alwayslookingnp

Except that the private world lives and dies by Press Ganey. Press Ganey Has a lot to do with the Opioid crisis and MRSA. How manipulative is videoing this event without the Dr permission?

Hello Colleagues, I spoke too soon about closing my study. When I looked at the reports, there were fewer usable surveys than I expected. Would you please consider clicking on the link and being a participant in my 2 group study? Here is the link to the study: Capability Beliefs to Access and Implement Research-Based Knowledge into Practice in Emergency Department RNs Who Provide Direct Patient Care: A Two-Group RCT Thank you

Sunburn

Today is the last day to participate. If you have already, thank you. If you have not, please consider participating . Please help if you can. Thanks

I have seen more nurses lose their jobs over schedule conflicts than anything else. You want to go to church, the other wants to be with her family, that one has small children. The list goes on and on. Scheduling is not easy. You cannot make everyone happy. I am an experienced NP and I can tell you no one ever made concessions for me because i had small children, had no babysitter, kids had an event at school or church, and on and on and on. The ones who whine and beg and demand annoy everyone, whether they will tell you so or not. If they give in and give you extra days, your manager and coworkers will be annoyed. Little things become big things and before long, you are ostracized and run off. I would strongly encourage you to take the schedule you are given and not complain. You knew what nursing was when you get into it.

I think your license is safe and you are doing the right thing to leave an unsafe situation that you are powerless to improve. You will most likely be a no rehire but I doubt you would want to go back anyway, if they are still in business. Do not put anything snarky on your resignation. I agree with the other post that you "are pursuing other opportunities". I think you are doing the right thing. Good Luck.

Nurses are the last line of defense for the patient. They are the last one to touch the patient before he medication is given, before the procedure is done, before the operation begins. Nurses have the power to save lives. Many nurses rely on what they have learned in school to guide their practice. Given the current age of the average nurse, this may present a problem. Nurses need a way to access current relevant information with which to guide their practice. Double checking medication dosages is only one way nurses can save lives. We have known about the "5 rights of medications" forever. We also need to be able to reference the disease and know if the ordered medication is right for the patient in their current situation. Ditto for treatments and procedures. Nurses have opportunities to save lives every day. Nurses do not necessarily have time to perform statistical procedures or perform research on salient clinical issues in the course of a workday. Particularly when they have one (or ten) problems right ow that must be solved under time restraints of patient care. One of my interests is advocating for nurses and finding ways to make nursing practice better and more satisfying. As an experienced Nurse Practitioner, my line of thinking is often changed by a conscientious nurse. At the same time, I have seen many good nurses go to peer review and lose their license for following provider's orders. Thank you for your question.

Here is the link to the study: Capability Beliefs to Access and Implement Research-Based Knowledge into Practice in Emergency Department RNs Who Provide Direct Patient Care: A Two-Group RCT Hello! Invitation to Participate My name is Ivy McKinney, APRN. I am a PhD student in nursing science at Texas Woman's University. I am conducting a 2-group random control trial study about emergency room nurses' confidence to access research based knowledge for everyday practice. Your decision to take part is voluntary and you may refuse to take part, or you may choose to stop taking part at any time. You may refuse to answer any question at any time for any reason. The Institutional Review Board of Texas Woman's University approved this research project. If you participate you will watch a video and then complete a short survey. Procedure If you agree to take part in this study: · Click on the provided link and your browser will be directed to PsychDATA, an online survey service. · You will watch an educational video · Next, you will respond to a two-part questionnaire. o First you will complete a short survey o Next you will answer a series of questions about yourself. · No questions will be asked that could identify you. · The IP information for your computer will not be collected. · Your answers will be combined with the other responses received and will only be presented in summary form. Time Commitment Watching the video and completing the questionnaire will take up to 15 minutes. Benefits You will not be paid to participate in this study. However, you can benefit from the satisfaction of providing your opinion from your own unique perspective, and knowing you have contributed to future nursing practice decisions. Risks There is a very small risk of a breach of confidentiality. However, steps to provide complete confidentiality have been taken. PsychDATA encrypts the hyperlink connection. This means that your name will not be connected with your answers. Withdrawal Taking part in this study is completely voluntary. If you choose to take part, you may refuse to answer any particular question at any time for any reason. Compensation You will not be paid to participate in the study. Questions or concerns I will be happy to answer any questions or concerns you may have about this study, or the concept in general. Please contact me by email [email protected] or by telephone at 832-483-3065. Consent to Participate Click below only if you understand the information given to you about this research and choose to rake part. Make sure that any questions have been answered and that you understand the study. If you have any questions or concerns about your rights as a research subject, call the Texas Woman's University Institutional Research Review Board at 713-794-2480. . Texas Woman's University Statement Your participation is voluntary. You may choose not to participate or you may discontinue your participation at any time without penalty. Your decision whether or not to participate will not affect your current or future relations with Texas Woman's University. Here is the link to the study Capability Beliefs to Access and Implement Research-Based Knowledge into Practice in Emergency Department RNs Who Provide Direct Patient Care: A Two-Group RCT If the direct link does not work, please copy and paste it in your browser. If you know of any RNs who provide direct patient care in an emergency department setting, please share this flyer with them. Thank you for your valuable input. Ivy McKinney, RN, MSN, APRN Texas Woman's University PhD student [email protected]

