NurseKnope

Sorry if this has been posted before, I tried searching but couldn't find anything. I'm having some confusion over CPAP and BIPAP, specifically in regards to ordering and ventilation. On our ventilated patients, if they are on CPAP trial they are generally on something like 5/5. If we have to increase them to 8/5 is this now considered "bipap?" Our vents do not ever said "bipap" on them, only cpap for the mode. Does this have to do with the invasive nature of this ventilation? Is NIV CPAP always the same epap and ipap setting? I may be having some confusion because I've only ever learned on one type of NIV machine or vent machine at our hospital. Can someone still be using CPAP mode but with setting of 10/8 for example? Sorry if this is confusing!! I understand continuous pressure vs biphasic. Just confused about settings and ordering

Thanks for the responses, you guys. It was really helpful!

Sorry if this has been asked a lot, I’ve tried searching but couldn’t find anything. I’m having a hard time differentiating between a fib with rvr and svt. Is a fib always considered rvr if the rate is greater than 100? Does it become svt if the rate is greater than 150? I may be splitting hairs. I understand causes and treatments but just don’t know these nuances. If anyone has any resources that would be appreciated. Dr Google has not been helpful and none of my textbooks/ekg books go into this much detail.

Advice in terms of what?

Ahh yes "fellowship" does sound a lot more NPish. Thanks for sharing that list! As I suspected, my state doesn't have any fellowship programs, but this definitely gives me something to go on!

I'm learning about residencies for NPs after graduation. Has anyone been through one? Did you think it was worth it? I don't have any in my geographical area, so would it be worth it to travel to another state for one? Are they paid or more like unpaid internships/further course studies? I'm a current NP student going into AGACNP studies. This subspecialty of NP is not as common as FNP in my area, so I'm not worried about finding a job per se, but I would like to learn as much as I can. Cross posted to NP student forum

I've seen a few posts about residencies post graduation, and I had no idea those existed but I am very interested now! Is anyone thinking of doing one or has gone through one? What was your experience like and would you recommend? There are none in my geographical area so would it be worth it to move out of state for one? Cross posting to NP forum.

Are you trying to apply for a DNP degree or a post master's MSN? I am currently enrolled in an ACNP post master's MSN with my first MSN being in nurse ED. I received credit for the classes I'd already taken (I was required to take the 3 P's for both degrees - patho, physical assessment, and pharm - and was given credit for these this time around since I'd already done them for MSNed, as well as some other random healthcare quality/nursing informatics type courses). I don't know about going straight into a DNP program with your current MSN. The DNP was not an option for me with MSNed because it wasn't a "practice" degree. The terminal equivalent was the PhD for MSNed. As for online vs brick and mortar, there are a lot of posts here about people doing NP degrees online, and I think a lot of the problems people have is finding preceptors and also making sure the school is kosher for whatever state's boards you'll have to sit for.

Is there any plan for if a second wave comes in October? Here we are concerned they may close hospitals to students again when there is another wave (though it seems we never left the first one ?). We are trying to decide between doubling up on clinicals, using weekend time, front loading clinicals, etc.

Here we are again!! It's planning time for fall. With all the COVID stuff going on, what are nursing programs in your areas doing for hands-on clinical experiences? Are hospitals still allowing students in your areas? Are schools allowing students to have in person rotations? Are you doing online simulations/case studies/projects?

Thanks for all the comments!! I have downloaded the epocrates app and it's pretty awesome!

Hi! I don't know much about informatics, but I have an MSN in nursing edu! I love this degree... I love teaching! I have several friends that are in NP programs and I've successfully converted one or two of them. And there's a really good job market where I live because a lot of the faculty are getting ready to retire and are ready to pass the torch, so to speak. I work with nurses from all sorts of backgrounds in a BSN nursing program - one of them only has NICU experience, so there's not necessarily a need to "diversify" where I live in order to teach. That instructor is expected to learn whatever topic she will need to teach on, and she will probably end up doing adult m/s or mother/baby clinicals in the future. Check different DNP programs because some programs in my area only allow MSN in nurse ED to do PhD, and reserves DNP for NP and nurse exec/admin degrees. Not sure about the informatics degree if that would be DNP or PhD route. I know someone who is working on getting an MSN in nursing informatics. She was telling me she will have to move 2 states away to find a job because they are so few and far in between. She said it would be worth it because apparently with that degree she could work remotely and from at home? Not sure, because the field has never really interested me enough to research, but a lot of nurses are really into it. Most of the informatics/IT/documentation jobs around where I live only require a BSN, so the informatics degree doesn't make much sense here, but it's all about your geographical area and supply/demand.

