BCzito

CONCLUSION: As hypothesized, management of patients who required prolonged mechanical ventilation with tracheostomy had equivalent outcomes with the ACNP team or the fellows team ( Hoffman LA, Miller TH,Zullo TG,Donahoe MP. 2006 ). respir care ___________________________ * Hoffman LA, * Tasota FJ, * Zullo TG, * Scharfenberg C, * Donahoe MP. Schools of Nursing, University of Pittsburgh, Pittsburgh, PA, USA. BACKGROUND: Many academic medical centers employ nurse practitioners as substitutes to provide care normally supplied by house staff. OBJECTIVE: To compare outcomes in a subacute medical intensive care unit of patients managed by a team consisting of either an acute care nurse practitioner and an attending physician or an attending physician and critical care/pulmonary fellows. METHODS: During a 31-month period, in 7-month blocks of time, 526 consecutive patients admitted to the unit for more than 24 hours were managed by one or the other of the teams. Patients managed by the 2 teams were compared for a variety of outcomes. RESULTS: Patients managed by the 2 teams did not differ significantly for any workload, demographic, or medical condition variable. The patients also did not differ in readmission to the high acuity unit (P = .25) or subacute unit (P = .44) within 72 hours of discharge or in mortality with (P = .25) or without (P = .89) treatment limitations. Among patients who had multiple weaning trials, patients managed by the 2 teams did not differ in length of stay in the subacute unit (P = .42), duration of mechanical ventilation (P = .18), weaning status at time of discharge from the unit (P = .80), or disposition (P = .28). Acute Physiology Scores were significantly different over time (P = .046). Patients managed by the fellows had more reintubations (P=.02). CONCLUSIONS: In a subacute intensive care unit, management by the 2 teams produced equivalent outcomes. _________ 1: Am J Crit Care. 2005 Mar;14(2):121-30; quiz 131-2.Click here to read Links Outcomes of care managed by an acute care nurse practitioner/attending physician team in a subacute medical intensive care unit. * Hoffman LA, * Tasota FJ, * Zullo TG, * Scharfenberg C, * Donahoe MP. Schools of Nursing, University of Pittsburgh, Pittsburgh, PA, USA. BACKGROUND: Many academic medical centers employ nurse practitioners as substitutes to provide care normally supplied by house staff. OBJECTIVE: To compare outcomes in a subacute medical intensive care unit of patients managed by a team consisting of either an acute care nurse practitioner and an attending physician or an attending physician and critical care/pulmonary fellows. METHODS: During a 31-month period, in 7-month blocks of time, 526 consecutive patients admitted to the unit for more than 24 hours were managed by one or the other of the teams. Patients managed by the 2 teams were compared for a variety of outcomes. RESULTS: Patients managed by the 2 teams did not differ significantly for any workload, demographic, or medical condition variable. The patients also did not differ in readmission to the high acuity unit (P = .25) or subacute unit (P = .44) within 72 hours of discharge or in mortality with (P = .25) or without (P = .89) treatment limitations. Among patients who had multiple weaning trials, patients managed by the 2 teams did not differ in length of stay in the subacute unit (P = .42), duration of mechanical ventilation (P = .18), weaning status at time of discharge from the unit (P = .80), or disposition (P = .28). Acute Physiology Scores were significantly different over time (P = .046). Patients managed by the fellows had more reintubations (P=.02). CONCLUSIONS: In a subacute intensive care unit, management by the 2 teams produced equivalent outcomes. ________ 1: Br J Gen Pract. 2005 Dec;55(521):938-43.Click here to read Links Comment in: Br J Gen Pract. 2006 Feb;56(523):137-8. Comparison of GP and nurse practitioner consultations: an observational study. * Seale C, * Anderson E, * Kinnersley P. School of Social Sciences and Law, Brunel University, Uxbridge. [email protected] BACKGROUND: Studies show that satisfaction with nurse practitioner care is high when compared with GPs. Clinical outcomes are similar. Nurse practitioners spend significantly longer on consultations. AIM: We aimed to discover what nurse practitioners do with the extra time, and how their consultations differ from those of GPs. DESIGN OF STUDY: Comparative content analysis of audiotape transcriptions of 18 matched pairs of nurse practitioner and GP consultations. SETTING: Nine general practices in south Wales and south west England. METHOD: Consultations were taped and clinicians' utterances coded into categories developed inductively from the data, and deductively from the literature review. RESULTS: Nurse practitioners spent twice as long with their patients and both patients and clinicians spoke more in nurse consultations. Nurses talked significantly more than GPs about treatments and, within this, talked significantly more about how to apply or carry out treatments. Weaker evidence was found for differences in the direction of nurses being more likely to: discuss social and emotional aspects of patients' lives; discuss the likely course of the patient's condition and side effects of treatments; and to use humour. Some of the extra time was also spent in getting doctors to approve treatment plans and sign prescriptions. CONCLUSIONS: The provision of more information in the longer nurse consultations may explain differences in patient satisfaction found in other studies. Clinicians need to consider how much information it is appropriate to provide to particular patients. ______ sorry so long .. there are many many many studies that show this... I suppose you are correct about them adding the more health assessment stuff, but if health care is comparable what is the purpose of this...? Still it appears that the majority of classes are not centered around pt care.. don't you think? also I agree about the need for new aprn's to have more confidence comming out of school, and therefore I am in favor of a required residency program that would require NP's and Psych CNS's to have either an experienced NP/CNS or Physican supervisor in their specialty field for a set amount of years before becoming fully autonomous. However, feelings of confidence does not necessarily indicate that these practitioners are not able to preform the appropriate care, it could be for many reasons. They are new, they have to face resistance from certain groups that want to criticize them before they even begin. I think its normal to feel vulnerable when you are new at something. Also nurses may be more socialized to vocalize their concerns while young doctors are often ridiculed by their superiors if they admit to not knowing the answer to something or feel unsure of themselves.. just a thought... -bczito

