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.

i saw this book and when i get a chance i want to read it. i am relatively new in the nursing field (i am in a masters entry program). when i found out about nursing i had a very stereotypical "white hat" view of nurses and what they do. i really didn't understand at all. i had considered medical school and was trying to decide if that is what i really wanted to do and began looking at my options. luckily for me i didn't overlook nursing school. i started to read about nursing and what i read really facinated me and gave me a new outlook on nursing. the more i learn about nursing the more incredible i think it is. i often think about how i can get the word out about nursing. i considered doing a project with my grad nurses assoc that would pay for ads in a local metro paper that actually talked about what nurses do . it sounds so simple but knowing from my own personal experiene, the general public has no idea of the scope of practice of the bedside nurse, and many people don't even know that an advanced role exists unless they have been to one. i think caring is a huge part of nursing, and its definately a large part of the job, but i think the public also needs to see the other side of it. the technical side and the knowledge side. they need to be told outright that nurses do more than stand by your bedside and get you your pills. i think i want to focus on that side if i do end up creating these ads. nursing rocks!

I wouldn't worry too much about your grades 10 years ago. Do well on your pre reqs (that doesn't mean you need all A's allthough that would be nice!). In addition I think (depending on the essay question of course) you should explain your mothers wish for you to be an RN how how that eventually changed... In addition I would focus on how your past experiences (good and bad) have made you come to realize (now) what you really want to do with your life. I found my best essay was the one that was completely honest and heartfelt... in the past I always avoided this in my essays for fear of sounding like a sap, but I felt so strongly about what I said this time, I just left it, and that was the one that got me in. as far as the no childcare help issue, that can be a real challenge because nursing school is stressful and time consuming. Childcare is often expensive. Try posting some ads at a local college for nursing school students for a nanny position. Or talk to the college you are planning to attend and see if they have any day care services for adult students going back to school. what type of program are you looking to get into?

I did my synthesis at McLeans its an awesome hospital and the role of the nurse there seems very valued. I loved every minute of it. The only downside is the hospital has lower pay than surrounding hospitals... however despite that none of the nurses ever want to leave... so...

I had a bs in neuroscience (although some of my classmates had bachelors in finance and english) and I am in a masters entry program and received my RN in one year, and will continue on in my second year to be an NP/CNS (its a 2 year masters program). most programs are 3 years though and there are pre reqs. also whats nice is you can work part time after you get your RN as a nurse and pay off some bills if you want... won't lie though its expensive.... much more than 18,000 bczito

go into a masters entry program. BS can go into higher management ranks where as it can be difficult if not impossible with an associates (depends where you live) many positions require at least a bachelors.. If you get your masters and become an NP or i CNS (nurse practitioner or clinical nurse specialist) you can prescribe medications and do primary care on your own... Also you can teach at a university as a proffesor at the masters level in nursing... let me know if you have anymore questions... currently I am in a masters entry program in nursing at Boston College in Mass. and have just recently taken my NCLEX.

Hey paula, no worries. I have a great test plan. get a kaplan book ( buy the 2003 version its cheaper and it doesn't matter). Get a new (or current) saunders NCLEX review book with CD ROM. Get a book called nursing made insanely easy (some places have this book split into two thinner books vol one and two, get both if this is the case). First: read the strategies in the kaplan book carefully. It gives great Tips and strategies that you can practice later... DON'T do the questions in the kaplan book they are too easy and have tons of typos which makes me not trust the questions too much. Second: Read nursing made insanely easy, spend time on each page making sure you really truely remember the important stuff. read it front to back. It shouldn't take you more than 2-3 hours even with breaks. Its pretty funny so its not really a chore at all. Third: Use the saunders CD and take a full comprehensive practice test keep in mind strategies from the kaplan book. once you finish the practice test (which you don't need to do in one sitting, you can break it up) you should look at your score and print out the results. next go through the review of every question (even those you got right) and make sure you understand why the answer is correct and/or why the one you chose was wrong... Fourth: Go to the study section and select the sections you got 50% or lower on, OR the TOP 10 areas that you did the worst on. Work on those study questions 1-2 hours a day (or more if you can stand it) every day, make sure you understand the rationales, if you are really unclear about a question look it up and write yourself some short hand notes in a notebook or pad of paper. Do this for a week (7 days) Fifth: Take the short quizes in each of the areas you have been studying. If you get less than 70%... continue to do more study questions in that area until you are able to get over 70% consistantly on 3 quizes in that study area. Make sure you go over every question you take to make sure you understand the rationale. Sixth: Take another comprehensive test (there are two available on the cd). check your progress..go over the questions. any areas you still are having trouble on review them in your book and do more study quetions. Seventh: The night before your exam re-read nursing made insanely easy.. (this book is awesome lots of pictures to help you remember_) make sure it all sticks ... this book helped me soooooooooooooooo much on my test....if you have time before your exam on the day of the test look over some of the ones you have trouble remembering again... You WILL pass. I passed at 75 questions and this was my method. hope that helps! good luck! ps do questions... don't study from your book unless it is to look up something on a specific question.

since we are talking about sweating, I don't sweat too much, but I always sweat a ton on my face, I feel like I am dripping when it gets slightly warm. I don't know if there are any treatments for that. anyone know... this is why I like fall weather.

Hi all, I need to write my proposal for my synthesis. Here's my deal. I am a masters entry student and I am doing the psych mental health track and I absolutely love psych. I think I would be happiest doing my synthesis on a psych floor, however being new to the field I feel like I would like some more practice with tubes, IV's and such. I have only had one clinical so far so it makes it very difficult to try to select a good fit for me. Does anyone have some suggestions for a floor where I would get that experience and would expose me to a good deal, but was still not so fast paced that it would not be conducive to learning. I'd rather take it slow and learn it right now. It possible a floor with some added psych issues might be good for me as well. any thoughts? advice is much appreciated. Thank you, BCZ

I had to take all of those courses as prereqs to get into my direct entry masters program in nursing. Not to mention the other 185 credits I had from undergrad besides that, all most of which were science courses. I don't really know what the convo is thats going on all I know is there are allot of direct entry haters here. -bcz

Hi friends, for those who have some experience under there belts I am looking for some advice on where to do my synthesis. I am in a direct entry for psych mental health, and I am absolutely sure I love this work and this is what I want to do (all that stuff). My professors do recommend that we try to get experience in our synthesis on things like IVs, tube stuff, meds, since this will really be our final chance to get this all under our belts before the NCLEX. I also agree I need this experience too, although I am sort of dreading it because I really love psych work. Anyway. I would like some advice on a place where I could get this experience and maybe get some interesting psych cases as well, and or a place where I would get a great deal of experience on tubes and IVs and such which out such an intense high paced atmosphere. I guess somewhere where I'd get exposure, but have a little more time to figure things out and learn with out quite as much pressure (I don't mean NO pressure, just something thats more conducive to learning). Is there anyone with any possible suggestions or experiences that may be helpful. I have to choose in two days. Does anyone think I should just do a psych synthesis and be happy? HELP! -BCZITO