rkealy

And that's what I am talking about. So many don't know what they don't know. Which brings me back to the different levels of treatment for practicing medicine. NPs have a significantly lower bar for minimum competency for medical practice. They just do. NPs should not advertise themselves as separate but equal....we just aren't. You might not, she/he might not, but academia and the powers that be do, or at the very least don't appear to try very hard to correct misplaced assumptions.

It doesn't?

not unless they mandate it for practice. Advanced practice nursing education has many issues to straighten out such as standardization of curriculum, experience requirements, diploma mills. Current DNP curricula is based on fluff such as infomatics, leadership, and healthcare policy crap. Now we have dilution of the MSN NP graduates from junk programs possibly making a DNP necessary to stand out. One might think this is an education conspiracy.

Should there not be physician control? After all they invented the practice of medicine. They are responsible for setting standards of practice. Why are there 2 different levels of requirements for practicing medicine? MD, DO and DC all have to take state medical boards. Why not NPs?

I am in my last semester in an FNP program after 15 years in a mixed Trauma 2 ICU. I think I am very cautious about FPA. I am reminded by the limitations of my education every day as I discuss my patients with the physicians. What used to be an inexpensive, quick but high effort degree for decent pay has now become a 4 year slog full of fluff costing 40,000k. This drive for the DNP is frustrating. What is the basis of this? Was there any evidence of need for a DNP? Is the traditional MSN model not enough? Or is it more of the same where academia feels the need to increase the educational requirements to justify the income level as has been done throughout the last 60 years of nursing. One big benefit of NP to the healthcare system are lower reimbursement rates.....increased education requirements = more educational costs, time, effort, group projects= same income. What sense is that? Oh thats right NPs are equal to physicians and should be reimbursed as such. Again no savings.... At my university it is possible to go from BSN to DNP with one year of bedside experience. Clinical experience only 1200 hours total and that doesn't even equal the PA's program requirement of 1500 hours IF DNP "must" be "a thing" then at least make it more clinically oriented... all these filler classes about leadership, healthsystems, informatics and health policy leadership is a bunch of bunk. Its like the nursing academia are trying to turn NPs into the koolaid man crashing through the door yelling "I am a case-manager! A policy leader! I am a practitioner! I am EVERYTHING TO EVERYONE! and you.......you are a puny physician!" Sometimes I wan't to say just pick a lane, be great in your clearly defined role, and help the system out.

So nurses that are practitioners, practice both nursing and medicine without supervision. what is the logic behind having different standards of practice levels. I mean why is it that doctors are held to a different level of education to practice medicine a nurse practitioners are not held to the same standard. But yet we are fighting for this independence without oversight without any real restrictions other than your own morals on how to practice. I have some difficulty squaring that as a public safety issue. Especially with so many diploma mills turning out NPs without standardization of education or standardization of experience requirements.

I am not sure on what side of the fence I stand on as of yet. I am having difficulty squaring the different level of standards for an APN to practice medicine vs a physician. Can somebody explain this to me?

I think of CPAP as a mode and pressure supports is the measurement of the amount of CPAP support. I also think a pressure support as peep I don't know if that's accurate but that's what I think of it . For instance you can have a non-invasive CPAP with a peep of 15 or you can be intubated on vent CPAP with a pressure support of 15. I know that's not completely Apples to Apples comparison but it's the way I think of it. BiPAP is really for someone who needs support with ventilation with volume of ventilation so it helps you get air in with a higher inhalation pressure which reduces Airway resistance with help you get larger volumes to facilitate gas exchange and a veal are recruitment in some instances and then also has a reduced usually lower expiratory pressure to help get that air out but still provide peep. BiPAP is usually used on those that require help compensating for metabolic acidosis or to help reduce hypercarbia in those that have respiratory acidosis.

Don't use luerlock with cvp

Yup pretty standard

Looking to see how different ICU do a standard I and O is it hourly on all Critical Care patients? obviously those are require invasive hemodynamic monitoring will be hourly I'm talking about the old lady on the vent who's in with pneumonia who's just on Versed and Fentanyl. I have heard every 4 hours, q 12 q 2?

I figure if ur gonna spend that much cash go with the Prevue Ultrasound by Bard http://www.bardaccess.com/ultra-siterite-prevue.php it will be more useful especially for the "fluffier" patients

just remember high dose neo kills the gut:eek:

Bob next time ask for KY:roflmao: And tell the others to quit stuffing there mouths with donuts and do something:)

That is true. Thats why after complete fluid resucitation fails, and levophed begin to become ineffective switch to Vasopressin ASAP. Vasopressin is a hormone that works much differently. Ideally you would begin CRRT Immediatly when noticing metabolic acidosis in septic shock