Michael M. Heuninckx

Currently in my program we are using the latest edition of Margret Fitzgerald's NP exam review. Something though that the director of my program is recommending to us as well, is a review course by the Advanced Practice Education Associates: A Nurse Practitioner Company, here is a link to their web site NP Students My plan is to use both of these resources and to do a whole bunch of questions and really divining the why and root of the questions to fully understand the concepts. GOOD LUCK!!! Michael M. Heuninckx RN-BSN

1. My go-to appsUpToDate- I live in UpToDate. Any question I have, UpToDate is my go-to resource for the most current information and guidelines. Everything can be found there, in one, easy to use place. Also, if you are researching a possible diagnosis, it also offers you a list of differential diagnoses that can help aid in your clinical decision process. The best part is, this is a resource that should be free through your university or workplace. Check first before you buy a subscription. Medscape- I use the Medscape app mostly when I am looking up medication: indications, dosages, compatibility and side effects. The app also offers current news in healthcare, a calculator for medical formulas and is a reference for medical conditions. GoodRx- GoodRx is a unique tool allowing you to search for medication costs at multiple local pharmacies. A good habit to get into is to see how much you will be costing your patients and the overall healthcare system. Also, you will be surprised how many first-line medications are available to treat the same condition, but one could cost a lot more than the other. 2. Find a solid group of NP student colleaguesMuch like nursing school, in a nurse practitioner program, you will develop friendships that will last a lifetime. This will be the group that you study with, look forward to seeing in class, send out friendly reminders to, bounce ideas off of, work together in group projects, vent your frustrations, and have your back when you are in a pinch or when you need a place to sleep and take a quiz that is due at midnight because your power is out 3. Take A VacationTo be able to do this, first, know the calendar of the University you are attending. Find the dates of when one semester is ending and another is beginning. This is the time when it is the safest to travel. Also, it will give you something to focus on and look forward to when the semester is becoming unbearable. 4. Don't get behind in logging your clinical hoursAs much as this is "busy" work, it really is important that you do not fall behind in logging your hours for two reasons. First, once you get behind, forget it. You will only continue to get further behind and you will be spending countless hours trying to log them all in one sitting. Second, take the time to turn logging your hours into a learning experience. Use this time to fully understand billing and diagnosis codes, what they mean and when it is appropriate to use which one. Doing the leg work now will only help you down the road. 5. Make an appointment with the writing centerA resource that is frequently underutilized is your University's writing center. I learned this lesson very early as an undergraduate student. In one or two appointments, my grade could go from a B to an A. Also, they are APA wizards, something that will help keep you from losing easy points. 6. Be on top of your scheduleYour schedule is everything. This takes time, strategy, organization and double checking your work. Do not forget to place all quizzes and assignment due dates in your schedule as well. Classes are not designed with a ton of points to fall back on and if you forget to take a quiz or turn in an assignment, you can forget the entire semester. You will not pass the class if you forget to do one of the above and in graduate school, there are no redos. As a soon to be NP, it will be expected that you will be able to manage and handle your schedule with no excuses. 7. Eat right and exerciseNurse practitioner school is no excuse to let yourself go in the diet and exercise department. Your body will need the fuel to make it through the program. Eating fast food/highly processed foods will only make you feel worse and slow you down. Also, taking the time to get in your exercise will help you clear your head and relieve some stress. 8. Find your clinical sites yesterdayNot all NP programs find clinical sites for you. If your school requires you to find your sites, do this ASAP. This is something that you think you might be able to do last minute, but this process can be like a full-time job. It would be terrible to get this far in the program and not be able to move forward because you do not have a clinical site. 9. Get involved with Nurse Practitioner professional organizationsMeeting nursing colleagues that are currently practicing and who were once in your shoes is very comforting and exciting at the same time. You will meet people who you currently look up to and will be one day. Also, you will be able to gain knowledge from experienced practitioners about their current practice and what lessons they have learned that will prevent you from making the same mistakes. Only one semester left! Good luck to all of my soon to be Nurse Practitioner friends! If you like this article then you might want to check out Michael's new book for nurses... Code Blue! Now What? Learn What To Do When Your Patients Need You The Most!

Indeed! I do think though that Amy Cuddy would change the wording a little bit as she did in her TED Talk. Amy states "don't fake it till you make it" "fake it till you become it" Michael M. Heuninckx RN-BSN

