ms_sheesh

Survey questions regarding mechanically ventilated critically ill adults receiving temporary enteral nutritional therapy (applies to intensive care registered nurses, nurse practitioners, or physician assistants): Select all that apply RN_____X___ NP_________ PA_________ OTHER (Please specify)_____________________________ Current level of education: ADN BSN MSN DNP PhD BSN/MSN/DNP/PhD student (please specify) Other_________MSN Student_____________________________ Years in the intensive care a. less than 5 years b. 5-10 years c. 10-15 years d. more than 15 years 1.) Does your intensive care unit have a specific guideline or protocol regarding enteral nutritional therapy in critically ill mechanically ventilated adults? a. Yes and it is clear, concise, and easy to understand b. Yes, but I don't quite understand it c. No d. Not sure 2.) In your practice, do you routinely insert a nasal or oral gastric tube in the critically ill mechanically ventilated patient? a. Always nasal b. Always oral gastric c. Whichever is easier d. The purpose of the tube drives my decision (for the purposes of draining or feeding) e. Other_________________________________________ 3.) In your facility, for the purpose of temporary enteral nutritional therapy, what type of feeding tube is most often initiated? a. Salem Sump (gastric) b. Other Gastric______________________________________ c. Post pyloric (Nasojejunal : NJ tube) d. Not sure e. Other___________________________________________ 4.) After enteral nutritional therapy has been ordered, what assessment criteria drives your decision that the critically ill mechanically ventilated patient is ready for enteral nutritional therapy to be initiated? a) Bowel sounds auscultated in all four quadrants b) Lack of abdominal distention c) Patient has been intubated for more than 72 hours d) The therapy has been ordered so there is no other criteria necessary e) Other_All of the above________________________________________ 5.) What rate do you currently initiate your enteral nutritional therapy in the critically ill mechanically ventilated patient? a. 10 milliliters an hour and advance to goal as tolerated b. 20 milliliters an hour and advance to goal as tolerated c. Bolus feedings d. I start my feedings at the goal rate e. Other (please describe)___________________________ 6.) What monitoring criteria do you employ when caring for a patient receiving enteral nutrition therapy? a. Gastric residual volumes b. Promotility agents c. Patient positioning d. All of the above e. Other_____________________________________________ __ 7.) What assessment criterion currently drives your decision that the patient will tolerate an increased rate of enteral nutrition therapy a. Bowel sounds auscultated in all four quadrants b. Lack of nausea and or vomiting c. Lack of diarrhea d. Gastric residual volumes e. Other______________________________ 8.) After initiation of enteral nutritional therapy, how often do you assess gastric residual volumes? a. Every hour if residuals remain high b. Every four hours c. Every eight hours d. Once a shift e. Other_____________________________________ 9.) What amount of gastric residual volumes would you consider acceptable to advance your feeding rate? a. There should be no gastric residual volume b. 10% of amount of feeding instilled c. 20% of amount of feeding instilled d. I do not use gastric residual volumes as an assessment criteria to determine patient tolerance to enteral nutritional therapy e. Other____________________________________________ 10.) When assessing gastric residual volumes, what amount would you consider "High volumes" which would cause you to "hold" the patient's feedings. a. Greater than 50% of the amount of feeding instilled b. Greater than 250 cc in a four hour period regardless of the rate c. Greater than 500 cc in a four hour period regardless of the rate d. Greater than 100 cc in an hour regardless of the rate e. Other _______________________________ 11.) When assessing gastric residual volumes, how much do you consider an acceptable amount to return to the patient? a. I discard all gastric contents b. I return all gastric contents c. I return only 250 cc of gastric contents d. I return only 500 cc of gastric contents e. Other____________________________________________ 12.) How often do you flush your feeding tubes? a. 60 cc every 2 hours b. 60 cc every 4 hours c. 60 cc every 6 hours d. After administering medications e. Other_______120 cc/per shift______________________________________

