DNP54

How much urine output for the last 24 hours? If he's got dark concentrated urine and constipation, he's not getting enough fluids. If you think he has a UTI, check to see if he's had a UA. Mosby's - Constipation r/t inefficient physical activity (and) impaired hydration r/t fluid deficit. Check his hydration status by oral mucosa, skin, and charted input. If he's good there, then he may have some renal insufficiency. Check his labs. Student nursing diagnosis.....fun times. Good luck in your studies.

I'm starting to think more and more that these medication reconciliations must be profit driven. I'm going to make it a point to see if it is some kind of requirement for reimbursement or somthing. The exact same thing has happened at my hospital, and the calls to physicians have gone up about 40%. Some nurses are just filling in the Dx or indication based on common uses. I stopped doing it when I got into the 'off label' territory with a patient. I assumed that she was taking Megace for her appetite since she appeared cachectic, and then the MD told me that she was actually taking it for hot flashes. Needless to say, they both thought I was a bone-head, and I was annoyed for our management for putting us in the situation that we had to guess what the med was prescribed for. We still have some paper charting, and don't have time to go down to Medical Records and pull the old charts or research each medication, every hospitalization, from every PCP or specialist. I'm all for letting it que up for the MD's to address with their discharge instructions. I sense a checklist in the works...

LPN to BSN is offered at Indiana State University (Terre Haute) at www.indstate.edu thru distance education. The gen eds are all completed via CLEP, Excelsior College and DANTES testing, and then thru the school directly with study guides marketed by the College Network. They will try and upsell you, so contact the school first. There are only 6 or 7 that you have to get from TCN and the rest you can get on ebay, thru CLEP or DANTES (www.collegeboard.com) or Excelsior directly. ISU allows you to challenge all the way up thru Nursing 208 (about 10 Credit hours) because your are an LPN, and if I am not mistaken, they offer the same to military medics and RT's that want to convert to RN-BSN. The clinicals are completed locally thru precepting agreements with local hospitals, and the rest of the curriculum is completed online via blackboard courses (their version of distance learning.) You log on and 'go to class' with professor that checks your work, gives tests and leads discussions. Check it out. California has its own special program that is offered thru ISU, but I couldn't tell ya what the differences are. It's about as pricey as a residential program, but you can save alot of time and money with the testing. The best part is that you start the corps program as a Jr. but you MUST do the foot work first and complete the tests/gen ed requirements. Good luck with that...that's what I'm doing.

The only side effect is that you may potentially begin to test as positive. That's what happened to me after I was serially tested in the military (x4 in 18 months due to lost records during TDY and transfer). One of my physicians that I work with thought I may have had an allergic reaction to a preservative or some other benign element of the suspension, but after that I just got a chest x-ray, and I've never had a TB skin test since. It looked like a positive, but it took a couple weeks to clear up and it did itch. AFTER that incident, I worked in a Native American population where active TB was all around me, but I have never had symptoms, and my CXR was still clear. I used to get them every other year, but now I am only required to fill out a questionaire, and I avoid the funky left forearm spot. I agree with caliotter3....get your own copy of the results and keep them handy. That's what I should have done.

interesting thread. The comparison of PharmD to DNP is probably the closest to correct, in my opinion. Bear in mind that the DNP is not the same as a PhD, usually based in education, administration or research so I can hardly see one being referred to as "Doctor." I would think that they would still be referred to as "the Nurse Practitioner," because the DNP is the doctorate for 'practice.' So many CRNA, CFNP, CNM, etc do their masters degree, and then post certify till they are blue in the face, so they can practice. This is the consolidation degree, so that you can be prepared to do the work without all the random disorganized certifications for whatever certificate granting body that oversees your specialty. As far as the comment about retiring off to advance practice...wow. I'll just have to take a pass on that one. In all the years that I have worked here in the trenches, I have learned that it's all nursing, and its all gotta be done. So if your a clinic nurse that takes B/P and gives vaccines, or a school nurse that keeps my kid safe your just as important as that critical care RN baggin the neonate for 2 hours straight in a crisis. If your burnt, then your burnt, but please don't ever think that one would pursue a DNP to 'get away from the bedside.' I would love nothing more than to be a hospitalist DNP, and I'm 46. Sign me, not afraid of bedside care and will work till I die

Things may have changed, but with the current shortages, I doubt it. The Army and the Navy used to have a 'civilain acquired skills' program. You could enter as enlisted if you were an LPN, or as an officer if you were an ASN-RN. The deal is that unless you get your BSN, you cannot progress beyond the rank of O-3. I went to a civilian school in New York on a military contract, because the shortage was great. In lieu of a sign on bonus, my 'm.o.s.' was to attend nursing school, and when I was done, I owed 3 months of service for every one month of school I received. Check into it with your recruiting command. My initial obligation was over, as I had already been in for 10 years when I changed to nursing, but its worth asking what the current programs may be.