As I was catching up on this past season of Grey's Anatomy, Amelia Shephard is about to start a marathon of a surgical procedure. Right before she is about to go into the operating room, she clenches her fists, places them on her hips, puffs up her chest, and stands tall with a powerful look on her face. One of the residents who is confused by this behavior asks her why she is doing what she is doing, Amelia states, "a scientific study showed that if you stand in the superhero pose for 5 minutes before a job interview, presentation or difficulty task, you will not only feel more confident you will perform measurably better".1 After this fact is stated, the resident buys this fact, and joins her in the superhero pose. Here is the clip from the Episode Amelia and Stephanie are Superheroes Videos | Grey's Anatomy TV - ABC.com As most healthcare professionals can pick apart when medical shows are right on, stretching the truth a little and just flat out wrong. When I initially saw the "superhero pose" I immediately placed it in the, shake of the head, chuckle to myself and the, "come on really!?" response. Even though this was my initial response, I did stop and ask myself, "What if this is true?" It really is no cost, can be done anywhere and could be a tool nurses could use it to boost their confidence and have a positive impact on the patients they are taking care of. So my research began. . . Much to my surprise, after some digging around, I came across a TED Talk conducted by Amy Cuddy. Amy holds a PhD in Psychology from Princeton University and currently is a professor at Harvard Business School.2 In her TED Talk, Amy discusses how dominance and power is shown in the animal kingdom and how that is also reflected in humans. Amy shows this by giving examples of animals and humans show power and dominance by expanding their body.2 Followed by showing how animals and humans show feelings powerless by wrapping ourselves up and making oneself smaller.2 Amy's hypothesis was, if you stay in a high power pose for two minutes, to what degree does it affect hormone levels in your body.2 The hormones studied were the dominance hormone, testosterone, and the stress hormone, cortisol.2 In the study, saliva samples were taken, then participants either did a high power pose for two minutes or a low power pose for two minutes, offered a chance to gamble, then another saliva sample was taken.2 In the high power posing group testosterone levels increased by 20% and cortisol levels decreased by 10% and 86% were willing to gamble.2 In the lower power posing group the exact opposite occurred, the levels of testosterone decreased by 25% and the levels of cortisol increased by 15% and only 60% of participants were willing to gamble.2 Also when this was further studied, the concept was applied to candidates using high power poses or low power poses before an extremely difficult job interview. Can you guess what occurred? The group of job candidates who posed in a high power pose for two minutes were chosen for the job over the candidates in the low power posing group.2 I encourage EVERYONE who is reading this article to take the time to watch the TED Talk below of Amy Cuddy discussing her research proving the validity of power posing. Amy Cuddy: Wow, wow, wow! Who knew! I could not have been more wrong with my above skepticism! Every time I watch the above video, I simply am amazed, inspired and motivated. As Amy states, people only need "their bodies, privacy, and two minutes." I believe if nurses were to work high power posing into their daily routine, multiple times a day if possible, they would see an improvement in their own leadership ability and increase their overall feelings of courage to engage in difficult conversations with colleagues. A difficult task all nurses face every day. This will then organically weave its way into your daily practice as a nurse also. Improving the quality of care you are able to deliver to your patients, leading to, improvements in patient outcomes. Keep up the great work Shonda Rhimes and the entire Grey's Anatomy team! I have been a fan from day one and I look forward to all of the future seasons to come! Michael M. Heuninckx RN-BSN If you like this article then you might want to check out Michael's new book for nurses... Code Blue! Now What? Learn What To Do When Your Patients Need You The Most!

I knew that after the list was posted that there would be, I was guessing about, 3 medication that I would later kick myself for not including in the list. Thank you for brining up Adenosine! It is given all the time and defiantly should be on the list without question. Good looking out and this is why these forums are such a valuable part of the allnurses.com community. Thank you again! Michael M. Heuninckx RN-BSN

In my Emergency Nursing career I have only used Romazicon once. With that being said, when ever I am orientating a new nurses to the ER, and we are discussing medications, I always focus on drug classes of medications they are administering. Along with, potential side effects and what reversal agents are available. I agree with you that Romazicon is not frequently used, due to its potential side effects, but still is important for a novice ER nurse to be aware of. There could be a situation where a newer provider/rotating provider wants to use this medication and due to the nurses medication knowledge, offers a suggestion to reconsider the medication order due to its potential side effects, in turn, saving the patient from a potentially bad outcome. I always encourage and motivate nurses to questions/double check an odd/risky medication order, and this medication, even in my own practice, I would question. Hence the importance, I see, in being well versed in knowing this medication. Just because something is not frequently administered, there still is value in knowing about the medication. Michael M. Heuninckx RN-BSN

Are you a brand new nurse that just obtained the first job in the Emergency Room? Or an experienced nurse that has decided to master a new specialty? Well, whichever boat you might be in, here is a head start for you. Below is a list of medications that I promise you will be using time and time again while working in the Emergency Room. This looks like it might be an extensive list, but as time goes on, you will know the entire list inside and out. In alphabetical order and not limited to. . . Acetaminophen Albuterol All of your fluids NS 0.9, Dextrose 5% NS 0.9, Lactated Ringers. . . Alteplase Amiodarone (Push and Infusion) Aspirin Ativan Atropine Atrovent Azithromycin Bacitracin Cardiac Arrest Medications (See your ACLS Textbook) Cardizem (Push and Infusion) Catapres Cefepime Ciprodex (Otic Drops) Ciprofloxacin D50 Push Decadron Dilaudid Diphenhydramine Dobutamine Dopamine Epinephrine (Push and Infusion) Esmolol Etomidate Fentanyl Flagyl Fluorescein Strips GI cocktail: Maalox, Donnatal & Lidocaine (PO Mixture) Haldol Heparin Ibuprofen Insulin Kayexalate Ketamine Ketorolac Labetalol Levophed Lidocaine (Injection, IV Push & Infusion) Magnesium Mannitol Metoprolol Morphine Narcan Neosynephrine, (nasal spray & IV Infusion) Nitroglycerine (Pills, Paste & IV Infusion) Ondansetron Pepcid Phenergan Plavix Prednisone Propofol Protamine Sulfate Protonix Rocephin Rocuronium 56. Romazicon Silvadene Cream Silver Nitrate sticks Sodium Bicarbonate (Push and Infusion) Solumedrol Succinylcholine Tetracaine (Ophthalmic Drops) Tylenol Unasyn Vancomycin Verapamil Versed Some of the medications are listed as the brand name and some of the medications are listed as the generic name. It is imperative that you are comfortable with both. Yes, I did do this on purpose, to not include both within this article. I am a teacher at heart, and I could not write this article without some homework involved! Also, know what your hospital's policy is for the administration of all of the medications listed above. What might be normal practice at one facility, could get you a write up at another. Along with that, as always, never forget the medication administrations safety rules we all were taught in nursing school. Oh yeah, and how could I forget the life-saving enemas! Saline and Mineral Oil. Lastly, I will leave you with another tip for all new Emergency Room Nurses. Go through all of the body systems and learn what the emergencies are for those systems. Master those and you will feel comfort in knowing that when you are drowning, you have ruled out all of the time-sensitive emergencies for your patients. Once this has occurred, go down that list again and prioritize your patients from there. The Emergency Room is a no joke place to work, very fast paced and stressful. Mastering this list will help take away some of the stress and improve your overall flow. Give the department some time though, when it gets difficult don't quit. It can be very overwhelming at first, but I promise it will get better. Extra Medication Safety Tip Set your medication pumps up for success, not failure. When programming your pump to administer a high alert medication, set the rate to match the volume to be infused. This will prevent the entire bag/bottle of medication being accidentally administered to the patient due to your programming error. If this safety measure is not in place, it could lead to a catastrophic and life-threatening event for your patient. Imagine if an entire bag of Cardizem was administered, or the whole bag of Insulin or the whole bottle of Nitroglycerin?! Yikes! It only takes an extra second and when the hour is up: go back to set the pump again, reassess your patient, ensure that they are improving and not getting any worse, and continue on with the rest of your patients that need your services.