I don't know the whole arguement for this but I do know a NP or CNS rather that is head of outpatient general psychiatry.

just wanted to remind people we already DO have "doctor nurses" they have PhD's ... did people forget this or something...

First of all the "just nurses" thing is just totally uncalled for. Nurses don't WANT to be medical doctors. Second.. I have read the AMA's little plans... and they are just that... plans...personally I don't like the DNP I prefer the PhD. However, the DNP has nothing to do with trying to be a medical doctor. There are many physicians I like and respect, however I also find many physicians treat patients like ****. And for your info I took all the same classes with the pre-meds students,,, actually I WAS a pre-med student. I had a CHOICE and I picked nursing. I had a 3.7 GPA too. oh did I mention I published a neuroscience study as an undergrad? XXXXXX Things are going to change in the world of healthcare. Thats not a threat, that means stop trying to hold this position of superiorty. Stop heckling and lets do whats best for the patient. It's also true that there is no reason for NP's to need collaboration with physicians. We HAVE shown comparable care...! (I am for a limited residency for NPs however, supervised by either a more experienced NP or physician in their specialty) My NP preceptor is the person who is supervising the havard residents on their pharmacology... XXXXX Do you honestly think the day those MDs graduate from their residency that they will be more experienced than her?! XXXXXX XXXXXXXXXXX XXXXXXXXXXXX OH and if someone has a PhD (or even a DNP) they have a DOCTORATE and should be called a DOCTOR just like anyone else in any other field who has a doctorate... PS we aren't MEDICALLY trained, WE are trained in NURSING to be NURSES,... its a different field.. XXXXXXX

Well we have to at least consider the money... I don't know when you went through college, but I will owe over 130,000 bucks when I'm done (just for 2 years!). I think that an extra 2-3 years of school at 700-800 dollars per credit is definately something I need to think about... unfortunately money IS a factor, and I think there are quite a few people who probably did get thier NP to make more money through private practice and other avenues....just my thoughts I guess....

get your msn its worth it, there's no way there gonna push this through!

here here!

I am still currently in grad school so I have been exposed to a lot of the speculations pros and cons and have read up on it. I have decided that the DNP is a horrible decision to begin with, not to mention making it required as an entry to practice here's why: The program was voted in by a VERY narrow margin. Those that vote on whether to have such a program are DEANS ONLY. Deans have a stake in the creation of the DNP for 2 reasons. One a practice degree like the DNP brings in a great deal of money for their instituion/college. Second university and/or colleges that do not have a certain amount of nursing PhD staffed (who need to have graduated from a certain tier school) cannot have a nursing PhD program until they meet these faculty requirements. The schools that do not meet these requirements have a HUGE incentive to bring the DNP to their school especially since they can't have a PhD program. The cirriculum of the DNP program is also questionable. There are no classes that further the nurse in treating or caring for patients. Instead it seems to be more business oriented. This will not further the benefit to patient care as they propose it would. NPs/CNS have been shown in various studies accross multiple specialties to provide comparable care to other health care providers (including MD's). This actually suggests that perhaps MD's go to school for longer than is needed to provide excellent patient care. So why make NP's go to school longer if their care is already at excellent standards? (unless of course someone wants to line their pockets) We already have an established PhD in nursing that is respected in nursing as well as other healthcare fields. Other fields such as psychology have applied practice doctorates such as the PsyD. Many times these individuals are the first to be laid off when institutions need to make cuts, favoring to keep those with a PhD. Finally (and most importantly), the role of the APRN has allowed greater access to quality care for patients in need. Increasing the years required to be certified as well as increasing the costs (by a ton) will decrease applicants and therefore decrease graduating APRNs. This will limit patients access to care. They will be the ones that suffer most. This is not right. We all need to do something about this. Write letters, talk to proffessors, co-workers, etc. With this change there may also be threats to those currently holding an APRN license... keep this in mind: degrees can not be "grandfathered in". Kinda scary. bczito

