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

It might be worth mentioning (if you didn't already know) that bipap increases ventilation which increases you PaO2 and decreases your CO2 while CPAP Primarily provides PaO2 support only:)

Yes...it is "sensitive" but not "specific"...to pull out some fancy statistic jargon

I disagree with being able to pick your own patients. In ICU Pts should (in my opinion) be assigned, with special consideration in this order: Staff Competency, Pt acuity, continuity of care and then proximity. Staff looking to expand thier competency may ask for more complicated patients as long as a resource member is available for support and as long as it doesn't interrupt continuity of care.

have a decent understanding of your vent settings, abg and how they relate. your not going to get it in one night.....:)

when a patient develops swelling in the same arm as a PICC. what is the best method for finding the cause. I understand that an ultrasound can be done to look for a CADVT. I have seen them results that state "Hypoechotic" area or mass noted. My question is what differentiates the PICC from a clot, or is that even possible. My question is based on a patient that had marked swelling in the arm with a picc. The dopplar ultrasound was done and stated the above up that extended into the subclavian. The pt was started on lovenox and the md wanted the picc removed the next day. 18 hours after picc removal pt developed SOB HTN desaturation. due to elevated creat no spiral ct available for r/o PE. Follow up ultrasound done to arm showed no obstructions at all. So the question is was the picc the Hypo echotic structure or did the clot dissolve that quickly?

Thanks Kathy...that helps somewhat...I will say we have had a surprising amount of interest from our surrounding rural hospitals mainly because the cannot maintain enough volume to keep staff competent in thier training. This leads to delays in care or possibly issues arising during insertion attempts. Personally I think this is a huge growth opportunity for nursing espec is areas that have only one or small tertiary facilities.

the only reason I say this is the competitive nature of Indepentent nurse owned/operated Vascular Access Agencies:). But we have been in business for nearly 8 months now and are ready to look into servicing Critical Access and Secondary Hospitals.... My question is in regards to billing for private insurance...I understand how it works in LTAC and SNF or even with MEDICARE or MEDICAID patients. But as Nurses are'nt considered "professionals" how does a hospital handle billing a private insurance patient for a contracted service?

easiest way is to have your hospital have thier rep come and do thier didactic class and then the practical....cheapest too:) cause its usually free to you

I believe what they are saying is that for extended dwell catheters this is where they should be placed. PIV can still be placed there but not for extended lengths of time. As for restriction..why would they? Upper arm piv are less prone to severe ranges of motion, causing less torsion on the catheter itself....just my observation...no real data.

Here is my 5 cents (inflation ya know). People should be responsible for their own well being. The reason why health care is so expensive is not because of profit...its because of third payer systems. Spending other peoples money (currently insurance) makes is less painful to go to the MD or ER for a stubbed toe 5 days after you stubbed it because you don't want to go to work in the am. It is also the reason why supplies cost so much. Much like the crazy inflation of tuition rates. The ease in which you can get govt money for college encourages the colleges to then increase the cost. Basic economics, basic inflation. The same has occured in healthcare. Get rid of a third party system....prices will come down. Just look at the discounts facilities give the insurance companies and even deeper discounts they give private pay patients. Those that TRULY cannot afford will get charitable care without govt interference. Americans GIVE more than any other country and will continue to give more. But those riding the system without concequence are beginning to become a greater percentage than ever. The govt demands equal treatment for all thats a joke now...the rich will always get better care no matter what. You think Hugo Chavez, Fidel Castro or Russian Prime Minister goes to the local community hospital:) AND what about those who abuse thier body willingly and frequently with repercussion. Do we continue to turn a blind eye? Less govt interference would allow facilities to make decisions on a case by case basis. Not about emergency care but about elective care. Again just my 5 cents