A resource every nurse should have in their back pocket! Michael M. Heuninckx RN-BSN

From first hand experience, I have gained a tremendous amount of knowledge by interacting with other healthcare professionals on social media. Given all of the negatives that have been pointed out in the article, and in this forum, lets not forget about all of the benefits as well. Michael M. Heuninckx RN-BSN

This most certainly is a valid question. One actually that I get frequently and have no problem answering. A life goal of my has been to write a book. I never knew what that book was going to be about, but I knew that I wanted to write one. Once I graduated nursing school I obtained a job as a graduate nurse in the Emergency Department. Here, I grew up quickly, adapted to my new environment, and found myself in an educational role through precepting new nursing graduates to the department. Throughout my life, I have always seemed to find myself in these roles. For some reason I was always deemed the go to person to educate others. I truly enjoy being able to educate others for the betterment of their career and the overall care they deliver to their patients. Last year I accomplished that life goal of writing my first book! It is called, Code Blue! Now What? Learn What To Do When Your Patient Needs You The Most! It is written specifically to nurses in the last semester of school or the first year of their career. It is a compilation of all the lessons I would teach my new graduates. Placing an emphasis of developing skills both professionally and clinically to prevent the Code Blue! from occurring in the first place. I then walk nurses though how to prepare yourself for the event to occur, offer lesson about what to do when the event occurs and what to do/expect after the event. Code Blue! Now What? also integrates visual, audio and the books own personal Twitter page to connect readers and myself alike. Long story short to your question, if you googled my name, you would see my book and all of my writings. All of which I am very proud of. I kind of lost that when the book was published. I believe social media offers a tremendous amount of value, but with that value comes a ton of responsibility. Hence the reason I wrote the above article, specifically to those just graduating nursing school. I do not know if this topic is currently being covered in nursing school today, but, if not, the lesson is here. I do know that I see nurses making one or more of these mistakes quite frequently on social media. So somewhere there is a gap in either, knowledge or awareness, that this article was intended to fill. On top of that, the members of AllNurses.com have done a phenomenal job of adding their words of wisdom in the comments section of this article as well. The amount of knowledge, sense of family and community that AllNurses.com offers is priceless. Today, the technology is everywhere, social media is everywhere, like it or not, the generations growing up will not know what it is like to not have it in their lives. Due to this reality, I would be very disappointed to hear that a new grad lost their chance to be a Nurse because they were not aware of what their social media presence looked like. All of the new nursing graduates have worked to hard for that to be taken away from any of them. I am proud to be apart of this community of nurses, I am proud to call myself a AllNurses.com writer and use my real name accordingly. If anyone has any questions they would like to ask me, never hesitate to reach out. I will always do my best to answer your question or direct you in the right direction. We are all in this together and as nurses, we all have to stick together! HAPPY NURSES WEEK TO ALL!!! Michael M. Heuninckx RN-BSN

I am intrigued by this statement. In what ways can you see not having a social media account being harmful to your career? Michael M. Heuninckx RN-BSN

It is very reassuring to hear that this young man has made his health a priority. Based on this story, I believe he will do very well in life. Thank you for sharing! It is one story that should be shouted from the mountain tops! Michael M. Heuninckx RN-BSN

This is very interesting, I recently saw a company like this on Shark Tank. It was a company that protected/made you aware of how your image was portrayed online to those who searched your name. Thank you for your suggestion, taking the time to bring this point up and reminding me of this. I defiantly am going to look into it. Michael M. Heuninckx RN-BSN

