chudder

Find a Nursing ROTC program near you....

USAGPAN is calling, AjaxAndronicus.......

"The Initiative" sounds so exclusive and mysterious. If you plan on staying in the Bay Area, try to do clinicals at hospitals you want to work at. If you're leaving the area entirely, just focus on getting excellent clinical experience and letters of recommendation. Depending on where you are going, the UCSF name may make a difference. You *want* to serve on committees. These are the kinds of things that distinguish you from other grads in a competitive new grad market.

The new Pocket Anesthesia is good... these laminated reference sheets are great: Anesthesia & Critical Care Reference Sheet | Home or Anesthesia Reference Sheets

If you're going to try for tuition reimbursement and a high salary, might as well get out of Florida now instead of later...

U.S. Army Graduate Program in Anesthesia Nursing

There are CRNAs at UCSD Thornton and Hillcrest.... and at the VA. Google a phone number and set up a few days of shadowing. Look into an accelerated BSN and do everything you can to make yourself the best candidate to get hired into an ICU as a new grad. Extern, work as an aide, certifications, letters of rec, etc. Be your best and work hard. Do a couple/few years in ICU developing yourself into a critical care nurse who can handle anything that comes through the doors... and then put in your applications to CRNA schools. Oh, and keep your mouth shut about your goals. Sounds strange, I know, but you will not likely get hired into an ICU if they know you intend to "use" them to get into CRNA school. ICU nurses can get sick of precepting a constant merry-go-round of new nurses on their way to becoming a CRNA. Invest in the unit as much as they invest in you.

It's possible that there is more to learn at your current job by digging deeper into the pathophysiology and pharmacology of anything and everything going on with your patient. Can you explain, to a molecular level, the acute and chronic changes occurring in, for example, a diabetic patient? How exactly does X, Y or Z medication work? Is there more to it? What alternatives are there, and why was this one chosen? You may want to seek out higher acuity patients elsewhere, but I agree that you will likely not get sick patients if you are per diem.

Susie2310, I started the thread to share a petition, not to bring you literature on a platter. I presented the results of a very cursory literature search, you snipe at the results, present no evidence to support your biased opinion, and then pass judgment on my "case." Get back to me when you have some evidence to share.

Feel free to perform a literature search on the subject and present the evidence yourself, or go ahead and continue to rely on your opinion. I have read only the articles pertaining to CRNA practice. It is not my goal, however, to correct your bias with evidence. This inquiry is one you need to undertake on your own, when you are ready.

I did include the link to the HealthAffairs Health Policy Brief from which I took the quote.... Here are some more articles to whet your appetite: Horrocks, S., Anderson, E., and Salisbury, C. “Systematic Review of Whether Nurse Practitioners Working in Primary Care Can Provide Equivalent Care to Doctors,” BMJ, April 6, 2002, Vol. 324, No. 7341, pp. 819-23. Jackson, D.J., Lang, J.M., Swartz, W.H., et al. “Outcomes, Safety, and Resource Utilization in a Collaborative Care Birth Center Program Compared with Traditional Physician-Based Perinatal Care,” American Journal of Public Health, June 2003, Vol. 93, No. 6, pp. 999-1006. Laurant, M.G., Hermens, R.P., Braspenning, J.C., et al. “An Overview of Patients’ Preference for, and Satisfaction with, Care Provided by General Practitioners and Nurse Practitioners,” Journal of Clinical Nursing, October 2008, Vol. 17, Issue 20, pp. 2690-698. Lenz, E.R., Mundinger, M.O., Kane, R.L., et al. “Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians: Two-Year Follow-Up,” Medical Care Research and Review, September 2004, Vol. 61, No. 3, pp. 332-51. MacDorman, M.F. and Singh, G.K. “Midwifery Care, Social and Medical Risk Factors, and Birth Outcomes in the USA,” Journal of Epidemiology and Community Health, May 1998, Vol. 52, No. 5, pp. 310-17. Mundinger, M.O., Kane, R.L., Lenz, E.R., et al. “Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians,” Journal of the American Medical Association, January 5, 2000, Vol. 283, No. 1, pp. 59-68. Naylor, M.D. and Kurtzman, E.T. “The Role of Nurse Practitioners in Reinventing Primary Care,” Health Affairs, May 2010, Vol. 29, No. 5, pp. 893-99. Needleman, J. and Minnick, A.F. “Anesthesia Provider Model, Hospital Resources, and Maternal Outcomes,” Health Services Research, April 2009, Vol. 44, No. 2, pp. 464-82. Pine, M., Holt, K.D., and Lou, Y. “Surgical mortality and Type of Anesthesia Provider,” American Association of Nurse Anesthetists Journal, Vol. 71, No. 2, pp. 109-16. Silber, J.H. “Anesthesiologist Direction and Patient Oucomes,” Leonard Davis Institute of Health Economics Issue Brief, October 2000, Vol. 6, No. 2. Wilson, I.B., Landon, B.E., Hirschhorn, L.R., et al. “Quality of HIV Care Provided by Nurse Practitioners, Physician Assistants, and Physicians,” Annals of Internal Medicine, November 15, 2005, Vol. 143, No. 10, pp. 729-36.

