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NP/PA supervision is a state by state issue. At least in my state (MS), NP's & PA's are essentially interchangable from a physician / hospital perspective. They both have a fairly broad practice. I would expect PA's would be similar in most states -- since they generally have the same training as most NP's (Bachelor & Master's degree w/ practicum). There maybe some Bachelor's degree PA programs left, but I imagine there won't be in 10 years. It was only recently (last 10-15yr) that a Masters was required for an NP as well. As for supervision that's a state by state issue. In my area supervision means that a physician must audit and sign off on 10% of your charts, be on hand 10% of the time, and sign off on your protocols. They also have to be willing to accept referrals. NP's in this area certainly can and do have independent practices, and hire physicians on a contract basis to provide supervision. In some cases in very rural areas NP's are allowed wider latitude than listed above (with Nursing Board and Medical Board approval).

All states require an internship, only a very few require a residency of one year beyond the intership. No state requries more than 2 yrs after graduation to recieve a license. The issue isn't licensure, its getting onto insurance panels and hospital privlidges. Most insurers and hospitals will not admit a physician who hasn't completed a residency or been in practice for 20+ years.

I would definately have your doc run the tests as part of your annual physical. There is a lot that still might be wrong with you -- or might not be. As to telling your doc about it, remember that even your average Family Physician manages medical issues for a lot psychiatric cases, many much worse than yours. You are not alone, but you need to be safe. Now... my one bit of advise is that you offer to pay for the tests yourself if the doctor can't find a reason to run them other than "prior liver damage". The reason is that if you run the tests and are fine, but your doc submits a claim to an insurance co. with a diagnosis of prior liver dmg, that could affect your ability to obtain life/disability/medical insurance in the future. The CMP, which is the test he will most likely order, is used for a lot of different issues though, so he might be able to bill it under something else if also indicated for that. (skin disorders, hair disorders, etc).

In the states its still all over the board. The US Preventative Task force recommends cervical smears q1 for high risk women, defined as age age of first sexual encounter and no later than 18. After age 30 if only one sex partners, they can go to q2 after two negative smears. The USPTF puts out some of the most aggresive guidelines out there -- usually recommending something only after you have Class A studies or multipe Class B studies. Most things done (at least here) are not part of their guidelines.

A lot of stuff in the states leads to disparities in the best medicine vs. best for the hospital/doctor. Mammograms aren't one of them. Unfortuantely this is a situation where the lack of radiologists and qualified technicians leads to screening fewer people than it should. The science is pretty good on this, and says 45 should be the latest a normal women is screened. The guidelines actually suggest 40. This comes from the American Cancer Society Guidelines for Breast Cancer Screening: Update 2003.

Federal labor law doesn't state that unfortunately -- either clearly or obsequiously. Individual states can adopt labor laws that prevent mandatory overtime; however, if they don't, federal labor law only requires that they pay time and a half. You most certainly can be fired for refusing to work mandatory overtime in many, if not most, states -- and won't be able to collect unemployment either.

I believe the poster is saying the get $1.25/hr, plus their regular salary, plus overtime if applicable. Even if not called in, the get $1.25/hr for their oncall shift as a bonus.

I agree. The most accurate BP measurement is a manual one done by a properly trained person, using a mercury spygometer, everything else is downhill from there. For speed of use, a handheld spyg is good, but remember to get it calibrated every 6 mos (JACHO). One big issue I see sometimes with this is that nurses (more usually CNA's) don't use properly sized cuffs -- which can cause a major difference in BP. As for automatics, I really think (even with callibration) they should be restricted to contineous monitoring as ordered by physician (ie.. icu pt. that the physician wants to make sure BP doesn't drop precipitiously). Maybe at night if the patient needs a q2 BP -- for purposes of patient comfort. I don't think they have any place in routine use.

One of the first things to realize is that today's ECT is nothing like it was 60 years ago. The reality that brought us "One Flew Over the Cukoo's Nest" and other popular images of ECT, is long past. That method of ECT has as much to do with modern medicine as an amputation done w/o anesthesia or painkillers in the civil war. The reality is that ECT is a safe and extraordianrily effective method to control acute symptoms of psychiatric illness. As to the protocol, I'm not sure of the number of treatments usually undergone; however, serveral are usually presribed. ECT is done is a state of anesthesia, with monitoring. The most common side effect is that of short term memory loss. As for you personally, I think its a decision you have to make with your doctor. Although the side effects exist, they may turn out to be minor in comparison to the damage that a long term psyciatric problem can cause.

