angel5113

I'm a family nurse practioner student and I'm looking for a resource to help me with management of patients who return for follow-up office evaluations. For example, in the Practice Guidelines for Family Nurse Practioners, 2nd edition (I know there's a 3rd edition) under endocrine disorders there is a section entitled "initial office evaluation" for diabetes. It identifies what to look for in the history, what to do in the PE, labs, goals etc. It then has a section on "follow-up office evaluations" which is exactly what I'm looking for. It identifies frequency of return visits, what to ask in the history, what to focus on in the PE, labs etc. Unfortunately, this edition doesn't do that for many of the other disorders. Say for example a patient comes in with diagnosed ___________ (HTN/CHF/ GERD - you fill in the blank) what should you include in your history, what do you include in your PE, what labs do you draw? I'm looking for a resource that gives direction on "follow-up office evaluations" for these and other conditions that require follow-up. Does the 3rd edition have more "follow-up office evaluations"? Is there another resource you would recommend?

Christine, Congratulations on doing so well in your oncology class and for being brave enough to tackle an MSN so early in your RN career. I feel encouraged that I'm not the only "new nurse" tackling an advanced program. It's interesting to hear that you're teaching others...I find myself doing the same thing. My fellow nurses are always surprised to hear that I've only had 18 months of nursing experience. I wish you continued success in your program!!

Hi everybody, I just joined this thread today and noticed that a number of people are considering MGH. Let me just say that all the programs have advantages/disadvantages and a lot of it boils down to which school is a better fit for what you want to do. I researched a number of different schools before I decided on MGH several years ago. One of the reasons I chose MGH was because of its affilation with Mass. General Hospital and the hospital's resources and world wide reputation. MGH students have access to many of the resources that Hospital employees have. And as an alumni I still have access to some of those resources today. MGH also had a class that collaborated with Harvard Med students (not sure if that's offered now). Many times doors were opened to me simply because I was a student at "MGH". There were some kinks in the program, but for the most part the instructors were fair, approachable, and flexible. Most all were knowledgeable about their field of expertise...some were more academically challenging than others. We had a 99% pass rate for NCLEX, and the MSN portion positioned me well for where I am today. My only criticism is that (at the time) they didn't have a residency program following graduation. The school I attend now has a residency program that requires a certain number of clinical hours after graduation (similar to medical school residency). This is nice because you have a lot of autonomy to practice your skills, but you still have someone to fall back on before you have to fly on your own. The administrators at MGH were also very helpful. They listened to student feedback and included students in all levels of the school's governance. I moved to the midwest and am now finishing my program at a school here. I have no regrets about choosing MGH. Its reputation has served me well.

Thanks for responding and thanks for the encouragement. Should graduate nursing programs be responsible for warning students with less experience of how difficult this might be? Or perhaps have a requirement for a certain number of years of experience. For example, there are some MBA programs that will only except students with "X number" years of professional business experience. This experience has tought me how valuable clinical experience is to accumulating a knowledge base. Does this mean then that graduate nursing programs should have a requirement for a certain number of years of experience before accepting students into their programs?

Thanks for all the great advice Yes, I agree. Confronting the instructors and telling them they need to change their exams are probably not the best ways to go about this. Although other students are complaining about the exams, I don't feel up to uniting them to approach the instructors. Talking with them and asking for their advice is a great idea. Great suggestion. I agree...they do have more clinical experience than me and consequently have learned more through their experiences. Identifying additional resources to fill in the gaps would be very helpful. I've taken all the other required classes (yahoo!!!). The only other classes remaining are the primary care classes (peds, adult health, & women's health) which I have to take one at a time in a series. If I don't get at least B's in these classes I won't be able to graduate. Yes, I'm probably an advanced beginner. It's good to know that my struggles are less due to my inability to learn the material than due to my lack of clinical experience. I'm sure that, given time, I will become a proficient nurse and perhaps even an expert one at some point. I'll just have to work very hard between now and the next couple of weeks before the next exam to supplement my knowledge base. Thanks again for the advice.

I need help. I'm toward the end of the MSN program and I'm having a tough time with the exams for the Primary Care classes - right now it's Peds. Part of the problem is a large portion of the material covered on the exams is not covered in the lecture notes (usually power point presentations) nor in the reading material (usually articles on the topic being lectured on). Some of my classmates are doing ok because they have experience in some of the areas being tested on the exams. I've been an RN for 1 1/2 years so I don't have a lot of experience outside of my clinical experiences and the short time I've been a nurse. I'm really upset with the instructors because they're testing us on material that's not being covered. I realize this is graduate level and they shouldn't spoon feed us...but I believe the material we're being testing on should come from either the lecture notes or the reading material. If, in order to pass the exams, we need to have outside experiences, then why do we need to spend thousands of dollars on school? I'm very clinically capable but I'm afraid of flunking out of the program because I can't pass the exams. Help...what do you think...would you confront the instructor on the unfair exam practices...or would you just suck it up and figure out how to pass the exams?

No I haven't. But I'll return Sure fire and order Chartsmart. Thanks for the headsup. Angel

Hi Cheerfuldoer, Thanks for the kind welcome. I agree with you regarding the checklist charting...I've seen that happen myself. I would like to get into the habit of doing it the right way. If you come across any good nursing notes would you mind posting them. I've seen plenty examples of bad notes posted on different websites and in articles...but I'm hoping to find examples of good notes. Thanks a bunch, Angel

Suzanne, Thanks for the reply. Yes, we are using flow sheets, and yes we're charting by exception, so it sounds like a shift summary would work.

If you write good progress notes or come across any, would you mind posting them. Hi everyone, I'm new to this forum. I'm a new nurse, but I'm also in school (working to complete an MSN). I found your site as a result of an exhaustive search on the internet for examples of good charting. I was taught the soap method in school. And there are plenty of examples of good soap notes on the web - problem is...Most of the examples are medical soap notes and are not applicable to nursing. There are also quite a few suggestions on "How to" write good progress notes (eg using dar, soap, soapie, soapier, pie, etc.). And There are plenty of examples of bad nursing notes. But I spent 8 hours Yesterday searching for actual "Examples" of good notes, with very little success. I've purchased the books recommended in this forum for charting which should arrive in a few days. (charting made incredibly easy & sure fire doc...) My unit charts by exception but the managers want the staff to start adding progress notes to the chart...Which they (staff) are reluctant to do (...Repetitive work argument - we're already charting on flowsheets). I was taught "Not documented, not done", so I see the value in narrative charting. I'm reluctant to ask my manager or fellow nurses for fear I'll be targeted for the "Oh, she's not doing what her preceptor tells her to do...She's not doing it the way we do it...She thinks she's better than us... She's not going to make it list." I really don't want to rock the boat and start asking for stuff the other nurses are opposed to. But I still want to protect myself...And learn how to write good notes. My thinking is...Medical students are given plenty of examples of good medical soap notes, why can't new nurses get the same help? As critical as charting is to legally protecting us and hospitals, why aren't new nurses given more examples of good nursing notes? There should be an abundance of good nursing notes out there...On the web, in med/surg books, clinical skills books etc. Please help. I'm looking for examples of good charting (eg discharge notes, admission notes, progress notes etc.). If you write good progress notes or come across any, would you mind posting them.