Kimmercris

Dear meandragonbrett- I am not sure why you felt the need to pick apart what I wrote. It should be understood that all levels of nursing start at the college level--in no way did I attempt to imply an LPN's 1 year curriculum was based upon "experience". Licensure does not occur until program requirements are completed and national boards are passed. It should then also be understood that a PA continuing on from a bachelor's degree would be entering into a master's level program. Never meant to imply otherwise. Yes, we should work together. Yes, there are differences in philosophy. No, it is no longer appropriate for the generic term "nurse" to be applied solely to ARNPs or APNs as this confuses the public and is unaware of the details and differences in scope of practice. That said, my reply to the person posing the question was to delineate that there is a marked difference between what he/she viewed in her experience in the ER for what RNs were practicing and how an ARNP would be practicing. The goal is to educate and allow for choice. In no way did I attempt to "slam" anyone in the medical field. Hope this clears things up.-kimmercris

Hello- In most states PA's have any 4 year degree, volunteer medical hours and then take a rigorous 2 year medical school program. After passing certification their licensure is attached to an MD's and they are an extension of that MD. Yes, there is a component of surgical assist included in the programs. And yes, they can be considered hard to get into and rigorous. But the bottom line is there is a difference of observing as a tech and functioning in a full medical capacity. To give a sense of what an ARNP difference is, and not a general nurse, it is important to know the nursing levels first. There are several levels of nurses. There are LPN's with 1 year experience to pass meds and work in a team capacity with RNs. They have a limited scope of practice that allows them to only perform certain skills/tasks. Their ability to give patient health education is limited to protocols. Focus is on skills. However, they have to have a certain number of direct patient hours and function in that role before passing for licensure. There are ADNs w/2 year degrees (usually a bit more because of prereqs) who focus on skills, assessing the patient (LPNs aren't qualified legally to do this level of care), they deliver meds, they perform IV skills, etc...All of this is apart of their rigorous program which includes lectures and clinicals. Later they must pass a licensure exam for an RN. There are BSN's w/4 year degrees (also usually more) who do all of the above that an ADN program has but critical thinking and team leading and greater care delivery is apart of this program. They have 3 years of clinicals or more caring for patients and coordinating care with the medical team. They can give patient information on their own and also determine if a Healthcare provider's orders should be carried out. They do not diagnose but they know what signs and symptoms are apart of a diagnosis and they monitor labs and report abnormals as well as provide patient family teaching and support. They also must pass a licensure exam. In addition, they carry out complex patient treatments and can become certfied in specialties of OB/GYN, surgery, Emergency medicine, wound care, lactation, oncology, cardiology, critical care, etc.. after taking advanced classes (beyond the BSN level) and sit for specialty certification. To become an ARNP, you must acquire your masters and take specialty courses that are approximately 7-8 quarters in length fulltime. You determine whether you are going to be an OB/GYN, Family practice, Peditric, geriatric, adult, acute care, psychiatric etc...ARNP with your particular field of study. Most programs require you to have been a full time medsurg BSN RN for 2 years before entering their program. The program often doesn't include a surgical assist component because it is understood that most BSN programs include that in their rotations. The program is rigorous and includes study in assessment, diagnosis, treatment, pharmacology, and fulltime clinicals for 3-6 quarters. Your preceptor and clinical experience can make or break your education. ARNPs are usually quite well rounded who view a whole patient verses one built merely on the disease model. We look at the balance of the patient and also hold them up to a disease model as well. We diagnose, treat, perform procedures (which vary where you practice) and prescribe most medicines MD's do (except in a few states), and in most states are not tied to a MD's license. We have more experience than PA's. We have a different style of approach in terms of being more likely to look at lifestyle and nutrition in addition to disease and medications. We are great at prevention but can also function as specialists too (I hold wound specialist and family practice certifications). Why might MD's hire a PA? Because they were developed by the AMA, ARNP's came from a nursing tract (but please do not call us "nurses") MD's historically have been unhappy with ARNPs because they have not been able prevent them from functioning independently (like most PA's). Now, that said, have I met some fine PA's? Yes! Have there been some ARNP's less clued in? A few. That is true of MD's too. If you want to do school fast and be supervised and learn under a medical model, o.k. If you want more of a wholistic medical model focus but a longer course of study and experience, then be an ARNP. Wherever you go, the program, the mentors, and what you put into it is what counts. But think about this, how would you feel if you knew your MD "rushed" through med school? Best of luck. kimmercris MSN, ARNP, WOCN edmonds, WA

I am an ARNP with many years of experience. Working with kids means that they are unpredictable. Best idea is to keep the kids safe at all times which means staff checks in their meds in the office but can come in and take them by themselves in the office at med times. This may not seem convienent to them but then, "camp is for the campers", not the staff really. Also, staff understand when you explain that it would not be great to explain to a parent how their kid got sick from access to your antidepressants ect...most staff working with kids get this. Additionally, staff have problems too. I always have staff and kids parents fill out health questionaires so that if they get sick I can be aware of what is going on. I had 2 staff members get stung by bees this last year and get throat swelling reaction. They got an epipen injection from me a quick physical assessment and a trip to urgent care for prednisone IV. Nuf said? Soo...err on the side of caution. You are legally responsible to know who has what when so be sure to keep all the meds safe--staff members too. You don't have to dole it, they can check it off the list, but it stays out of campers curious hands. K?