I need a .gif of Cuba Gooding Jr saying "show me the evidence!" Does educational level correlate well with patient outcomes? You present "evidence by proclamation" only. AFAIK, NPs can practice in independent, unrestricted roles in 18 states. Are their citizens suffering? I'm not trying to push NP care on you or your family. Increasing APRN utilization by removing practice restrictions promises to increase access to primary care for all. Check out https://www.healthaffairs.org/do/10.1377/hpb20121025.457840/full/ An excerpt: There is a growing body of research demonstrating that patients perceive that receiving primary care and having a usual source of care is more important than who it was that provided these services. Studies comparing the quality of care provided by physicians and nurse practitioners have found that clinical outcomes are similar. For example, a systematic review of 26 studies published since 2000 found that health status, treatment practices, and prescribing behavior were consistent between nurse practitioners and physicians. What's more, patients seeing nurse practitioners were also found to have higher levels of satisfaction with their care. Studies found that nurse practitioners do better than physicians on measures related to patient follow up; time spent in consultations; and provision of screening, assessment, and counseling services. The patient-centered nature of nurse practitioner training, which often includes care coordination and sensitivity to the impact on health of social and cultural factors, such as environment and family situation, makes nurse practitioners particularly well prepared for and interested in providing primary care.

The "just a signature" comment was meant more to deflect criticism of the petition... as if signing the petition takes away from other advocacy efforts. It was not meant to diminish its importance. By the same token, nobody expects a whitehouse.gov petition to change to world... but a multimodal approach does work well in most advocacy efforts. value = quality / cost... and I can't speak to any theories about restricting access for primary care physicians.

Agreed! Thankfully, there is no need to pick one over the other.

Swans are definitely on the way out. We only see them in hearts, and plenty of places are doing hearts without swans these days, too. The evidence for their use just isn't there. I would LOVE to get my hands on one of these !Most of the non-invasive options have one limitation or another. Esophageal doppler is great but not for conscious patients and it only looks at flow in the descending aorta. SVV, SPV etc is, AFAIK, only really validated in patients who are not breathing spontaneously. Here is a fantastic review article on some current noninvasive monitoring techniques, written by Dr. Marik. His 2008 systematic review of the utility of CVP as a guide for fluid resuscitation is a very good read.

We transitioned to a completely open unit and took the locks off the doors in the name of family and patient centered care. The literature presented clearly supports it, and family members love it. Nurses generally hate it, because they treasured the no-visitor shift change time to prep for the shift without any distractions. It is workable and even beneficial, IMO, if nurses are consistent with what they tell family members about what to expect about shift change and bedside report. After addressing any pertinent questions or needs right before shift change, request no interruption during report. Let them know that you will come into the room to do bedside report and medication and IV line reconciliation with the oncoming nurse, too. If family members grow to expect a routine, the majority of them will be respectful... in my opinion. There are always outliers. If it were my family member hospitalized, I would be offended if I were not allowed to be bedside at an hour of any day.. as long as I was not interfering with care.

I answer in generalities if police are present in person, but never over the phone. If it's a phone call I transfer it to the charge nurse or give the officer the nursing supervisor's phone number.

New policy: white scrubs for the two nurses who have gone the longest without a code brown!

Was my post moved or deleted? I had one reply from a moderator/guide concerned that advocacy efforts might better be focused elsewhere, I replied respectfully, and now the thread is nowhere to be found. What gives?

Of course, and good point! Lobbying the executive branch on matters that the President can't directly regulate can still make an important difference, though. e.g. if CMS doesn't pay, then it doesn't matter (as much) what any state says the APRN can or can't do...... or lobbying may have an effect on the President's overall health care message or platform. Plus, it's just a signature!

https://petitions.whitehouse.gov/petition/remove-barriers-prevent-advanced-practice-registered-nurses-practicing-their-full-scope/4Z8X6s7C Please take a few minutes to create an account and sign the petition!

from what I understand, CRNA malpractice rates actually dropped in the years following passage of the Medicare Opt Out rule.

better that they jerk you around now instead of later when you are a student!

as a civilian, you will not get one. you will get your first DA 31 when you PCS to your Phase 2 site.