I wish someone would point out some research.... Thermisol, the form used in vaccines, is not chemically reactive, and is expelled from our body in a matter of days. Ethyl Mercury is the stuff that is dangerous because it bonds with our neurons, and remains there essentially forever (about 1% a yr is expelled). There has been no study showing a definative link, and multiple studies of thousands of children showing no link at all. These have been done in Japan & Europe, as well as the US, and have been government funded (not at behest of drug companies). Finally, the amount of thermisol was cut to 1/100th of its then current amount in 1998, and yet there is no decrease in the diagnosis of autism (usually diagnosed between 2-3). No one has made a credible argument, backed by science, that thermisol is a contributing factor in autism. That being said, their IS some evidence that the ETHYL Mercury found in our drinking water and in the air from coal exhaust may be responsible for this increase.

~What are some good high school courses to take to prepare me? I can't add too much to the post above (great post), but would recommend the following... Take every course your high school has in Math, Biology & Chemistry. Even if you choose not to use any AP credits you might earn, when you take these courses in college you'll have a leg up on everyone else. I would also take a statistics class if offered in addition to Algebra & Calc or Pre-Calc.

If you get a -, it means the patient may not be allergic to PCN. Also, performing the skintest in this context is considered a medical procedure -- it has a billible CPT and everything -- meaning in most states it cannot be legally delegated anymore than say suturing a wound. Additionally, Medicare rules require that it be done by a MD or NP/PA. "Cowboy OB" is a phrase I made up. It means (to me) a OB/GYN performing the role of a very different specialist, well outside his field, only having read the book or asking the nurses what to do. Unless your OB is trained at desentization, I would again state that the proper protocol consists of a consult to the allergist. If you don't have one, then to either the pulmonologist or ENT (although ENT may back out of this, many do a lot of desentization in their practice). Although there are generic "protocols" available from the CDC, they cannot be used w/o physician supervision because every patient is different -- sometimes very different. The procedure itself, when properly supervised with adequate staff, is safe. Most allergists (who routinely do this type of thing) usually only have 1-2 general reactions a year, and maybe full blown anaphalyxsis every few years. However, they are prepared for it. Finally, things like insect desen takes place over 6mos to a full year, with shots weekly or monthly. PCN Desen in this context means 24-48 hours.

Yea maybe... except there are double blinded studies with allergy shots -- and a lot of it.

I know this isn't a natural suggestion... You might want to try 550mg of Naproxen (Alieve). That was our neurology groups first line treatment to abort migraines before all the triptans were out. If it works for you, you can get 60 pills w/ a script for about $15.00.

I'm just thinking aloud here, but you should really check out the following if your interested in health care.... 1) A BSN or Direct Entry MSN program will take the same time as a standard ASN, but since you have your bachelors already you get either a BSN or MSN, or both. 2) You might want to look at the Physician Assistant programs... It may not be but a year longer for your (or even less), depending on what undergrad work you did. The pay would be much better, but its a different job. 3) You also might want to look at the X-Ray Tech, Ultrasound, etc. With your engineering background you may not have many classes to complete to finish them. Specialized people (MRI Techs, etc.) make similar amounts to nurses. 4) You *might* want to investigate an RHIT program, if you'd like to be around healthcare but still in technology. An RHIT won't be doing customer support, but usually is in charge of policy making, medical records, etc. RHIT's are in every bit if not more demand as nurses right now.

The problem with tetracyclince isn't the teeth, its that it is not known to work in pregnanent women, it may cure the mother but not the child, or may not cure either, but rather cuase it to go into remission and be undetectible for a few years. This disease is one of the most insideous, destructive, diseases known. In many ways it makes HIV look mild. We haven't had to deal with it since the 50's because of the miracle of PN, but this disease is one of the great scourages and victory's of modern medicine. I would rather not take the chance of the child getting it, for doing a process that although somewhat dangerous and a pain in the orifice, has very few reported deaths or long term side effects, and is relatively safe if done in the right environment with the right doctors.

It doesn't neccissarily get better, but one of the hardest lessons for me to learn as a manager was how to delegate. It took some of my staff -- who I have a LOT of respect for, to nail me down before I finally gave way. I easily delegated the small stuff, but it was the more complex things that I kept to myself -- and gave me a lot of 16 hour days and sleepless nights. I'm still working a lot, but at least I now feel like I have some help, and am accomplishing a lot more.

Suzanne, PCN is the only treatment that has evidence behind it to treat a pregnant women/child with syphilis. Desensitization is dangerous, but so is untreated syphilis. I would be hesitant to do it w/o allergist involvement, but like many other medical treatments it has risks and benefits. The evidence shows that its best to do this in pregnant women.

In that article above, there is a protocol listed, but its meant for physicans. Unless you've got a cowboy of an OB, I imagine he'd admit the pt and ask for Allergy consult.