AbstractAccording to the Institute of Medicine, as many as 98,000 patient deaths occur each year in U.S. health facilities. One primary limitation of current research of nurses' use of research-based knowledge in practice is that the vast majority of studies, which have described barriers and facilitators of evidence-based practice have been qualitative or quasi-experimental designs. There is a paucity of research related to studies about the acquisition and implementation of research-based knowledge in nursing practice in the context of real-time problems that must be solved with on the spot reflective practice. This study examined the effect of a 3-part evidence-based-practice exercise on capability beliefs of RNs to access and implement research-based knowledge into practice. Bandura's Social Cognitive Theory guided the study. Confidence levels were measured using the Evidence-Based Practice Capability Belief Scale post-intervention. For inferential findings, data was analyzed using Independent T-tests, and Mann-Whitley U. Descriptive statistics and p-values compared the two randomly assigned groups on the demographic variables. Chi-square statistics were used to report these findings. IntroductionPurpose. The purpose of this study is to promote evidence-based practice behaviors in RNs who provide direct patient care in an Emergency Department setting on a number of important indicators. Also, this study will aim to redirect incorrect self-beliefs and habits of thinking that EBP behaviors cannot be regularly used in nursing practice. Background. There is a need to understand nurses thought processes in situations that require them to acquire new knowledge. Despite efforts to move research knowledge into regular nursing practice, the scholarship of research remains primarily in academia. Many problems nurses face must be solved by on the spot reflection and actions must be undertaken with time constraints that further add to the complexity of patient care. It is not reasonable to expect nurses to take time to form research questions and perform statistical designs while caring for patients. Furthermore, it is not reasonable to expect nurses to possess all knowledge available to solve every problem they may face on a typical day. Nurses should be confident that they can access and implement research-based knowledge into their practice and there should be user-friendly ways to do so. Evidence suggests that research knowledge integrated into nursing practice makes patient care safer, more economical and increases patient satisfaction (Melnyk, Fineout-Overholt, Gallagher-Ford, & Kaplan, 2012). However, nurses do not routinely participate in the acquisition and implementation of current research (Brown et al., 2009; Fink et al., 2005; &Kaplan et al., 2014). Although nurses agree that implementation of research knowledge would improve patient care, nurses do not see the relevance of research in their own practice (Aboshaiqah, Qasim, Abashaireth, & Patalagsa, 2014; Estabrooks, 1998), nor do they consider it part of their professional responsibility (Majid et al., 2011; Wallen, et al., 2010). Researchers have attempted to bridge the gap between research and practice. Numerous studies identify personal and environmental barriers as well as facilitators to implementation of research knowledge into practice. In one such study, researchers aimed to link scientific evidence to nursing practice, by providing a cadre of research mentors, who were knowledgeable in research implementation and made the mentors available to staff nurses. The mentors assisted nurses in formulating answerable clinical questions supported by sound research evidence. Other researchers aiming to stimulate scientific curiosity in nurses introduced research concepts in easily understood terms, such as whether sugar-free chocolate chip cookies taste better than regular ones (Walden, Cephus, Gordon, & Johnson-Hagan, 2015), or whether healthy potato chips taste as good as less healthy ones (Wolf, Paoletti, & Hongyan, 2012). While there have been research interventions that claim statistical success, these interventions are expensive and emphasize the learning of research jargon and statistical designs. Furthermore, no evidence was found that these efforts have resulted in the sustainable long-term use of research knowledge translation into regular nursing practice, or how nurses translate research knowledge into practice. In order for behavior change to take place, nurses must acknowledge that (a) the standard of care for patient care changes as new information becomes available, (b) it is the responsibility of nurses to seek sound research knowledge to guide their practice, © there must be nurse buy-in to the concept of lifelong learning. This does not necessitate that nurses master statistical design. There has been little or no research that incorporates practice friendly strategies, such as smart-phone apps, whereby nurses can access sound clinical information, and apply it to their practice. This study has the potential to change the concept of research knowledge implementation into regular practice, in alignment with the vision of the IOM Future of Nursing by assessing capability beliefs of nurses to implement research evidence into