Dear Joy- I understand you are venting and good for you. Yes, nursing school doesn't fully prepare you for the realities of being a registered nurse. It is even more difficult if you went through a fast track or 2 year program because the focus is on recognizing diseases and caring for the patients that have them. The expectations are the ideal and you are correct in needing the "big picture". I recommend getting a mentor. Someone who is positive, can help you navigate the unspoken decision-making that nurses need to make and set clear and appropriate boundaries with the staff members you interact with. Remember, it is really easy to kick yourself for the 2 things you didn't get done in a shift (that may not be remembered in 2 weeks) but not applaud yourself for the 54 things you did get done and did correctly. Learning organization is key. Knowing the type of person you are is also helpful. Keeping your expectations realistic is important to avoid burnout. A mentor picked wisely can be someone you can debrief with. Someone you can ask social-scenario-professional questions of who will "get you" and who can offer valued insite. They should be o.k. with you making your own decisions though, despite their advice. Learning about the role medical providers (ARNPs, MDs, surgeons, and PAs) have and the decisions they have to make is important too. This will help you know when to interrupt them when they are thinking through their assessments/plans and when to wait to chat. Nursing education continues well beyond school. There are some really good articles about your role growth from a novice to expert. When you master your area, don't forget that the newbie nurses will need your kindness and support. Best of luck (and hope this helps).-kimmercris arnp

I am sooooo sorry. First, it sounds like you did EVERYTHING you could possibly do. Second, most Diabetics never experience chestpain due to neuropathy. When you have someone who's physical body has had some much going on, it is really hard to say what really occurred. I know that Type 2 Diabetics are considered cardiac risk factors BEFORE they even have noticable cardiac complications like HTN and hyperlipidemia. So their risk factor goes up when they get the complications. This is going to be a really hard thing to live through with your kids. Your kids watching the situation will know you did what you could, would have seen that everyone tried to help dad, but you both will have things you will want to work through. I really recommend grief support for yourself, for your kids, and for your teen. I work with kids in these situations and they really experience help and support when they are connected with other kids who have lost a parent and been through a traumatic situation. Give yourselves time to work through it, but don't go it alone. Again, it sounds like you did what you could do and your husband's body had a lot of burden on it that couldn't have been overcome. If it isn't to late, did you order an autopsy? Sometimes you can get an answer for what caused his death. I'll be keeping you all in my thoughts and prayers.-kimmercris, arnp

Hello- You never have to put up with inappropriate unprofessional behavior. Ever! School alone is mentally and physically exhausting. Who is doing the yelling and the grabbing? Who is your mentor or instructor? If it is your preceptor, discuss this with your school. No one who works with patients in the medical profession should put up with being yelled at, scolded, grabbed, etc... Yes, you need to tough out grueling hours, really "bone" up on your stuff, and present yourself as a professional. You do need to find out who your advocates are, use them, and find out what the institutions policy on harrassing behavior is to handle in calmly, discreetly, and professionally. Do not let people with bad behavior make you drop out. Carry yourself well and demand calmly the respect you deserve as you are learning all of this. Be sure to seek out a mentor who can help you navigate the waters. Also be sure to speak about 20% of the time and listen 80%. Surviving my masters and ARNP school was hard and awful but not that hard and awful. Be encouraged and good luck! kimmercris, arnp, edmonds WA

Hello- I am an ARNP with a Masters of Science in nursing. One of the things that registered and licensed nurses fail to do is to report anyone representing themselves as nurses and offering medical/clinical advice. You have to be licensed by a state certifying body to call yourself a nurse and you have to be a registered nurse to give medical education but you cannot diagnose nor recommend treatment unless you have an advanced practice degree. We as licensed professional nurses need to educate and inform the public/administrations, protect our licensures, and crack down on non-nurses. This is a serious legal issue that we need to take seriously because people get hurt by non-nurses all the time. We have standards of care we work hard to uphold and stay current on. It is important that a written letter go to the school board, the district superintendent, and the state nursing board of quality assurance as well as the state medical boards. Does this sound harsh? No! If we were identifying ourselves as physicians, diagnosing, and treating and the state medical board found out; we would be in BIG trouble. Why do we not defend our profession to protect our patients from "well meaning" people practicing out of their scope? This may be difficult, uncomfortable, and time consuming but please do this for our patients and our profession. Good luck! kimmercris arnp, edmonds WA