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Lane Therrell FNP, MSN, RN

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Nurse Practitioner, Coach, Writer

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  1. Lane Therrell FNP, MSN, RN

    What I Wish I’d Known About Continuing Education: Know Your Requirements [Part 1 of 3]

    Hats off to you, Winniewoman9060, for remaining certified post retirement. Being surprised by changing renewal requirements is definitely no fun. Maintaining credentials means meeting “… the renewal requirements in place at the time of … certification renewal.” As a point of clarification, the 75 hours I mentioned in the article were specifically for renewing my own FNP-BC certification. I’m not familiar with the specific renewal requirements for the RN-BC certification (which I’m assuming is synonymous with your ANCC Med Surg certification). I hope I didn’t create any confusion by providing my own example in the article, but I felt it was important to spread the word that the requirements we may think we know are subject to change during the renewal period. And if you don’t know what the changes are, you can really be blindsided. We’re all responsible for getting the information that pertains to our specific certifications straight from the certifying bodies themselves, not via hearsay.
  2. Lane Therrell FNP, MSN, RN

    What I Wish I’d Known About Continuing Education: Know Your Requirements [Part 1 of 3]

    Yes, you would think that both certification renewals should be accommodated by a single account-- especially considering the price. You were clever to think of setting up two accounts, though. Others may benefit from the same tactic, so thanks for sharing. Meanwhile, I hope they get their site fixed sooner rather than later.
  3. Lane Therrell FNP, MSN, RN

    What I Wish I’d Known About Continuing Education: Know Your Requirements [Part 1 of 3]