Summary of Recommendations The following recommendations are based on good and consistent scientific evidence (Strength of Recommendation Taxonomy [sORT] = A; see page 1201 for an explanation of SORT): * Most women with one previous cesarean delivery with a low-transverse incision are candidates for VBAC and should be counseled about VBAC and offered a trial of labor. * Epidural anesthesia may be used for VBAC. The following recommendations are based on limited or inconsistent scientific evidence (SORT = B): * Women with a vertical incision within the lower uterine segment that does not extend into the fundus are candidates for VBAC. * The use of prostaglandins for cervical ripening or induction of labor in most women with a previous cesarean delivery should be discouraged. The following recommendations are based primarily on consensus and expert opinion (SORT = C): * Because uterine rupture may be catastrophic, VBAC should be attempted in institutions equipped to respond to emergencies with physicians immediately available to provide emergency care. * After thorough counseling that weighs the individual benefits and risks of VBAC, the ultimate decision to attempt this procedure or undergo a repeat cesarean delivery should be made by the patient and her physician. This discussion should be documented in the medical record. * lady partsl birth after a previous cesarean delivery is contraindicated in women with a previous classical uterine incision or extensive transfundal uterine surgery. http://www.aafp.org/afp/20041001/practice.html is the ACOG recommendations (even though its aafp). Rural/small hospitals aren't like that out of choice, the reality that we've seen in my state is that if the hospital closes their OB ward, the emergency room physician becomes a OB by default.

Cause I'm in nana land with my brain :)... Glad I'm not working this week. The standard is OB or Surgeon (in some rural hospitals the GS does the emergency c-sections, and there is no OB on staff. FP or CNM does normal deliveries). The problem is that it requires immediate availability, which usually means decision to cut is 10 minutes, so both the OB and Anesthesia have to be ready to go the entire time the lady is in labor. This might not be a problem with a large OB group which rotates the hospital duty, and it isn't a problem in a level I trauma where anesthesia is readily available, but its a nightmare at smaller hospitals.

VBAC is one of highest threats for malpractice for OB/GYN's. Many malpratice carriers will not cover a VBAC -- period. In addition, new JACHO requirements basically make a VBAC an impossiblity in any but Level I tramua centers -- you must have a GS (not in scheduled surgery), OB/GYN, and Anesthesiology on site for the entire duration of the delivery. Since hospitals aren't big about offering it anyway, and GS get pissed at being woke up and told to sit around for hours with nothing to do, the VBAC is generally going the way of the Dodo. Even at our local hospital, which is a Level I, they have a separate women's hospital (with a couple of OR's), and JACHO won't let them do it since the surgeon is at the main building.

Umm... desentization isn't something to take lightly -- it can be very serious. I would get one of your allergists on staff to order it, set up the protocol, and be responsible for it. AKA -- get a consult. I don't know that much about it, but desentization for previous insect anaphalyxis can take a year or more, however, I think rapid desenitization exists for penicillin that can do it in a day or so. It might can be accellerated, but this needs to be seen by an MD allergist who can do it. That being said, many doctors will perform an allergy skin test, to see if the patient is truley allergic or had a poor side effect profile. Anesthesiologists do this occassionaly for patients with novacaine allergies. But if they are truley allergic, the desentization is a medical procedure that most physicians won't touch with a 10 foot pole. From the CDC (endorsed by ACOG amonst others): Sexually Transmitted Diseases Treatment Guidelines 2002 ... Parenteral penicillin G is the only therapy with documented efficacy for syphilis during pregnancy. Pregnant women with syphilis in any stage who report penicillin allergy should be desensitized and treated with penicillin. Skin testing for penicillin allergy may be useful in pregnant women; such testing also is useful in other patients ... Patients who have a positive skin test to one of the penicillin determinants can be desensitized ( Table 1 ). This is a straight-forward, relatively safe procedure that can be done orally or IV. Although the two approaches have not been compared, oral desensitization is regarded as safer to use and easier to perform. Patients should be desensitized in a hospital setting because serious IgE-mediated allergic reactions rarely can occur. Desensitization usually can be completed in approximately 4 hours, after which the first dose of penicillin is administered. After desensitization, patients must be maintained on penicillin continuously for the duration of the course of therapy. ..... There is a table in the report if you OB wants to try to do this...

Are you getting a BSN or ADN? I've never heard of a BSN program that goes from start to finish in 18 months.... I believe that that to be accredited a bachelor degree (any degree), must have at least 92 credits, and most have about 110 or more. Bachelor degree->BSN can get away with it since they already have enough credits for the degree (obviously), they just have to take enough to make the nursing board happy.

Oops sorry... Looking at the 1993 data from ARHQ, there were 3,916,469 deliveries total with 1,170,408 being c/s, for a 30.0%. (http://www.arhq.gov) I was thinking of c/s after c/s (VBAC) which was of which 230k patients recieved of 422k admited for it (54%) -- again 2003 ARHQ numbers.