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t2krookie

t2krookie

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  1. t2krookie

    Struggling NP student

    Sounds like you have some confidence issues there. I might sugest talking to friends who have been in your shoes and are now working the job instead of styressing over perfection. Preferably over a glass of wine or a good single malt :) Learn to laugh at yourself. It is almost over. Another point is, your clinical practice area may be a big part of the problem as well. Think about it, and identify the true source of the anxiety. It usually can b found.
  2. t2krookie

    Nurse Practitioner with an MSN

    I will seek to clarify this further and say that this is ONLY one "sugestion" from ONE of two national nursing program certifying bodies (I believe more are popping up) and in no way is law or even foreseable future rules. Futhermore, this is the same organization that has stated that BSN should be the mandatory entry point for RNs and that "sugestion" has a thirty year old history. Heck there are still certificate RN programs around though they are diminished IMO due to compitition from community college programs more than due to a strive for advanced degrees. A big issue to be resolved is that of the current DNP programs in existance, most have a curriculum that is definately not focussed on patient care but rather a not so subtle drive to increase available Nursing doctorates for management, leadership, and faculty roles. Having reviewed over 50 of these programs, that was my overiding impression. Most had only one or two courses in the entire program that had anything to do with clinical care. I for one am not willing to fork out a small fortune as well as invest even more of my time for schooling that doesn't address my needs as a practitioner. K, done B & M ing
  3. t2krookie

    UTHSC Houston Vs TWU for FNP track,fall 2011

    My best friend is a TWU FNP student and attended the Dallas campus and after speaking with him and meeting some of his fellow students, I am so glad I did not apply there. they might be local but they are amassing a poor reputation among the student body with hostile and unreasonable instructors. Most of the students I spoke with were desperate to change to the Denton campus. I will qualify this with the fact that this IS hearsay as I have no direct experience, but I do trust the word of my friend and that word is not good for the faculty of the Dallas extention campus. Plus what guy wants TWU on his degree anyways huh? :)P JK
  4. t2krookie

    Shadowing a Psychiatric Nurse Practitioner

    She could go the route of local public OP clinic. The clientele zenman is describing I find more often in the private practices. In the public mental health clinic, the clients are often simply happy to have someone to talk to about refills or side effects and most often they end up seeing a different practitioner every two visits anyways so while desirable, the therapeutic relationship is not really a reality among this socioeconomic group. Another good part of this approach is that you see a high volume of patients and a nice case mix. Best educational opportunity available in my opinion. However, be prepared. Psych work takes an incredible amount of patience and a damn good control of ones temper at times. It may or may not b your cup o tea.
  5. t2krookie

    Which is better for Psych NP: Yale GEPN or Columbia ETP?

    Umm at Case we do 3 of general pharm and 2 or psychpharm but the general psych meds are included in the general pharm.
  6. t2krookie

    Antipsychotics and Pregnancy

    Hypothyroid,a new cutter @ 15, and preggers with alleged psychosis decompensation? Was she psychotic before? Long past time to pass that buck. The trifecta in hallucinations is very questionable. Sounds like a bigtime axis 2 but ya got a big mess there it seems.
  7. t2krookie

    PMHNP

    Case Western. Very nice program but very expensive. I would highly recommend getting your masters first and waiting for the dnp programs to become more clinically relevent. Currently most DNP corricullums has little clinical aplication and a whole lot of quasi educational and leadership/management. Not worth it in my opinion unless thats the route you wish to take.
  8. t2krookie

    The latest good news for all of us

    Thanks and I do appreciate your view on engaging the repeated offenders. The only reason I do so is that I fear that many nurses may become discouraged if they start believing the c#@p some are peddling. For some it makes it difficult to distinguish conversation from bs when the poster mixes in some truth along with the aforementioned cr&@ola. I also am a bit disappointed that more nurses are not researching and refuting these types of responses but perhaps many just don't have the time or are just plain tired of responding to it. In my view that is worse. When we give up on responding, we in essence give up on advocating, and validate the bs. I know It can become old though. I guess I'm just stubborn. Back to the books.
  9. t2krookie

    The latest good news for all of us

    I got the Email that said you had actually posted to this thrad so I decided that was worth an early reply. I agree that the same issues keep being rehashed but I hope you can see that it was a self identified non-nurse that brought those tired arguments to the thread. I will vigerously defend myself and my views against their attacks but it would be nice if APNs and APN students could actualy have a thread celebrating our sucess and acomplishments without seeing the same two or three individuals trolling around and pouncing anytime we say something positive about APN outcomes or studies. I dont troll medical discussions and engage in that kind of behavior and it would be nice if Allnurse admins would recognize trolling behavior for what it is and do something about it. It has got to the point that we are unable to say anything positive on our own "nurses" forum without having the thread hijacked by the same people and the discussion runs it's typical course. Please do something. It tires a person to the point they are not interested in advocating for the profession when we recieve little support. Sounds a bit like the real world of nursing:twocents:
  10. t2krookie