I've had a few NP instructors tell me in the past they have "cookbooks" they like to carry with them - pharmacology books they've found helpful when they are prescribing a medication they don't prescribe super often as a refresher to know the correct dosage, frequency, etc. Does anyone have any knowledge of this or have a special "cookbook" they like/use? I'm starting post MSN NP program in August and am interested in any pharmacology books that are helpful in the clinical setting!

I had this question about switching when I was in school. My school basically told me I'd have to apply to the program I wanted to switch to, and then I would be considered along with the rest of the candidates. I agree with the person above who said it may not be the best move to change from midwifery to FNP. Where I live (and I think a lot of other places too) the FNP market is so saturated, there are several new grad FNPs that are having to continue to work on their floors as RNs sometimes for 1-2 years before they find a job, and then the pay for FNP is not much better than what they were making as bedside RNs at that point. There also is the question of litigation issues when you have someone who is a licensed NP working as an RN, which has always been questionable where I work. I also think that as a FNP you may not have the option of doing women's health/peds. Where I'm from at least, they would prefer to keep specialist NPs in those specialties and the FNPs usually get stuck doing just adult/geri health/gen med. Just something to think about, but you have to do what sounds best for you! My opinion of the midwives was always that they were hardcore, passionate caregivers and serious advocates for women's health issues. They went into that specialty because that's where they thought they could make the most difference.

Hi guys! I just found out I was accepted into an adult geri/acute care NP program for my post MSN. My other MSN is in nurse ED, so I'm a little nervous about going into a more practice type setting. I've done critical care for around 3.5 years and med/surg for around 4.5 years. Any tips on what to study up on going into the program? Or did you guys just wait until the program started and just winged it from there?

My school has decided to extend Spring break and move to online format after that because of the covid pandemic. Our clinicals have been cancelled as well, so we are to create "clinical" activities for students to complete at home in their place. These are activities that should take the students a number of hours to "make up" their clinical time they are missing and hopefully spur some critical thinking. These can be case studies, NCLEX questions where they answer the question and provide rationale, matching of diseases and signature symptoms with follow up definitions, etc. What do you guys do at your schools when you have to miss clinical days?

I'm a full time instructor and still work part time at the bedside. I could easily work 4 shifts a month, if I wanted to, even more when I think about how many breaks we have (Spring break, easter, Summer, fall break, Winter, etc.). The burnout in academia is so much less for me that I'm not as tired on my days off and can therefore work back at the bedside (when I'm feeling froggy ?). Since you'll be online, it shouldn't be too difficult. Prior to the students starting, you should already have a plan for the semester so you can begin early on getting prepped. For the next semester, it will be even easier because you should have most of your materials prepared (assuming you're teaching the same courses).

I'm not really sure and no one has been able to tell me, other than to say they feel like the students may not pay as much attention because they already have all the notes they need. It really is pointless, however, because our topics come straight out of their textbooks so there's really no information on the slides that couldn't be found in the book (if they would crack them open).

Hi guys! I'm a fairly new nursing instructor and still learning the best way to do a traditional lecture that students can learn from. I was wondering what everyone else's lecture style is like, including if you post notes or hand outs for students to follow along with. Currently I lecture using powerpoint. Our institution does not want us to post our powerpoint slides for the students to have, so many instructors have posted what is basically their powerpoint sides in word format with blanks here and there for students to fill in. I've done this before, but I was wondering if there was something else someone may be doing that their students enjoy. Thanks in advance!

Thanks for the input!!

Sorry you are having such a hard time! I've been working in neurology for about 3 years now. Medical, surgical, trauma, spinal injuries, ICU, I've done it all and I can tell you it is not for the faint of heart! Sometimes it feels like people confuse neuro for psych, but on our unit it's more manageable because we have a 4:1 on days and 5:1 ratio on nights. It still gets crazy, but there's nothing like a success story. The recovered stroke patients are the sweetest thing. And for the really confused ones? Four point restraints: HALLELUJAH!

Hello all! First time poster to the main forums so let me know if this post should be in a different place! I am a new nurse manager (just finished up first month) on a neuro/med-surg overflow unit. Coming in to this new role I am seeing there is a MAJOR deficit with our PCAs and their duties and it seems they haven't been held accountable in the past. I'm skeptical that baths are being done, rooms are always left a mess, supplies in the rooms are always low, patients' trays are often left in rooms for HOURS after meal times, and water jugs are never filled. Not to mention, I was doing some chart audits today (just for fun) and realized none of the CNAs chart anything except I's and O's. So, my question is, how are CNAs held accountable for their duties on everyone's units? Do you keep a bath log? A daily CNA checklist? Our hospital has done away with in room rounding sheets in the last year or so, so I doubt I could use that. I tried checking for similar questions first, and couldn't find any, so please point me in the right direction! Any opinions/ideas are welcomed.