regular practice. Emergency nurses will be used for this study. Emergency nurses are well suited to innovative approaches because of the variety and complexity of their clinical experiences. Also, emergency nurses have a multitude of problems that span all disciplines of nursing practice. Furthermore, emergency nurses are often the first point of contact into the health care system for at-risk populations (Hawk, 2013). This study proposes to introduce novel approaches to bridge the research knowledge gap using hand-held and computer technology to develop nurse confidence in the acquisition and implementation of research-based knowledge in practice friendly ways that can be used at the point of care. Handheld technology is an effective clinical tool that can be used to access research knowledge and support evidence- based practice and the complex thinking required to approach clinical problems (Hudson & Buell, 2011.) Research Question. Do Emergency Department (ED) nurses who provide direct patient care and participate in a 3-part Social Cognitive Theory (SCT) evidence-based practice video report higher beliefs in capability levels as measured by the belief capabilities scale, than comparable ED nurses who receive an attention control video about healthy lifestyles? Theoretical FrameworkBandura's self-efficacy theory conceptualizes personal efficacy beliefs as "beliefs in one's capabilities to organize, and execute the courses of action required to produce given attainments" (Bandura, 1997). Bandura, (1986) proposed a sociocognitive perspective of human functioning that recognized individuals as pro-active and self- regulating. Bandura (1986) emphasizes that a critical element of human behavior is self-belief. Bandura viewed people as self-organizing, proactive, self-reflecting and self-regulating rather than only reactive individuals, which are shaped only by their environment (Pajeres, 2006). According to SCT, human performance results from a dynamic relationship of personal, behavioral, and environmental influences (Glanz, Rimer, & Viswaneth,2008). For example, how people interpret the consequences or benefits of their behavior informs and may change subsequent behavior. This is the foundation of Bandura's (1986) conception of reciprocal determinism, the view that (a) personal factors (b) behavior, and © environmental influences create interactions that result in a triadic reciprocality. MethodsResearch Design . A pilot study was conducted in the fall of 2017. A randomized two-group experimental design was implemented using a sample of 45 nurses. Research procedures are described in detail in Appendix A. Setting. The setting was an anonymous, secure, online survey delivered via PsychData®. This method enabled the respondents to complete the questionnaire at their convenience, in their preferred environment. The questionnaire could be completed via any device with Internet access, such as a computer, tablet, or cell phone. Sample. The sample was drawn from a population of nurses, who were at least Registered Nurses that are employed in the emergency care setting and provide direct care to patients. The participants were licensed nurses employed in the U.S.; males and females; had the ability to read and understand English, and were 18 years of age or older. The participants for the study were recruited via placement of the recruitment letter with embedded link onto discussion boards in hospitals. Snowball sampling was utilized by encouraging participants to forward the recruitment letter with an embedded link to other potential participants. A power analysis was conducted using a literature search. Because of the scarcity of experimental studies that closely correlate with my study, in terms of acquisition and implementation of research-based knowledge directed at the place where patient care occurs, characteristics of my study variables, such as self-management and self-efficacy were used. Three experimental studies were found that had enough information to calculate an effect size. The effect sizes of the studies reviewed were .3, .56, and .37. The effect size closest to my study is Borycki et al., so that effect (.3) was used for the study (See Table 1). A minimum number of participants for the pilot study was 30. For a full study, a sample size of 240 was determined via power analysis using a power of .8 and an alpha of .05 based on a literature-based effect size of .35. An anticipated attrition rate of 10% added 24 participants for a total sample of 264. Therefore, 30 (more than 10%) was deemed adequate for the pilot study. Instrument. The Evidence-Based Practice Capability Beliefs Scale (EBPCBS), developed by Wallin (2009) was used for data collection (Appendix B). The instrument has six items that measure the latent variables of capability beliefs; personal factors, environmental factors, and behavior. EBPCBS is a one-dimensional scale that specifically evaluates capability beliefs. The instrument adds to the construct of the study because it measures capability beliefs, which aligns with Bandura Social Cognitive Theory that measures self-efficacy, not intent. The answer choices for the six items on the scale were designed to assess nurses' capability beliefs to access and incorporate EBP