talk to the people at suffolk community college they have an ADN program and its inexpensive. talk to a live person. there is no reason you shouldn't be able to do it... also there are programs called masters entry programs that you can apply for... all you need is a bachelors degree in some other field and the prereqs and you end up with an RN and a masters degree... something to look into... check out the site http://www.allnursingschools.com hope that helps. Don't waste your time doing an LPN program if you really want to do the RN.

You can do it, it seems like you have lost a lot of confidence in yourself. You have to keep in mind that you've been through an awful lot recently and its simply not possible sometimes to just forget it all. My dad was 50 when he went to nursing school. Age is not a matter. I definately would use the sauders CD. The CD is excellent because you can see the rationales about why your answer was wrong or right immediately. In addition I would pick up a copy of nursing made insanely easy. it has lots of funny pictures to help you remember key concepts. (some books stores sell them as volume 1 and 2 .. get both!)... when studying it is more important to make sure you understand the rational of why you got a question right or wrong then simply doing the questions and checking them without ever knowing or understanding the rationale. you can do, but it requires intense concentration.... It sounds like you have some anxiety as well, this could definately effect your ability to study and/or take the test. Have you ever considered seeing someone about an antidepressant? This would help with an xiety a great deal. not to mention you have had a lot on your shoulders the last few years. Just cause you go one doesn't mean you'd need to stay on it forever... it might just give you the space you needed to refocus your life again... just a thought... either way I am sure you can do it. Believe in yourself! best of luck! dz

what is a nursing entrance exam? is it the GRE? I'm confused cause I never had to take an entrance exam

I was getting in the 70's on sauders and passed with 75 questions! I think they are much harder in that book which is good.

most likely you passed if you felt you did a good job studying. If you failed at 75 questions that means you had to have gotten allot wrong... if you were doing "eh" then it would have kept going to see if you'd do any better before deciding. I'm sure you passed! don't fret.

So what did the doctor say in response. Its sounds legitimate to me that you would not want to continue morphine (at least at that drip rate) if the respirations were 6? I was more curious about the situation... I think the above advice is all good advice. thanks!

Yeah but who said anything about an emergency, maybe some want to work in this area but not most. And as far as needing to work side by side with a physician, that is just simply untrue. some do yes, but many many don't. Most go into community or private practice doing primary care services. Some states do not require any physician collaboration at all. Others like MA where I live its one meeting every 3 months. NP and CNS that work in hospitals have a very different role than those out in the community. as most nurses that have worked as bedside nurses and then went into homecare or community (at the adn or bsn level) will tell you that being in the community requires a completely different skillset. Research on this has shown that community RN's feel that their time working in a hospital setting impeded their progress in the community because of the difference in autonomy and the lack of the availability of a team or certain equiptment. As far as outcomes of NP/cns primary care, research is showing comparable health and safety outcomes to MDs. In addition surveys and questionaires show that most patients actually report better experiences with NP/CNS's than docs because they feel they are given more time and are more thouroughly evaluated. I think the need for bedside experience really depends on the setting you wish to work. There is some really interesting research going on about this now. You should check it out. Its pretty interesting. one last thing... it makes me sad that you would turn your back on nurses and say you wouldn't want to see an NP or CNS. It sounds from your post that there is some sort of jealousy involved. Personally I think bedside nurses are incredible and amazing and extremely smart and knowledgable. Sometimes I get the impression that bedside nurses are projecting their feeling of insecurity about not having an MSN on those who are CNS or NP's because they are afraid that those people think they are "better" in some way. I don't think thats the case at all. I am amazed by all the things that bedside nurses do and will forever have an undying respect for them and their work. I think we need to all support eachother as nurses instead of trying to find ways to undermine eachothers value or competence.