According to the Money section of Time magazine, it is reported that 93% of hiring managers will review their candidates' social media accounts before making a hiring decision1. At the click of a button, a momentary lapse in judgment, could destroy your nursing career before it even begins. Soon, all of you will be applying for your first nursing job. Something that you have dreamed of and have worked so hard to obtain. Today, all employers have to do to know more about you, is simply Google your name. After a few clicks, your future employer will have gained their first impression of you. As the saying goes, someone's first impression is most lasting and takes a long time to change, if ever. To help this reality not become yours, here are some tips and strategies you can use to protect yourself and your career: Refrain from Reference to Any Illegal Drug Use If your future employer found any indication that you use illegal drugs, you can almost certainly count yourself out of a job. In fact, 83% of future employers saw this as a negative quality1. Not to mention this is a criminal activity that can put your nursing license in jeopardy, it will potentially endanger the lives of the patients you will one day take care of. Also, every day, you will be in direct contact will substances that have the potential for nurses to become addicted to. Do not Write about Excessive Alcohol Consumption 44% of employers also frown upon future employees posting on social media how they get drunk all of the time1. When you work for an organization, you not only represent them while you are working but outside of work as well. Also, they might assume that if you drink excessively, you might come to work drunk/hungover or frequently call in due to your self induced illness, both of which directly impact patient care. Avoid Illegal Activity First and foremost, don't break the law; you know better. Secondly, if you do break the law, don't brag about it on social media. This is a sure fire way to not get hired, but also will give the police the evidence they need to arrest you for the crime you committed. Use Proper Grammar Before you post something, read it to yourself and read it out loud. 61% of employers were not impressed by poor grammar2. You will be surprised how small errors can quickly decrease your credibility. Also, do not fall victim to autocorrect. It is amazing how one autocorrected word can make a non-offensive post, offensive. Refrain from Swearing On Social Media Nothing positive will come from using profanity on social media, 65% of employers feel this way2. Not even the censored to disguised words. Swearing is not a good representation of the professional you are. The last thing you would want is to have your application skipped because of a poor choice of words. Clean Up Your Past Posting History Go through all of your social media accounts, back to the day it was created and remove, delete, and edit any posts that could be perceived as negative or not becoming of a nurse. Untangle yourself, and if at all possible, remove any offensive photo or post. If the post is not yours, kindly send a message to your friend to remove the post. And fingers crossed, the post will be removed. Update Your Privacy Settings Update your privacy settings and remember that anything you post is public, even if you think it's not. Anything can be hacked, a picture can be taken in a second and redistributed just as easily. This article also applies to the most seasoned nurses as well. Seniority will no longer protect you from a social media post that in any way your employer deems inappropriate. Also, have your fellow nurse's back as well. If you see one of your colleagues post something that could be perceived as inappropriate, reach out to them and express your concern. There is a very good chance that they might not have even noticed or ever thought that what they posted could be jeopardizing their career. When all is said and done, if you choose to be active on social media, you must be very careful with what you post. Use the tips above to help guide your posting decisions and to take an active step to educate and protect yourself. Social media is a powerful tool, but, with power comes responsibility and as healthcare professionals, don't give anyone the platform or any reason to think less of the nurse you are or the one you will be. Congratulations again to all of the new graduates and welcome to the profession of Nursing! References 1. The 7 Social Media Mistakes Most Likely to Cost You a Job 2. The top three things that employers want to see in your social media profiles

Sorry for the confusion! Currently I am in graduate school to become a Family Nurse Practitioner. Since I have started my clinical rotations, I have been feeling the pressure and responsibility, that one day I will have when prescribing medications. I was researching techniques that I could incorporate into my practice that were statistically proven and different than the traditional questioners that are currently in practice. Through this research I was able to find the screening tool mentioned above and thought that I would write and article about the topic. It has been phenomenal to read everyones feedback and THANK YOU to everyone who has posted. Your words are not going unread! Michael M. Heuninckx RN-BSN