behaviors into practice. It is criterion based because it was designed specifically to address capability beliefs. using a four-point response format (1 = to a very low extent, 2 = to a low extent, 3 = to a high extent, 4 = to a very high extent). The Likert-scale questionnaire was validated in a 2012 study conducted by Wallin, Bostrom, & Gustavsson. The reliability coefficient was established by Cronbach's alpha. Data Collection Procedures. Following approval from the Texas Woman's University Institutional Review Board, data collection began. The survey was uploaded into the secure electronic platform, PsychData®. Participants remained anonymous to the researcher and consent to participate in the study was implied by completion of the online survey. The survey was open until adequate sample size was achieved. The participants accessed the survey by clicking on the link in the recruitment letter or by copy-and-pasting the link into their browser. The participants were recruited via the recruitment letter with embedded link, which was posted in 3 hospital breakrooms. Snowball sampling was encouraged in the recruitment letter. Demographic information was obtained following completion of the survey. Information gathered included information about personal practice, including length of time in practice, whether the participant provides direct care to patients, employment status, and number of patient ED visits annually. Personal information was collected that included age, gender, educational level, and race. Demographic questions are listed in Appendix C. Data Analytic Techniques. The completed surveys were exported into the Statistical Package for the Social Sciences (SPSS), Version 25 for analysis. Parametric and nonparametric tests were employed to answer the research question. For the data analysis, a statistician was consulted to determine the best analytical method based on the data collected. The choice of analytical methods would allow for appropriate conclusions to be drawn. FindingsSample Description. 56 participants accessed the link. Of the 56, 48 answered the questionnaire/posttest in full. Of the 54, 28 were randomized to the control group and 28 to the intervention group. 3 participants answered that they did not provide direct patient care, so those surveys were eliminated. There were 45 useable surveys. Of these, 20 were randomized to the intervention group and 25 were randomized to the attention control group. The principal investigator was unable to obtain information on the number of participants who copied the posted link. In addition, snowball sampling was encouraged in the recruitment letter. Therefore, the response rate for the survey was unable to be determined. (See Table 2 for sample description). Instrument Reliability and Validity. Content validity was examined for the CBS with Item-Content Validity indices between 0.8 and 1 (Bostrom et al., 2009). Construct validity was examined by Wallin et al., (2012). The internal structure of the CBS was performed by using two groups for exploratory and confirmatory analysis. Factor analysis of item correlations between the two groups was performed and confirmed the fit of the scale was invariant and could be replicated. Forsman et al., (2012), reported construct validity, with factor loadings between 0.78 and 0.84. Reliability for the CBS has been examined using with Cronbach alphas reported between 0.75 and 0.90., (Forsman et al.,2012; Rudman et al., 2012). Research Question. The completed surveys were exported into the Statistical Package for the Social Sciences (SPSS) Version 25 for analysis. First, Likert type items were checked for normality using skewness and kurtosis statistics. Despite the small sample size, none of the skewness or kurtosis statistics are above an absolute value of 2.0, therefore it can be assumed that each distribution is normal. Next, the statistical assumption of homogeneity of variance was tested. The two groups were compared using independent samples t-tests. There was a non-significant difference between the groups for Likert item 4, p = .16. However, it was violated for Likert items 1, 2, 3, 5, and 6. Therefore, Mann-Whitley U tests were done for questions 1,2,3,5 and 6. The statistical assumption of homogeneity of variance was checked using independent samples t-test. Homogeneity of variance is the assumption that the samples are obtained from populations of equal variance (Pallant, 2013). The independent samples t-test is a parametric technique that requires one categorical independent variable with two groups (intervention and control), and one continuous dependent variable (confidence levels) (Pallant, 2013). The independent samples t-test compares the mean scores of 2 different groups of people (Pallant, 2013). Homogeneity of variance was violated for Likert items 1, 2, 3, 5, and 6 because, for these items, the significant values are less than .05. Therefore, Mann-Whitley U was used for analyses for those comparisons. An independent-samples t-test was conducted to compare the confidence levels for group 1 (control) and group 2 (intervention). There was a non-significant difference between the groups for Likert item 4, p = .16. Because homogeneity of variance was violated for question 1,2,3,5, and 