...good luck!

  • Mar 23

    Quote from SobreRN
    Actually that is what I said. I do not care if they want to get high. Was not my drug of choice but could've been I suppose...I feel a bit sorry for anyone who is strung out on Rx meds given the hoops they jump through. Really I do not see what the big fuss is over anyone altering their mood, that is the whole idea behind alcohol...
    If I interpret your post correctly, I think that you are grossly downplaying/understating the effects/consequences of alcohol and narcotics addiction. Addiction is often a tragedy for the individual afflicted and has negative effects and huge cost on society as a whole. If it was isolated to people simply "altering their moods" and had no other detrimental effects I'd agree with you, but that's far from reality.

    Alcohol and narcotic addictions often lead to a number of crimes, both violent crimes like assaults, spousal abuse, child abuse (and neglect), robberies and murder, property crimes/thefts and prostitution. Addiction often has very negative effects for the addicts themselves. Loss of job, loss of home, loss of custody of children, loss of health, loss of freedom etc.

    My opinion is that as a healthcare professional it's not my job to "police" my patients. My focus as a nurse is to provide appropriate treatment for whatever the patient is hospitalized for, and not moralize about someone's personal choices or withhold medication based on my own personal opinions and biases. My decisions should be based on medical considerations and since I'm cognizant of the fact that I can't objectively measure what my patient is experiencing, in an acute care setting I will err on the side of "overtreating" rather than "undertreating", as long as it's safe (for the patient) to do so.


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