As primary care providers, it is our duty to ensure that the medications we are prescribing to our patients do not do more harm than good. Any goal of pharmaceutical therapy is to aid our patients during their time of medical need. As with anything in medicine, there is always risk involved. No matter how small the risk is, there is always some degree of risk. Primary care providers, when prescribing medication, must always do a risk/benefit analysis to see if the overall benefits of the medication being prescribed outweigh the risks of the medication. In America today, prescription drug abuse is steadily on the rise. This has led the Drug Enforcement Agency (DEA) to reschedule hydrocodone combination products from a schedule III medication to a schedule II medication("Schedules of controlled," 2014). Becker & Starrels directly correlate a rise in the misuse of prescription medications to the rise in the number of prescriptions being written (2015). Specifically, opioid analgesics for the treatment of chronic pain and stimulants for the treatment of attention deficit hyperactivity disorder (ADHD) (Becker & Starrels, 2015). These medications have seen a drastic increase in the volume of prescriptions being written between the years of 2010 and 2014 (Becker & Starrels, 2015). Patients who were never addicted or abused medications before, now are. Lives are being destroyed and even lost because of prescription drug abuse. This paper will discuss the importance of this topic, a screening tool that can be used to identify patients at risk and strategies to implement the screening tool into practice. Why Is Identifying The Risk For Prescription Drug Abuse Important? At times our own biology can be working against us. Our brain is a fascinating and complex organ, but there still is a ton of information that is unknown. We do know our brain is able to detect pleasure, but at times, has the ability to fool us in regulating what is too much of a good thing. Prescription medications such as opioid analgesics, benzodiazepines, sedatives and stimulants have a vital role in managing medical conditions but have the ability fool the pleasure centers in the brains of susceptible individuals (Becker & Starrels, 2015). Opioid Analgesics The increase in opioid analgesic medications for treatment of pain has been increasing since the 1990's (Becker & Starrels, 2015). With this increase, there has also been a spike in the morbidity and mortality of this drug class (Becker & Starrels, 2015). In the year 2010, there were over 38,000 deaths in the United States due to drug overdoses (Becker & Starrels, 2015). Of those, 16,650 (43 percent) involved opioid analgesics (Becker & Starrels, 2015). Of the 16,650, 30% of those deaths also involved another drug family of potential abuse, benzodiazepines (Becker & Starrels, 2015). Stimulants & Sedatives Stimulants do not have the profound number of deaths as opioid analgesics, but they have gotten some attention for an increase in patient visits to the Emergency Room (ER) (Becker & Starrels, 2015). From the year 2005 to 2010, ER visits have increased by 134%; from 13,379 visits a year in 2005 to 31,244 visits a year in 2010 (Becker & Starrels, 2015). In regards to sedatives, patients run into a problem when the medication is used in combination with opioid analgesics or alcohol (Becker & Starrels, 2015). This combination has a cumulative effect in the body that has proven to be a deadly one. Evidence-Based Screening Tool The evidence-based screening tool that can be used to evaluate for risk of prescription drug abuse is called, a single item screening test (Saitz, 2015). When screening, prescribers will ask the single question, "How many times in the past year have you used an illegal drug or a prescription drug for non-medical reasons?" (Saitz, 2015). Patients might be confused with the phrase "non-medical reasons", that can be further clarified with the response, "for instances the experience or feeling it caused" (Saitz, 2015). If the patient's response is anything greater than zero, this would indicate a positive result for the screening (Saitz, 2015). Statistically, a score greater than a zero would be 100 percent sensitive and 74 percent specific for a drug use disorder (Saitz, 2015). Also, a score greater zero would statistically be 93 percent sensitive and 94 percent specific for a past year drug use (Saizt, 2015). Concluding that if primary care providers were to prescribe this patient a potentially habit-forming or historically abused medication, it would not be the best medication choice and other medications should be considered. This screening tool has been proved to yield comparable results to longer questionnaires (Saitz, 2015). Specifically, the screening tool has a similar sensitivity and specificity to the 10 Item Drug Abuse Screening Tool (Saitz, 2015). Implementation Into Practice Creative Social History Gathering When providers are gathering their social history, the provider can replace their usual method of assessing illegal drug use with the screening question. Using the screening question, "How many times in the past year have you used an illegal drug or a prescription drug for non-medical reasons?" will allow for a more thorough assessment (Saitz, 2015). Assessing both potential drug use, and risk for potential prescription drug abuse through a statistically proven screening question. Timing Of The Screening Question Work the screening question into a part of the exam when you are not asking the patient a "history list" of yes or no questions. It is easy for the patients to just say no to a list of questions. This question can be a sensitive one for the patient and critical for providers to truthfully know. Thus, working the question into a more relaxed, conversational portion of the exam may lead to a better result and outcome in the end. Established Patient Episodic Visit During the established patient episodic visit, there is a high probability that a full history gathering will not take place at this time. One, because this is an established patient episodic visit and the practitioner is already familiar with the patient. Two, unfortunately there are time restraints that practitioners are under to keep the flow of patients throughout the day and obtaining a full history is not realistic. It is imperative though, that the single item screening question is asked every time a prescription of potential abuse is prescribed. An established patients life can be going in a positive direction one minute and disaster can strike the next. The single question screening test can be easily worked into any conversation and requires no extra time to perform by either the patient or the provider. The consequences though can be catastrophic and when the stakes are so high, it would be a shame for something to be missed because the provider felt under a time constraint. Conclusion Primary care providers have an enormous amount of responsibility when caring for their patients. With this responsibility, it is imperative that when primary care providers are writing prescriptions, they are cognizant of the risks involved. Not only the side effects of medications but drug classes that have a risk of dependency and abuse. Specifically, medications that fall into the drug classes of opioid analgesics, benzodiazepines, sedatives and stimulates hold a high risk of life-altering consequences (Becker & Starrels, 2015). Primary care providers must first increase their awareness of these pitfalls and educate themselves on techniques to identify the risk of patient abuse. All that it takes is asking the statistically proven single-item screening question, to prevent the poor outcomes detailed in this paper. Incorporation to this screening test into any practitioners daily routine will lead to safer practices of writing prescriptions. It would be a tragedy for a patients life to be lost all because one simple question was not asked, "How many times in the past year have you used and illegal drug or a prescription drug for non-medical reasons?" (Saitz, 2015). References Becker, W. & Starrels, J. (2015). Prescription drug misuse: epidemiology, prevention, identification, and management. UpToDate. Federal Register. (2014). Schedules of controlled substances: rescheduling of hydrocodone combination products from schedule III to schedule II. Retrieved from Federal Register Schedules of Controlled Substances: Rescheduling of Hydrocodone Combination Products From Schedule III to Schedule II Saitz, R. (2015). Screening for unhealthy use of alcohol and other drugs. UpToDate.