ALBANY PASSES MIDWIFERY MODERNIZATION ACT Bill Eliminates Barrier to Midwifery Care for Women Across NY State NEW YORK - June 30, 2010 - New York women now have the right to expanded health care options, including access to the safe and satisfying care of a midwife, with today's passage of the Midwifery Modernization Act by Albany lawmakers. The law removes the requirement for a signed written practice agreement between licensed midwives and obstetricians or hospitals. The legislation does not change the midwives' scope of practice and supports collaborative, clinical relationships with hospitals, obstetricians and other specialists such as pediatricians and perinatologists. Physicians who enjoy collaborative relationships with midwives are now unencumbered from signing a document that many feel implies responsibility for patients they may never see. "This is a major victory for women's health care across New York," said Laura Sheperis, president of the New York State Association of Licensed Midwives (NYSALM). "Midwives are the acknowledged experts in normal birth - and this legislation ensures that New York's women have the right to choose the birth options and health care providers they desire - including the care of highly educated and licensed midwives. From those seeking care for home birth to those in rural areas with limited access to maternity care, the passage of this legislation will have a significant impact on increasing access to safe health care options across the state." With New York State Assembly and Senate passage of the Midwifery Modernization Act, New York joins many other states that offer women and their families access to a full range of birth and women's health care options. Assemblyman Richard Gottfried and Senator Thomas Duane sponsored the legislation (A8117-b/S5007-a) with numerous co-sponsors. "This is an important step forward for women's health and the 1,300 licensed midwives in New York who perform about 15% of the non-Caesarean deliveries, with exceptionally high rates of successful outcomes and patient satisfaction," Assembly Member Richard N. Gottfried, sponsor of the Midwifery Modernization Act, said. "The written practice agreement is an unnecessary restriction that blocks many midwives from serving their community and the families who chose a midwife." The legislation has a variety of supporters, including Amnesty International, the New York Perinatal Association, the New York State and New York City chapters of the National Organization for Women, statewide BirthNets and many physicians and nursing organizations across the state. About NYSALM The New York State Association of Licensed Midwives works to promote the health and well being of women and infants through midwifery care, facilitate the professional practice of licensed midwives in the State of New York, and to encourage and maintain collegial relationships with healthcare providers, institutions, and organizations. For more information please visit www.nysalm.org.

Hi nastasha284, It is very unusual for no one to return your phone call. However, I urge you not to be discouraged. As a Frontier student, I can tell you that Frontier Bound is an extremely busy time for staff and faculty, (especially on the Wednesday before it ends. I'm sure any student can attest to that.) Today, the students are preparing to leave if they haven't left already so you may get your return phone call today. Frontier is a really good school with a strong curriculum and well-worth the wait. I promise.:)

Thanks, David. I'll be sure to pass this information along to her. Maybe she'll delve a bit deeper and do some research of her own.

Hi all, I have just gotten off the phone with my friend who is very upset about her school's requirement to be vaccinated against the h1n1 virus in order to remain enrolled in classes. She is currently taking core classes which have all been online - yet is being told that she has until the end of the month to get vaccinated or she will be dropped from her classes. Her reasons for not being vaccinated include: 1. There is a very small percentage of infected persons presenting with life-threatening symptoms (Most time it is self-limiting) 2. Its a new vaccination - where most vaccinations/medications are tested for years, this vaccination was just developed last year and immediately used without proper testing. 3. The recent recall 4. She claims that in her hospital there has been a incidence of Guillain Barre after a pt received the h1n1 vaccination. Personally, I don't feel that anyone should be coerced into taking the vaccination especially given points 1-3 (I can't agree with point 4 as I've never witnessed it myself) Jost curious, what are your thoughts?

Congratulations, oldnightnurse!! See you there!

oldnightnurse, I wouldn't fret. I believe they notify students based on programs. It is possible that they haven't started to notify accepted students into the CNM or WHNP programs yet. I don't think a phone call would harm anyone. Good luck to you and I'll keep my fingers crossed for you too.