6, Mann-Whitney U tests were used for analysis of those questions. The Mann-Whitney U test is a non-parametric test that corresponds to the parametric independent samples test (Pallant, 2013). The Mann-Whitney U test compares medians of the two groups, converts the scores on the continuous variable to ranks across the two groups, and then evaluates whether the ranks for the two groups differ significantly (Pallant, 2013). There was significant difference between the groups for Likert item 1, p = .025. There were non-significant differences for Likert item 2, p = .08, item 3, p = .12, item 5, p = .09, and item 6, p = .08. Descriptive statistics and p-values were used to compare the two randomly assigned groups on demographic variables. Chi-square statistics were used to report these findings. There was a non-significant difference between the groups for all characteristics. The results are summarized in table 4. DiscussionRelationship of findings to Literature and Theoretical Framework. Bandura Social Cognitive Theory (SCT) is concerned with people's beliefs in their capabilities to produce given achievements (Bandura, 1997). Bandura emphasized that human behavior and motivation are driven by beliefs that people have about their capabilities (Pajeres, 2006). The theoretical basis for the dependent variable in my study, capability beliefs to access and incorporate research-based evidence into practice, aligns with Bandura's ideas about self- efficacy. Self-efficacy is one's beliefs about how his or her actions produce future attainments. Modification of self-efficacy is directed by self-efficacy theory (Bandura, 1997). According to Bandura (1997), how people behave can be better predicted by their capability beliefs, then by what they are actually capable of doing. Table 3 shows how the proposed study connects with the SCT. Evidence-based practice behaviors are described in this study as accessing and implementing research-based knowledge in practice. The study is designed to reflect strategies that can be used to reflect development of EBP behaviors in practice, identify strengths, and highlight areas for potential growth, using examples of clinical situations. In order to ensure a well-rounded perspective, feedback from interdisciplinary colleagues is essential. Use of research knowledge in nursing practice has never been more important because changing paradigms in healthcare demand quality more than ever before (Perez-Campos, Sanchez-Garcia, & Pancorbo-Hidalgo, 2014; Institute of Medicine (IOM), 2001; 2003; 2010). Development of research knowledge is a part of contemporary nursing education, and nurses are expected to contribute (International Council of Nurses, 2013). However, acquisition and implementation of current research in practice is not widely implemented after graduation. In fact, nurses persist in reliance on peer opinions and what was learned in school to guide their practice (Aboshaiqah, Qasim, Abashaireth, & Patalagsa, 2014; Estabrooks, Chong, Brigidear, & Profetto-McGrath, 2005; Pravikoff, Tanner, & Pierce, 2005; Shaflei et al., 2013). The average age of today's nurse is greater than 40 and most nurses graduated before 1998 when research was not routinely included in nursing curricula (Estabrooks, et al., 2005; Fink et al., 2005; Pravikoff et al., 2005). Patient care guided by habit and peer opinion becomes outmoded and has the potential to be dangerous. Evaluation. A major aim of the study is to redirect incorrect self-beliefs and habits of thinking that EBP behaviors cannot be regularly used in nursing practice. From the six questions in the instrument that describe confidence to use EBP behaviors, only question 1 showed a significant difference between groups. However, the remaining p values come close to a significant value. It is, therefore, possible that concluding that the other questions are not statistically significant could represent a type II error, whereby we fail to reject a false null hypothesis. A larger sample may produce significant results. ConclusionsThe small sample size was a limitation of the pilot study; however, 84% of the participants who began the survey completed it, indicating that the use of the survey would be a reasonable method to collect data regarding the knowledge, attitudes, and self-efficacy of nurses working in emergency care. Recommendations for Revisions for Full StudyFor the full study, additional methods to access the ED nurse population were warranted and considered. The recruitment methods for the full study were amended to include accessing several Facebook discussion boards of groups of ED nurses, such as "Show Me Your Stethoscope". A reminder letter will be posted on the same member discussion boards two weeks after the study begins. Furthermore, incentives for participation will be considered. References Aboshaiqah, A. E., Qasim, A., Abashaireth, A., & Patalagsa, J. G. (2014). Nurses' perception of barriers to research utilization in a public hospital in Saudi Arabia. Saudi Medicine Journal, 35(9), 1136-1139. https://www.ncbi.nlm.nih.gov/pubmed/25228191 Bandura, A. (1991). Social cognitive theory of self-regulation. Organizational Behavior and Human Decision Processes, 50(2), 248-287. https://www.sciencedirect.com/science/article/pii/074959789190022L