    The problems you're describing might be worth bringing to the attention of your state's Board of Nursing (I'm assuming they're the ones doing the mandating and funding the contract with the app developer). If they want to mandate an electronic system for CE tracking, it makes sense to choose one that allows for tracking of multiple licenses and displays data accurately. You are likely not the only one who has experienced these types of unnecessary headaches. I definitely feel your pain, and have found that maintaining my own (paper and electronic) records is still the best way to avoid hassles.
  4. I recently renewed my family nurse practitioner credential (FNP-BC) for the first time since successfully sitting for the American Nurses Credentialing Center (ANCC) national board certification exam 5 years ago. I’ve always loved the idea of lifelong learning, and while I have benefited from leveraging continuing education to enhance my professional development, I’ll admit I’ve been frustrated with the level of detail and complexity involved in maintaining my professional credentials. While reflecting on what I can do, moving forward, to streamline my own overall license and credential renewal process, I came up with a list of things I wish someone had told me about continuing education and maintaining my professional licenses and credentials. Maintaining those hard-earned professional licenses and credentials requires a bit more than just taking a bunch of continuing education courses (CEs)—you’ll need to develop strategies and tactics for yourself in three categories: 1) knowing your renewal requirements; 2) managing your time and money; and 3) maintaining accurate records. In this first article of a 3-part series, I’ll share my view on why knowing your continuing education requirements is more complex than it seems on the surface. Requirements can change, certain CEs may not be recognized at all or in full, and not all types of CE credits convert to the number of hours you may expect. The complexity intensifies when you hold multiple licenses and credentials. Requirements Change You already know that continuing education and license renewal requirements vary by state, type of license, and credential. But did you know that your continuing education and certification renewal requirements are likely to change over time? Yes, credentialing bodies are constantly reviewing and revising their renewal criteria. It’s up to you to stay on top of these changes. First, be sure to get your information straight from the credentialing agency instead of relying on world-of-mouth information. Don’t depend on what your professors told you, what your classmates said, or what your colleagues discussed in the break room. Use what you’ve heard as a launching pad to conduct your own research: Go to the source and see it for yourself in writing. Second, build an ongoing plan for staying aware of changes. This means checking in with your licensing or credentialing organization periodically. Professional organizations can provide a gateway to finding out about these changes. Another way is to bookmark your credentialing bodies’ renewal criteria pages and check them routinely. Of course, this doesn’t work unless you actually remember to go and check the sites. I was amazed at how many of the criteria for my FNP board certification changed significantly during my 5-year renewal period. Know What Counts Not every continuing education activity you do will count for every license or credential renewal requirement you need to fulfill. (I know, right?!) Ideally, any continuing education credit you earn would be applicable cross the board, but that’s not always the case. Some CEs may not be recognized in full or at all by every credentialing agency. For example, the ANCC only recognizes 50 percent of the credit earned from providers not approved by the ANCC, and the California Board of Registered Nursing (CA BRN) only recognizes CE earned through CA BRN-approved providers. So, if I earn CE credits from a provider that is not recognized by the ANCC or the CA BRN, only half of those hours will count toward renewal of my FNP-BC, and none those hours will not count toward renewal of my state licenses. Conclusion? Before I enroll in a CE opportunity, I check to see if the provider is honored by the ANCC and the CA BRN. Being aware of this ahead of time helps me make savvy CE choices, and keeps me from being disappointed, frustrated, or panicked at renewal time. Some credentialing bodies allow professional activities other than CE courses to count toward license and/or credential renewal. For example, hours spent in clinical practice, precepting students, volunteering, making presentations, earning an advanced degree, or doing research can all count toward renewing my FNP-BC board certification if documented correctly. But, unfortunately, none of those things except taking academic nursing courses would count toward renewing my CA RN license. Knowing your requirements also means paying attention to the specific subject matter covered in the CE opportunity. For example, I need 75 continuing education hours every 5 years to renew my FNP board certification through ANCC and 25 of those must be specific for pharmacology. With this kind of specificity, the key is to make sure I earn enough pharmacology-specific hours to meet the pharmacology requirement. This can be tricky to track because some CE courses offer only a portion of the total hours as pharmacology-specific. For example, a CE course may offer 2 hours of total credit, but only 0.5 hours of that time counts as pharm-specific. Do The Math Closely related to the idea that not every CE credit you earn will count toward the renewal of every license or credential you hold, is the idea that the credits themselves are counted differently depending on who’s providing and who’s counting. The takeaway is: Know how ahead of time how each of your particular credentialing bodies recognizes, calculates, and converts CE hours. Admittedly, counting CE hours can be confusing. Descriptive words are a tip-off to how the calculations may vary. Various providers offer “contact hours,” “continuing education units (CEUs),” or “continuing medical education (CME).” Words matter because they are not all calculated or recognized the same way. The ANCC offers a conversion formula: 1 contact hour = 1 CME or 0.1 CEU or 60 minutes; 1 CEU = 10 contact hours. Make sure you know the conversion formula that is being used by your credentialing body. Be aware that any algorithms embedded in online renewal or CE tracking applications should include consistent conversion calculations, but they may not always be accurate. The bottom line: Do your own math and double-check it. Being aware of this and knowing how to count your credits will help you decide which CE opportunities are right for you and prevent the worst-case scenarios of coming up short at renewal time or during an audit. Ultimately, continuing education benefits both you and the patients you serve. However, I wish someone had told me, back in the day, that “knowing your requirements” involves in-depth proactive thought and planning, especially when you hold multiple licenses and credentials. My intention in sharing this is to help you streamline your own personal continuing education strategy. In Part 2, I’ll share my thoughts managing your time and money to keep continuing education from breaking the bank. Meanwhile, here’s a question: What do you wish you’d known about continuing education before you embarked on the adventure yourself? Sources and Resources 5 Reasons to Invest in Continuing Education ANCC 2017 Certification Renewal Requirements Continuing Education for License Renewal Lifelong Learning
  5. Lane Therrell FNP, MSN, RN

    What is most important to chart on?

    Develop a systematic approach for the multi-step processes you do routinely (like assessments). When you develop good habits of always doing things the same way in the same order, you're less likely to forget something when things get hectic, and the charting flows easier and quicker.
  6. Lane Therrell FNP, MSN, RN

    5 Reasons to Invest in Your Continuing Education

    Continuing education allowed me to acquire a specialty certification while simultaneously meeting the requirements of maintaining my state licensure. I've always loved the idea of lifelong learning.
  7. Lane Therrell FNP, MSN, RN

    Older Doctor doesn't think nurses should be in charge

    Your comments speak to an idea that's been rattling around in my head for a long time: Almost all healthcare professionals at all levels could use a refresher course in teamwork, leadership, and communication. "Equality" should be irrelevant on a team because we all have roles to play. One of my communication professors taught a great lesson on teamwork which began with the question, "What would happen on the field if everyone on the football team was a quarterback?" When someone play their role and plays it well, that's when they deserve praise. When everyone plays their role well, that's when everyone benefits. I've worked with a couple of old-school docs who were just awful, and I've worked with a couple of old-school docs who were fantastic. Unfortunately cranky personalities show up everywhere all the time, and sometimes we have to work with them. I deal with it by trying to figure out what my role is within that relationship, and then play it well.
  8. Lane Therrell FNP, MSN, RN