    PMHNP

    Okay. glad you mentioned your perceptions because you have been mis-informed. Most distance programs (I had researched in detail nearly 100 during my undergrad) do not require more than an initial meeting to orient to the information delivery and teachers speech. My program does in fact have a clinical assessment on-site requirement but it is worth it to me for other reasons. I repeat, most do not require more than an initial meeting and many do not even require this. Don't go by the limited listings in the sponsered sites telling you about NP programs. Instead do a google search for "distance NP program" or something along those lines and expect to spend a large amount of time telling the "sorta" distance programs form the real ones. It is worth it. It opens a heck of alot more options for you. RODP programs comes to mind. The colleges involed in that colaborative do not require onsite meetings. UAB is the same I believe but some have spoke ill of their experience. Good luck and start early. There are some programs that begin in the spring but most begin in the fall only.Still others start in the summer only. Several have due dates for applications one year out. Very little consistancy.
  11. t2krookie

    The latest good news for all of us

    Agreed for the most part. In reference to patient satisfact/preference I do however feel that patient satisfaction does have to be a small part of the measurement of quality in comparison to outcomes, however not nearly as much as current initiatives. Makes good PR though . As we all know, ya can't cure stupid but we can treat it:D
  12. t2krookie

    The latest good news for all of us

    in response to points 1, 2, 3, and 5 i refer you to the references/literature sources for the asa response. i went and did indeed look at all of the information that is being passed as sources for the asa president’s article. he really didn't take much at all from the articles. but as i quote you, “[color=sandybrown]if you didn't read a study yourself, you shouldn't be drawing conclusions from it". otherwise your just another talking head right? i'm sure if we were drinking buddies we would agree but being as we have very different perspectives on apn autonomy it would not be strategic to admit this in a public forum. thus i will put this in words that may satisfy you present requirements for valid discourse. you presented an article from the asa president in support of your views that was based on data (with a simular yet smaller data set than the crna article) , as well as data from a study of pt. preference (analogic with satisfaction? since pt.’s as you say don’t know a thing about what is good care and what is not)( i repeat your own words "they're not my words. i hope you realize that much at least" when referring to the asa paper yet cite information from that very article. so in what universes are you living that you can use information from a source for your position and not be subject to the critique of the quality of information of that source that you so readily heap upon others in opposition to your view? i'm not putting words in your mouth dg. i'm re-inserting them into your mouth. one advantage of debating you and your pet is that i have become familiar with your tactics, and i have a good memory of our many "discussions". ya just can't have it both ways. in reference to #4 i will say that you just did not read that part well. if you read it without being inebriated or stoned (i.e. clearly) it acknowledges that specialists have to retest boards, but that re-testing for "licensing" would be interesting in a not so nice way for professionals(both nurses and physicians). also it was a side point to the discussion and a speculative tangent. are you writing these late at night? get some sleep man! i cannot spend too much time on this as we are deep into new material this semester so i need to hit the books. before i go though, i have to say that it is unfortunate we disagree on so many things. i actually agree with many of your positions in other areas, but we can’t have it all right? good afternoon. i'll stop by in a week or two.
  13. t2krookie

    PMHNP

    Quick question first. If you want a distance education, why limit yourself to SE schools? After this answer it would be easier to give information.
  14. t2krookie

    The latest good news for all of us

    OHH!!! I allmost forgot, the study from 2000 that you are so fond of had an even SMALLER base of patients (Nearly half) so if we use your argument that the CRNA favoring study was too small to come to a conclusion, what does that mean for the study you like so much? That just came to me as I was about to shut down. Night..Be back in 3 days with a smile on my face and a procedures symposium under my belt. Get to stitch oranges and if I'm really lucky, a cat!!! WHoot!
  15. t2krookie