Brown, C. E., Wickline, M. A., Ecoff, L., & Glaser, D. (2009). Nursing practice, knowledge, attitudes and perceived barriers to evidence-based practice at an academic medical center. Journal of Advanced Nursing, 65(2), 371-381. https://www.ncbi.nlm.nih.gov/pubmed/19040688 Bandura, A. (2006). Guide for constructing self-efficacy scales. In F. Pajares & T. Urdan (Eds.). Self-efficacy beliefs of adolescents, (Vol. 5., pp. 307-337). Greenwich, CT: Information Age Publishing. Estabrooks, C. A., Chong, H., Brigidear, K., & Profetto-McGrath, J. (2005). Profiling Canadian nurses' preferred sources for clinical practice. Canadian Journal of Nursing Research, 37(2), 118-141. https://www.ncbi.nlm.nih.gov/pubmed/16092784 Fink, R., Thompson, C. J., & Bonnes, D. (2005). Overcoming Barriers and Promoting the Use of Research in Practice. JONA: The Journal of Nursing Administration, 35(3). https://www.ncbi.nlm.nih.gov/pubmed/15761309 Glanz, K., Rimer, B. K., Viswanath, K., & Orleans, C. T. (2008). Health behavior and health education: Theory, research and practice. San Francisco: Jossey-Bass. Hawk, M. (2013). The Girlfriends Project: Results of a Pilot Study Assessing Feasibility of an HIV Testing and Risk Reduction Intervention Developed, Implemented, and Evaluated in Community Settings. AIDS Education and Prevention, 25(6), 519-534. https://www.ncbi.nlm.nih.gov/pubmed/24245598 Hudson, K., & Buell, V. (2011). Empowering a safer practice: PDAs are integral tools for nursing and health care. Journal of Nursing Management, 19(3), 400-406. https://www.ncbi.nlm.nih.gov/pubmed/21507112 Institute of Medicine. (2001). Retrieved from Crossing the Quality Chasm: A New Health System for the 21st Century : Health and Medicine Division Institute of Medicine. (2003). Fostering rapid advances in health care: Learning from system demonstrations. Retrieved from http://iom.nationalacademies.org/Reports/2002/Fostering-Rapid-Advances-in-Health-Care-Learning-from-System-Demonstrations.aspx Institute of Medicine; Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. (2010.). The Future of Nursing: Leading Change, Advancing Health. Retrieved from The Future of Nursing: Leading Change, Advancing Health | The National Academies Press International Council of Nurses (2013). Scope of Nursing Practice. 404 Not Found Kaplan, L., Zeller, E., Damitio, D., Culbert, S., & Bayley, K. B. (2014). Improving the Culture of Evidence-Based Practice at a Magnet® Hospital. Journal for Nurses in Professional Development, 30(6), 274-280. https://www.nursingcenter.com/cearticle?an=01709760-201411000-00002&Journal_ID=54029&Issue_ID=2651313 Majid, S., Foo, S., Luyt, B., Zhang, X., Theng, Y., Chang, Y., & Mokhtar, I. A. (2011). Adopting evidence-based practice in clinical decision making: Nurses' perceptions, knowledge, and barriers. Journal of the Medical Library Association, 99(3), 229-236. https://www.researchgate.net/publication/51489842_Adopting_evidence-based_practice_in_clinical_decision_making_Nurses'_perceptions_knowledge_and_barriers Melnyk, B. M., Fineout-Overholt, E., Gallagher-Ford, L., & Kaplan, L. (2012). The State of Evidence-Based Practice in US Nurses. JONA: The Journal of Nursing Administration, 42(9), 410-417. https://www.ncbi.nlm.nih.gov/pubmed/22922750 Pallant, J. (2013). SPSS Survival Manual (5th ed.). Berkshire, England: Open University Press. Perez-Campos, M. A., Sanchez-Garcia, I., & Pancorbo-Hidalgo, P. L. (2014). Knowledge, attitude and use of evidence-based practice among nurses active on the Internet. Investigation and Education Enferma, 32(3), 451-460. https://www.ncbi.nlm.nih.gov/pubmed/25504411 Pravikoff, D. S., Tanner, A. B., & Pierce, S. T. (2005). Readiness of U.S. Nurses for Evidence-Based Practice. American Journal of Nursing, 105(9), 40-51. https://www.ncbi.nlm.nih.gov/pubmed/16138038 Sackett DL, Strauss SE, Richardson WS, et al. Evidence-Based Medicine:How to practice and teach EBM. Second edition. Edinburgh:Churchill Livingstone, 2000. Shafiel, E., Baratimarnani, A., Goharinezhad, S., Kallhor, R., & Azmal, M. (2014). Nurses' perceptions of evidence- based practice: A qualitative study at a teaching hospital in Iran. Medical Journal F the Islamic Republic of Iran, 28(135), 2-8. https://www.semanticscholar.org/paper/Nurses’-perceptions-of-evidence-based-practice%3A-a-a-Shafiei-Baratimarnani/261084af5f4e65ad93971b10b2fa1c01b72170b2 Titler M.G. (2008). The Evidence for Evidence-Based Practice Implementation. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US) ;Apr. Chapter 7. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2659/ Wallen, G. 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What bothers me about this line of thinking (bypassing specialists or any other recommended discipline) is that the ER does not take the place of a specialist. It will not take care of a chronic problem. A complaint like this one will likely be triaged to the fast track area. There, your husband will be seen by a NP or PA. This person may do some imaging and write a prescription but they will refer you to a specialist for follow up. In the end, you have bypassed nothing and have added an extra step and added expense to your care.I would recommend following up with the specialist you have been referred to.