Currently I am in graduate school to become a Family Nurse Practitioner. I am in my first of three clinical rotations, and in December of this year I will graduate. I never once have regretted the decision to go back to school to become a Nurse Practitioner. Below is a list of 7 tips that I know will help any nurse who is contemplating on whether or not to apply to a Nurse Practitioner program. It is my hope that this article will answer some questions that are holding you back and will lead to you starting that application process. 1) Ask yourself... Do you want to work in the Hospital or Office? This will help you decide if you should apply for an Acute Care program or a Primary Care program. I will say, do not get a degree in primary care and expect to work in a hospital. I foresee the days of the Family Nurse Practitioner working in the ICU is a thing of the past. 2) What scenario do you see yourself resonating with more? I want nothing to do with adults = Pediatric Nurse Practitioner I want nothing to do with children, they scare me = Adult/Gerontology Nurse Practitioner I like taking care of all ages = Family Nurse Practitioner I don't like pediatrics or adults, I like the neonates = Neonatal Nurse Practitioner These are just examples of the multiple options of specialties you will be able to choose from. There are many more degree options for Nurse Practitioners that are not listed here, but this will get your mind churning. Use your answer to question one to guide you in the right direction of choosing primary care or acute care for the specialty you have decided on. Remember, do not choose a primary care degree and plan on working in the hospital. 3) School Full Time or School Part Time? My vote is for school full time. Any type of schooling you want to commit to and be able to submerge yourself in fully. Where there is a will there is a way, and you will be surprised with how resourceful you can be when placed in a challenging situation. As nurses, it is in our DNA to just "figure it out". Get the ball rolling and get the program completed. 4) Work Full Time or Work Part-Time? Personally, was able to manage working full time while in school up until my clinical rotations started. Then, it was too much. Three twelve hour days at work and the requirement of all the clinical hours for the semester, plus your regular class work, on top of all the work that goes into clinicals and not to mention if you have real responsibilities of a house, kids or family members. There are just not enough hours in the day to do everything to your fullest. 5) Online Program or On Campus Program? What appears to be the trend are hybrid classes, an online-ish program. There still are all on-campus programs and all online programs, so you will be able to choose. Don't let the technology scare you, but think about how technically challenging a program might be when you are selecting one. In my opinion, regardless of online, hybrid or on campus, what you put into the education is what you will get out. 6) If you don't work in the ER, transfer there! I was fortunate enough to get a job in an Emergency Room directly after passing my NCLEX. I directly correlate all of the lessons that I have learned in the Emergency Room have helped me TREMENDOUSLY in the Family Nurse Practitioner program. First off, in the Emergency Room, you see and care for all sorts of patients, birth to death and everything in between. Also, you will see everything across the acuity spectrum as well, from primary care issues to acute care issues. Another reason to move to the Emergency Room is the ability to have a flexible schedule, with a large staff and many shifts to choose from. 7) DNP program or MSN program? I will start this out by saying I am currently in an MSN program. It is my goal to complete my DNP, but there was some strategy involved with choosing the MSN program first. My thought process was, I am not required to complete the DNP at this time and once I complete my MSN I will be able to start working as an NP. Completing the MSN portion first, roughly in 2 ½ years, and start working as an NP, versus the 4 plus to complete the DNP and all this time would be spent working at a nurse's salary. Choosing this route, you are losing out on 2 ½ years of NP salary that you could be making if you chose to get your MSN first and complete your DNP after. The trend for all programs seems to be moving to the BSN to DNP structure, without the MSN, so this is even another reason to start the NP program sooner than later. Still not sure what program, but you know you want to be an NP. Then just start! Start searching different programs, start critically thinking about what specialty you think you would enjoy the most, spend some time in conversation with both Nurse Practitioner students and practicing Nurse Practitioners and start the application process. Just put one foot in front of the other and everything else will fall into place. If you don't, then "life" will happen, time will go by and then you will no longer have the option to go back to school. Again, I have no regrets about entering Nurse Practitioner school and I am excited to start the next chapter in my nursing journey! Michael M. Heuninckx RN-BSN

Good Afternoon Tinemarie, I am glad that you loved the article and thank you for helping get the message out there by sharing this article with your colleagues. Also keep up the strong work and keep chipping away at that nursing degree. Michael M. Heuninckx RN-BSN

Hello jaycam, It is difficult for me to put in writing how appreciative that I am for your kind words. You are more than welcome, I am glad that you see the value in the article, having lived this both as a healthcare provider and sister. Keep up your hard work to get through nursing school, I have no doubt that you will be a phenomenal nurse!!!! Michael M. Heuninckx RN-BSN

With increased rates of children being diagnosed with Autism Spectrum Disorder (ASD), it is ever so important that nurses are increasing their awareness and education about the disorder.1 According to the Centers for Disease Control, 1 in 68 children are diagnosed with ASD.1 Also, ASD is more prevalent in boys at a rate of 1 in 42, versus girls at a rate of 1 in 189.1 Given these statistics, lets dive into what ASD is defined as. "Autism spectrum disorder (ASD) is a developmental disability that can cause significant social, communication and behavioral challenges. There is often nothing about how people with ASD look that sets them apart from other people, but people with ASD may communicate, interact, behave, and learn in ways that are different from most other people. The learning, thinking, and problem-solving abilities of people with ASD can range from gifted to severely challenged. Some people with ASD need a lot of help in their daily lives; others need less."2 What that being said, it is important to recognize that just because your patient has been diagnosed with ASD, it does not mean that every patient will present the same way with the same symptoms associated with ASD. As nurses who work in the Emergency Room, we know how chaotic of an environment it can be. Now, imagine if your patient has ASD and has an increased sensitivity to stimuli. I am sure you can imagine how this environment could be problematic for this patient. To better illustrate this, watch this video below, take note to all of the different stimuli in the home and replace those with stimuli that can be found in the Emergency Room. Also, follow the link to learn more about all of the details that went into creating this video. This Chaotic, Hypnotic Autism PSA Is Truly (and Literally) Sensational | Adweek Moving right? After watching this video, I felt guilt for not knowing or being more aware of this reality. I could only think to myself, I hope that I have not dropped the ball on this if I was caring for a patient that I did not fully understand what they were going through. If I had I only been more aware, I could have been able to do my job better. In my quest to further increase my knowledge about ASD, I was also able to find techniques to improve my assessment skills and ways to manipulate the environment to be more comfortable for my patients: Modifications To The Exam RoomUse a room if available that has no medical equipment in it.3Place the child in a room with a door to decreased noise from the hallway.3Dim the lights.3Remove all unnecessary equipment from the room.3Turn off all nonessential fixed monitoring equipment in the patients room.3Questions To Discuss With ParentsWhat is the baseline for their child's psychosocial and cognitive functioning?What works as the best way to communicate with their child?3Have a discussion with the parents about what helps sooth the child.3Ask what has been problematic in past visits to the Emergency Room or doctors office.3A Tailored Approach To The Physical AssessmentFirst, start your assessment away from the child.4Let the child observe the conversation you are having with the child's parent.4Start your assessment at the hands and feet, then progressively moving centrally.4Use your medical equipment on the parent first before on the child.4Let the child see and touch and equipment first before you use it.4Lower yourself to the child's level so you are not towering over them.4Moving forward, recognizing my weakness and increasing my awareness and education, it is now time to implement change. I will be doing my best to implement these changes to my practice and I hope you will as well. It is my hopes that it will get your mind churning with even more ideas that you can take to the bedside. Also, you will help with the educational process of sharing this knowledge with your fellow nurses and healthcare providers. Also, keep in mind that when you are working with pediatric patients, we are not only caring for the child but the parents as well. All of these interventions will not only help the child but, you will be gaining trust with the parents about your ability to help their child and through this difficult time. I can only imagine the stress and anxiety parents must have about having to bring their child to the Emergency Room. This is their child, their loved one, their son or daughter, their flesh and blood. The last thing that any parent wants to see is their child struggle or in pain. Anyone who is reading this article and is getting all fired up with excitement and motivation to get out there and make a change, run with it! Take that passion and use to it make a difference. I encourage you to make a positive change in your department that will increase the quality of care as healthcare professionals we are able to provide to the patients we serve. Michael M. Heuninckx RN-BSN References What Is Autism? | | Autism SpeaksCDC | Facts | Autism Spectrum Disorder (ASD) | NCBDDDCaring for autistic children in emergencies | Contemporary PediatricsCaring for autistic children in emergencies | Contemporary Pediatrics