    The latest good news for all of us

    ahh dg!!! you heard me calling you!!! soo if mds back in 2001 does a study on cited imperfect billing data (says so in its abstract) and comes to a conclusion and another crna favoring study uses billing information with the same weaknesses (noted in the abstract), how do you come to a conclusion that one is self serving and the other not ? ohh, i forgot to mention you have never seemed to show much in the way of respect for patient choice (reference our previous discussions on nps rating higher satisfaction levels than mds) but now such data is pertinent? well i guess ya gotta use the tool appropriate to the problem. if it's a nail use a hammer, and if it's a screw use a driver. we all do that to one extent or another so i understand completely. now before the flames get hot, i wanna say i really respect your tenacity. you are obviously a very intelligent person and i really appreciate you coming here. gives me the impetus to educate myself and do research. ohh, before we go on, i'll post a little snippet from the same article you are quoting in the same fashion (just the part i wanna emphasize) "this was a retrospective analysis based on administrative claims data and is limited by the associated errors inherent in using such data.(billing information on "one" states medicare patients. can't have that!! ohh wait, this is the md study so its ok to use such data) the accuracy of our definitions for anesthesiologist direction (or no direction) is only as reliable as the bills (or lack of bills) submitted by caregivers. we also cannot rule out the possibility that unobserved factors leading to undirected cases were associated with poor hospital support for the undirected anesthetist and patient. local, temporal, even psychologic factors may play a part in patient outcome, and such factors may not be noted in the available data set. for example, if anesthesiologists had a tendency not to submit bills for patients who died within 30 days of admission, our results could be skewed in favor of directed cases. although our clinical experience suggests that this scenario is quite unlikely, we cannot rule out this possibility. we also cannot rule out the possibility that undirected cases occur more often in emergency situations that developed outside of the emergency department"(silber et al, 2000) "for example, if anesthesiologists had a tendency not to submit bills for patients who died within 30 days of admission" now this just can't be happening. what would be the point? almost as cheap a shot as the description of the crna favoring article in the asa position 1st paragraph. anywho, what is important is that we can all read english and see from our own point of view. i still have no access to more than the abstract (not gonna pay 12$ for it) so i have yet to pour over the details to gauge the accuracy of the asa critique. it did not cite anything other than the comparison article, a "do you want a doctor or a crna? questionnaire", the old silber, 2000 article, and a article on the state of medical errors which i found quiet provocative and not very complimentary towards physicians or nurses. matter of fact, i found in that last article what i "think" may be something holding back various medical boards from wanting to look tooooo deep into outcome studies. just imagine if we all had to retake our licensing boards periodically? specialty boards are retaken by board certified physicians and are one path for np specialties (in my state at least) but imagine if mds had to retake medical boards!!! here's an excerpt from the last article(to err is human, building a safer health system, 1999) in the citation of the asa position statement; "[color=#632423]the iom report called for such licensing bodies to "implement periodic re-examinations and re-licensing of doctors, nurses, and other key providers, based on both com- petence and knowledge of safety practices." 90 no state medical boards require routine testing of skills and competency. 91 requirements for license renewal are general- ly limited to continuing education, despite research indicat- ing that continuing education alone has little or no impact on practitioner competency. 92 once practitioners earns medical license, they may never have to demonstrate their medical competency again. professionals can become incompetent over time because they don't keep up with current medical knowledge, they suffer from drug addiction, alcoholism or mental illness, or they just weren't that good in the first place and their shortcomings only become evident as they treat patients day after day. without ongoing testing, these kinds of problems may not be recognized by licensing agencies before serious harm occurs"(jewell & mcgiffert, 2009) found here: www.safepatientproject.org/safepatientproject.../safepatientproject.org-todelayisdeadly.pdf wouldn't that be a hoot? anyways i digress. here is me trying to be conciliatory. when apns stay in their focus specialty, we do a good job (well, i will do a good job). for the same reason, anesthesiologists' defer/refer to im, im defers/refers to pulmonologists, blah blah blah. they do it because the other guy knows his own area more than the other guy. real simple stuff. in the same way, apns are given the load they are familiar with. now of course mds get the more complicated cases. nobody is arguing that (much). the case most of us make is that for the vast majority of patients, that level of training just isn't needed. it's like asking an indy car driver to pilot a school bus. sure he can do it, but is it necessary? (please insert your own analogy here. mine suxs). like the sith emperor shadah the wise, "he became so powerful that the only thing he feared was losing his power". this is a turf war and nothing more. mds don't want to give up control of the whole tree citing that they can pick the most difficult to reach fruit, and nurses don't want to be their lackeys doing the work and not getting the credit and autonomy they deserve as usual. i think zenman coined a provocative statement about looking into the microscope, and the diminishing returns of seeing deeper and deeper... (someone please correct my quote). wow, i spent way too much time on this again. i need to sleep. got a flight in the am. g'night all.
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