There is a lot going on here. First, your husband has a DVT and a torn meniscus. He also has arthritis. These are separate issues with different treatments. Your husband is also a bricklayer so may have some occupational issues (look up carpenter's knee). There is no quick fix for these problems, and it seems as if that is what you are looking for. I can see where these issues might involve family medicine, rheum, and ortho. Is compression ok for one condition or all 3? I am not surprised that the NP did not have an immediate solution for you. You don't like the wait time for ortho and your insurance had some problems with the one you selected. While I can understand your frustration with this, the NP is the starting point for this complicated place and not the endpoint of treatment. Yet, the NP is the one your frustration seems to be aimed at. If you have no confidence, then I think you should change but I do not anticipate the next provider will be able to provide short term solutions for what seems to be a long term problem.

I think most times it is a customer service thing than anything else. The patients want it, it makes them feel like we are doing something, and we live and die by Press Ganey these days

So sorry for the position you are in. Have you thought about moving or traveling? I had to do that for a yesr. Can't say it was the most pleasent of experiences but it was a job.

QUOTE "Perhaps only COMPASSIONATE people agree that the fight against universal health care is an uncaring, selfish thing. " ...or opinionated ones

QUOTE: "I think healthcare should be a basic right. It is not fair that if a person does not have insurance and they are poor, their health is not important but if you have unlimited amounts of money like a certain presidential candidate, your health is a priority. It does say in the constitution that all men are created equal. " Don't be so flip about candidates. Both have what would most likely be "unlimited amounts of money" to most of us and I'm pretty sure both care about the health of others. This is a really biased statement and one reason others stpo listening when opinionated (not necessarily informed) people start to spew their political rhetoric and justify it by how "deeply they care."