For the majority of nurses, working the holiday is a requirement that we dread. For me, I choose to accept what I cannot change and to actively seek the good given the situation. It is my hope that this article can change your view on working the holiday. Or at least, bring to light the positive impact being at work on this day you will be able bring to your patients. I am grateful to be working on Thanksgiving Day... To serve my patients on a day that could be the worst day of their lives and on top of that it is a holiday Working the in Emergency Department, I have learned first hand that when it comes to: death, trauma or exacerbations of chronic medical conditions, they all do not care that it is a holiday and could turn your world upside down at any moment. Nor do any of the above events take heed to age, gender or socioeconomic status. Anyone at any time can be negatively impacted at any moment. Having lived this fact, I am grateful to be standing and of sound mind to help those who are not so fortunate on the holiday. To create an environment of home for my patients in a place that is the furthest thing from home In my opinion, the hospital is the furthest thing away from the warm and fuzzy feeling I have when I think of home. Even though I can wear my pajamas to work, let's say I would not want to lie down on the floor to read a book. With that being said, as nurses, we can have some fun with this to make it feel as comfortable as possible for our patients. Ask your patients what would make them feel like they were at home and use your creativity and imagination to make that happen for them. I am sure with whatever you make happen, no matter how big or small, they will notice and appreciate the effort. To be family for those who do not have a family to share the holiday with Unfortunately, we all have seen this as well. Some more than others, but the joy some people feel about the holidays, others might feel nothing but sorrow. Be an ear to listen to a story or the shoulder to cry on. Try to make them feel at home or maybe even have dinner with them so they do not have to eat alone. Going the extra mile here will not go unnoticed and has the potential to truly make a day that has been miserable for years, positive for once. To spend the holiday with my work family No matter how you slice and dice the numbers, when you are working full time or even part time hours, we are spending a ton of time at your place of employment. The bonds that you build with your colleagues in the healthcare arena are unique and unless you live it, you won't get it. Not to mention dinner, I mean, THE UNIT POT LUCK! They never disappoint and I look forward to them every time. For the Thanksgiving Holiday, let this article give you a different perspective on working the holidays. Think about the topics discussed, come up with ways that you can benefit others by working the holiday and after, see how this has changed your day. Looking through this lens will make the 12-hour shift more enjoyable and you will bring more joy to the patients you serve on this day. Happy Thanksgiving To All! Michael M. Heuninckx RN-BSN

I could not agree more. Moving forward, I would not worry about losing any sleep if I was to have a conversation with my patient about the Health Care Marketplace. I appreciate your input and perspective. Michael M. Heuninckx RN-BSN

Thank you for your very informative post, it adds an interesting perspective given the topic of conversation. I think that it is important for all nurses to be comfortable with their nursing scope of practice in the state they practice in. I still do see value in nurses becoming educated on the ACA and the Health Insurance Marketplace. Through this awareness, nurses can then help with at least being a resource for direction to places that patients could educate themselves on. Also, could not discuss or advise the patient, but speak to the patient from your perspective and not tell your patient what to do, but share with them what you would do and the questions you would ask yourself when you are looking at purchasing health insurance. So it looks like there is a way, but some creativity might be needed. What do you think?