I haven't read the whole thread, only the opener, so maybe ya'll have covered this one...I noticed in different parts of the country, different pronunciations occur. I have learned to control my 'big eye' look whenever I hear one but for starters....there's AN-ginna and then in the midwest there's an-GINa, like lady parts. Then there was med ee ASTinum, but again in the heart land that shows up as MEEDI-a-STINE-um...it just digresses from there. The funniest one was bisacodyl which runs the gamut from bisc-O-dill to BIsa CO dill. I say, if you don't know, ask. I have never had anyone bust my chops for asking for the correct pronunciation, and if they give me the eyebrow, I mutter something like..."did i say that right?" Sometimes they will correct me but its usually something that is frequently mistaken so I don't feel like a total dork. Spelling is a bugger too. Rhus vs ROOS, which cracked me up. Or how about if you ever actually have to listen to dictations? Nothing against ESL physicians, but some of those can be hilarious....Zee patient vas prepped and draped in zee usual fashion...

Hi - I've been an LPN for 17 years and I've pretty much only ever worked in a Hospital Med/Surg environment. In my state, there is no 'defined' scope of practice for an LPN, basically the law states that an LPN can do whatever the facility that employs her feels she has been trained (school, continuing ed, inservice, skills lab) to do. Our assignment for night shift is 1 RN, 1 LPN and a student/cna for up to 10 or on a bad night 12 patients. It's a small county hospital, so we get a little bit of everything. My facilties policy is that I cannot hang blood, although I have had to several times, initiate a care plan, do an admission assessment (again, all the time...its night shift) and thats about it. We take orders, hang and push IV meds and give insulins. There has been alot of discussion about 'critical drips' on the med/surg floor, but in the end, they are all critical. Sometimes the computer charting system requires co-signing, but that's the same for RN's as well. In our hospital its required for insulin, TPN, K+ protocol bolus and some cardiac drips. Only chemo nurses do chemo, but everything else is just kind of out there needing to be done. There are not any LPN's in Pediatrics, not that they couldn't be, there just aren't right now. Same with L&D and ER. Personally, I have been telemetry certified and ACLS, but thats just because my hospital paid for me to take the course and I up date it with my BLS every 2 years. I have worked in Dialysis out patient clinic, organ transplant (stable post op only) and private duty for a couple of quads on vents (adults, alert and oriented). After reading these forums, I realize that I am EXTREMELY lucky, as most LPN/LVN's don't ever get to do some of the stuff that I have gotten to do. There are 6 LPNs in my hospital Med/Surg, and 5 of us are in ASN or BSN programs. One is just working to support her golf habit. The RN assesses the patients, I pass meds, and we round and reassess q 4 hours. We both do patient care and prn's, and I tell her what I have done, or am about to do, or if I am thinking it through, I'll run signs and symptoms by her. I do the line draws for lab, she starts the IVs, not by policy but because I'm a crappy stick. If we need help the house supervisor helps us out. It works out pretty well. I'm alot older than alot of the RN's and we respect the roles. We use our resource people if it gets wild, and it does. I have worked in much more restricted states; no IV meds, only PO and injectables, co-signed. Basically I have been a CNA with a license. So its a really broad range of stuff out there. So, are you thinking about working in a hospital? Its really different than clinic or long term care.

how long have you been a nurse? 17 years do you feel that there is a shortage of nurse educators? yes if yes, do you feel that it affects the number of students accepted into nursing programs? yes do you feel that this shortage affected your ability to become a nurse? (small number of individuals accepted, small classes, etc) no, i was trained in the military thru civilian contract training and got a 'pass' via military funding. do you have any suggestions that could improve the number of nurse educators? i would love to see the return of the diploma program, 3 years, the final year being all clinical. would the nursing profession not be better served by the instructors staying with the class from start to finish, weeding out the inappropriate candidates and mentoring their students to a higher standard and skill level? do you feel that there should be more emphasis on getting current nurses into education? yes, i can make more $54k working 2 weekend 12's only, but instructors are making $40k. something is wrong with that, as i view the instructor as the expert in the field.