QUOTE "Maybe, with some luck, you won't find yourself in the situation of millions of Americans that didn't expect to find themselves without insurance, and with nowhere to turn but the ER for care. " ...for gum in their hair...

I would say procedures- suturing, intubation, CPAP, I&D Radiology- (This was 100% OTC for me) Psych- meds, emergency holds

I would certainly try it. It is very challenging right now in the job market.I think there is a glut of NP ( at least in my area) and PAs seem to be preferred.

rlianne- good post! I think this is a phenomena that plagues nursing in general not just NPs. I have been an NP for 5 years but in nursing school they chipped out my diploma on a stone tablet! In the old days a "good nurse" was one who could get all the charting done, all the meds passed and everyone fed and bathed by the end of the shift. No more- thank god! Nuses are expected to actually have some clincal knowledge and expertise. I think some of the older nyurses are resistant to change because they are comforatable in the old model and are not sure where they fit in to the newer model.I think we need to respect these NPs and where they have been but we all need to move forward. Practicing evidence based medicine (EBM) is the only thing that will give us credibility. Look at it this way... I was taught in nursing school not to wear gloves when giving an enema because it makes the patient feel "dirty." Good Lord!- That is NOT EBM! So we need to be able to defend our actions by EBM. No longer is "that is the way I was taught, or that is the was Mary does it" acceptable. This kind of thinking is one of the biggest critisims medicine has of Nursing (and rightly so.) That being said it is sometimes a fine line you walk as far as patient satisfaction. Even with all kinds of explanations why folks don't need antibiotics there are studies that support that the more tests that are ordered the higher patient satisfaction is. If you donn't give azith for URI, do you give loratidine or tessalon, maybe something to help the patient sleep? You have to use your own practice guidelines but these are strategies that some providers use. As far as alienating the nutrition provider....sigh....when will Nursing ever learn to collaborate??? And collabiorate is the rightb word becazuse we need to collaborate with everybody.Nutrition, nursing, PT, housekeeping, ect... We need to create as much good will as possible most especially in today's climate. (Have you read th Institute of Medicine's recommendation for the future of nursing?) Take care Blue, you sound exactly like the kind of provider I would love to work with.

Finding a job is very challenging especially in the present climate. There is a lot of competition from PAs (Drs tend to prefer them in my area- long story...) Anyway, a good place to start is to look at the website for NPs in your area- here it is HANP (Houston Area Nurse Practitioners.) There is also a site called "indeed" where you can type in your zip and look at jobs that way. You might want to consider travel. I worked for a company that let me work 7 days on and 7 days off- (Comp- health.) It was flying back and forth but it was a job. You didn't say if you live in a rurual or urban area but approaching a busy Family Practice might be fruitful. They may be really busy and have not really considered what an NP can do for them. You would have to make an appointment and sell yourself. You could see patients, make hospital rounds, half days on Saturdays- this might really be attractive to someone who is really busy or someone who is getting older and wants to slow down a little.keep in touch and let us know how it goes...Good Luck!

Another reason is pay. In many instances, RN and NP pay in some parts of California are not much different. NP's who practice in salaried office settings and work long hours actually end up making less than RN's who work 3 twelve hours shifts. Sad but true here in Texas, too.

Jeweles- You are right! Sorry all- I meant to quote the "NOONE DID NOTHING" comment. Sorry RN- dude!

Oh dear Rndude. Are you really an RN? Did you take English in College?

I don't know why Romney has not yet released his taxes. I do not, however believe we should judge Romney or anyone else for their actions. Honestly, I don't think anyone should be forced to release their taxes because it is thier personal buisness and not really ours. Just MHO...

Ummmm...there are a lot more perks than $$$ only. There is untold amounts of free stuff. You don't need money anyway when you have taxpayor dollars. vacations, nice clothes, private jets...I could deal with that- no prob