Nurses play a vital role in educating our patients. One that is critical to the overall welfare of their health. It saddens me that a nurse would fear an opportunity to educate a patient for fear of litigation. Michael M. Heuninckx RN-BSN

How did it go? Did you enjoy your journey? Were your eyes opened? Did you gain a new perspective of what your patients go through to obtain Health Insurance? Do you now have a greater appreciation for the Health Insurance you have? We will be able to discuss this and much more in the comments section below. Let's complete this journey with all of the educational information I was able to find and learn from regarding the Health Insurance Marketplace. First, let's get some of the confusing terminology out of the way, HMO"Health maintenance organizations (HMOs) cover only care provided by doctors and hospitals inside the HMO's network. HMOs often require members to get a referral from their primary care physician in order to see a specialist."1 PPO"Preferred provider organizations (PPOs) cover care provided both inside and outside the plan's provider network. Members typically pay a higher percentage of the cost for out-of-network care."1 POS"Point of Service (POS) plans vary, but they're often a sort of hybrid HMO/PPO. Members may need a referral to see a specialist, but they may also have coverage for out-of-network care, though with higher cost sharing."1 EPO"Exclusive provider organizations (EPOs) are a lot like HMOs: They generally don't cover care outside the plan's provider network. Members, however, may not need a referral to see a specialist."1 Copayment"A fixed amount (for example, $15) you pay for a covered health care service, usually when you get the service. The amount can vary by the type of covered health care service."2 Coinsurance"Your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service. You pay coinsurance plus any deductibles you owe. For example, if the health insurance or plan's allowed amount for an office visit is $100 and you've met your deductible, your coinsurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount."2 Deductible"The amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1,000, your plan won't pay anything until you've met your $1,000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services."2 Out Of Pocket Maximum"The most you pay during a policy period (usually one year) before your health insurance or plan starts to pay 100% for covered essential health benefits. This limit must include deductibles, coinsurance, copayments, or similar charges and any other expenditure required of an individual which is a qualified medical expense for the essential health benefits. This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing, or spending for non-essential health benefits. The maximum out-of-pocket cost limit for any individual Marketplace plan for 2015 can be no more than $6,600 for an individual plan and $13,200 for a family plan."2 Now that we have gotten that out of the way, the rest should flow a little more smoothly. Let's discuss the different Marketplace Insurance Categories: Bronze: "Your health plan pays 60% on average. You pay about 40%."3 Silver: "Your health plan pays 70% on average. You pay about 30%."3 Gold: "Your health plan pays 80% on average. You pay about 20%."3 Platinum: "Your health plan pays 90% on average. You pay about 10%."3 Catastrophic: "Catastrophic coverage plans pay less than 60% of the total average cost of care on average. They're available only to people who are under 30 years old or have a hardship exemption."3 As nurses, we can play a key role in working with our patients to help them choose which Marketplace Insurance Category will best suit their needs. First, start with their current medical history. Are they currently being treated for numerous medical conditions that would require them to access the healthcare system frequently? Do they only see their primary care doctor once a year? Is this the first time they will have access to see a healthcare provider in 10 or 15 years? How many times did they visit the Emergency Room last year? Did those Emergency Room visits lead you to get admitted to the hospital? And how many times? Do they plan on having a surgery this year? How many medications do they take on a daily basis? Using these questions as a guideline for how frequently they will be accessing the healthcare system will help guide your Marketplace Insurance Category selection. The more times you could see them accessing the healthcare system, the higher health plan paying percentage you would want to guide them towards. If you did not see them accessing the healthcare system at all, or maybe just for their annual visits then a lower health plan paying percentage might be a better option for them. Also, you will have to take into account what your patient might be able to afford and guide them to the best solution given their financial status. I will warn nurses to tread lightly when it comes to finances. I trust your judgment, and as nurses, we are able to tell how comfortable our patients are with us. Just to be safe, ask if they don't mind sharing these specifics. You might be surprised that they do not have a problem with it, but if at all you sense they are getting uncomfortable, just stay generic to be safe. If your patient does feel comfortable sharing their financial information with you, I would encourage you to ask them this question. Do you have a saving account or enough liquid cash that you will be able to pay your Out Of Pocket Deductible today with? If you sense you have to tread lightly, you can also use a general statement here as well. A way to "plant the seed", would be to offer a suggestion about how you save your money for this situation. This way the conversation is being had, but they are not directly being asked the question. Hopefully, fingers crossed, they will revisit the conversation you had with them and they will develop a plan of action to figure out a reasonable solution. The next question that I thought Americans would like to know would be, does it truly matter what insurance company I bought my plan from? The short answer is, a big YES! This choice of insurance company determines what hospitals are covered under their plan and what doctors under their plan take this specific type of insurance. Also, the copays vary, the medical management programs they offer vary and what "other" services will be covered vary from insurance company to insurance company. Just because you have selected a Bronze HMO, does not mean that what is covered under this plan is all the same. The MAJOR difference here is the insurance company you are buying the plan from. When I was sorting through the different plan options, a way I stayed organized was to use the compare function. This way I could flip back and forth easily to compare and contrast plans. I cannot stress enough that what insurance company you choose for your plan and the huge impact it has on what will and will not be covered when you need to use it. With all of this being said, I can honestly say that this has been a positive and motivating journey. One that I believe my patients will benefit from along with all of the nurses who are reading and interacting with this article. I believe there is an educational gap between healthcare providers, patients and the Health Insurance Marketplace. As nurses, have the ability to help close this gap by taking the time to educate ourselves, and in turn, educate our patients. Making the transition of obtaining Health Insurance and accessing the healthcare system a smoother process. Now, let's get to work! To see how this journey began, go to The Health Insurance Marketplace: One Nurse's Journey - Part 1 References HMO, PPO, EPO: How's a Consumer to Know What Health Plan is Best? How to Choose Marketplace Insurance: Comparing health plans How to Choose Marketplace Insurance: Marketplace insurance categories