MSPRN01, Thanks for the congrats. Don't worry, I won't stop crossing my fingers for you. The only difference between getting into class 73 vs. class 75 is the dates for Frontier Bound (February v. March). Both classes actually start in April. We'll probably start classes together anyway.

Congrats to you, Sugah. :clphnds: I'll see you there

Drum roll please..........I GOT ACCEPTED INTO CLASS 73!! No more pacing about. I can finally breath!! WOO HOO!! Please check your emails and let me know. I won't uncross my fingers (or toes) until you do!!

Boy, they weren't exaggerating when they said the end of the month!! Checking my email everyday...several times a day...still keeping these fingers crossed. Hope everyone had a wonderful thanksgiving

I am in the process of taking both classes together. I will not lie...there are moments where I feel I may have bit of more than I can chew. However, I have been able to maintain an A average thus far. May I add that I am a new mom (6 month old baby) and I work part-time as a house supervisor at a local hospital? I am definitely sleep deprived and I am counting the weeks until this semester is done. The two courses coincide in that each system is done at the same time in each class. So when I covered the cardiovascular system in patho, we were doing meds for HTN, Hyperlipedemia, angina, etc, in pharm. I think that is what makes it easier. It really is a personal choice whether you should take both classes at the same time. If you decide to do both, just keep in mind that it takes up time and and requires dedication to do well. If you are willing to commit your time, then I think it can be done.

Ditto.

Yeah, I was told we wouldn't hear anything until late November, early December. I don't really mind if I get into Class 73 or 75 as long as I'm able to start in April. Fingers still crossed!

Hi MSPRN01, Welcome to the applicant pool!! I'll keep my fingers (and toes) crossed for you also.

Hi Berkshire, Was wondering how school has been going for you. I'm just one more post away before I can PM you. Again, thanks for being so helpful.

Hi Sugah, I haven't uncrossed my fingers or toes yet but now that I know you're applying as well, then I'll cross them even tighter. Isn't it torture to know that we have to wait two more months before we can get a reply? Did you have your interview yet?

Hi, Have you looked into UMDNJ? The nursing school has several NP programs. Currently, cost is 486 per credit. The core classes can be taken either online or on campus. I've actually attended the information session and it seems like a decent school. My only problem with the school is that because they offer clinical classes once a year, it can take a long time to finish, but if this doesn't bother you then I say go for it. You can find the link below. [email=http://sn.umdnj.edu/]http://sn.umdnj.edu/[/email] Good Luck

Hi all, I was just wondering....what was your hardest graduate course? And what would you tell other students to do in order to prepare?

Hi Barb, I actually applied for Class 73 so I won't hear anything from them until the end of November. ( I think they are still handling applications for Classes 71 and 72). But I had the interview already and things went pretty well. I get excited thinking about it. It's great that you are willing to share your experiences with me and I would really appreciate that. However, I can't PM you just yet. I have to post a few times more before I able to use that function. However if you don't mind PM-ing me, I would appreciate that too.

Thanks, Berkshire. I have already sent in my application. My fingers are crossed. Hopefully all will go well.

Thanks Smark. Good luck on your journey to becoming a midwife.

It is my understanding that most schools will want to see your college transcripts before making a decision. But I suggest you give the school's admissions office a call to ask them. They are best equipped to answer that question. Good Luck!

Hi all, I am thinking about applying to Frontier for the FNP Program. While I have read and heard great things about the midwifery program, I haven't heard much about the FNP Program. I would appreciate any feedback from current students or graduates of the program. Thanks.

Well, its obvious there is a difference of opinions (which each of us are entitled to). And while it certainly has been a few years since I've graduated, I do have a friend currently attending the school who has complained about professors and med math exams (just as you are and like I did when I was in school) but still states she would recommend the school to other people wanting to become nurses. According to her, she learned a lot. I'm sorry your experience is not/has not been the same but I do wish you the best of luck in your studies.