    Enhance Patient Engagement with Thorough Family Health History

    Thank you for the kind words, ChrisRN0529. I'll be happy to continue our conversation privately, and will e-mail you soon.
  9. Lane Therrell FNP, MSN, RN

    Enhance Patient Engagement with Thorough Family Health History

    Nurses at all levels of practice are sometimes surprised to learn that a family health history is not just a tool for primary care providers, genetic counselors or family planning advocates. It’s a detailed record of the diseases and health conditions in a patient’s family that can serve as a foundation for healthcare decision making. When you begin to think of family health history as more than a non-modifiable risk factor for chronic disease, or a key component of a SOAP note, you can deliver truly patient-centered patient education, while supporting patient engagement. The more details you know about your patient, the better the quality of your patient education. When you can speak to the patient’s personal experience, you can make any type of health-related education relevant to their individual situation. By encouraging patients to gather the information for a complete family health history, you’re empowering them to have health-related conversations with their families in a way that requires them to engage with their health outside the healthcare setting. More than just genetics It can be tempting to think of family health history as being synonymous with genetic variations and mutations, but health histories are more than just genetics. Family health history also encapsulates shared behaviors, cultural practices, and the patient’s living and working environment. These epigenetic factors influence health directly and indirectly and may contribute more to long-term health outcomes than other factors. Indeed, they open the door to revealing the consequences of lifestyle choices. Risk is not reality Family history points to risk, not reality, nor is it a guarantee of outcome. In other words, a family history of a specific disease does not necessarily mean an individual will also have the disease. Family health histories reveal risks in a way that opens the door to prevention and proactive action steps. Once that door is open, you can help your patient guide and direct their lifestyle changes and intervention options. Patients’ interests and questions While some patients may be interested in family histories thanks to the growing popularity of direct-to-consumer genetic testing, others may be fearful, skeptical, or reluctant to explore their family health history. In its most basic form, a family health history does not involve genetic testing. If genetic testing or counseling is medically indicated, it can be ordered and does not have to be direct-to-consumer. A basic family health history begins with information gathering. Vital information to gather (in writing) includes: information on ethnic background; major medical conditions; age at diagnosis and death; and cause of death for parents, grandparents, siblings, half-siblings, aunts, uncles, nieces, nephews and children. Action and engagement Once a basic family health history has been gathered, there are many ways to take action. For example, providers may order more frequent or earlier-than-recommended screenings or preventive medication. And, since most patients will have a family history of at least one chronic condition, lifestyle change and better-informed patient choices are likely to be indicated. The most significant action steps nurses can take involve empowering patients to start conversations with their families at home about health history, and pointing them to useful (free) tools and resources. Here are some ideas to get started: For patients who might be interested, but don’t know where to begin, the tool, “Does it run in the family?” can be a great conversation starter. The Surgeon General’s “My Family Health Portrait” is a great way to organize the information gathered. Try gathering family health history information yourself and share your experiences with your patients. Encourage patients to engage with health history in ways that are relevant to their personal family situation. For example, young couples engaged in family planning are a natural fit for family health history discussions, while families with elders at home might try focusing a specific reminiscing session on health history. Remember that by encouraging your patient to become interested in their own family health history, you are helping them engage with their health. Patients who embrace accountability, ownership, and engagement can be successful in making real and relevant lifestyle changes that lead to improved health outcomes. Patients with young families can influence the next generation, modeling lifestyle change and good habit-building for their children. And for you, as a nurse, when you serve more fully engaged patients who are more aware and interested in their health, you’ll likely feel more fulfilled in your work delivering quality care. Your patients can’t change their past, their age, their race, or their ethnicity, but they can arm themselves with the powerfully preventive knowledge that comes from a thorough family health history. Gathering family health history data can motivate your patients to make lifestyle changes that set them up for a healthier, happier future. Sources and Resources Does it Run in the Family? Health History Tool G2C2 – Genetics/Genomics Competency Center Knowing is Not Enough—Act on Your Family Health History My Family Health Portrait Family Health History Day Social Media Toolkit - NIH National Human Genome Research Project Family Health History Family Health History and Chronic Disease Family Health History is a Non-modifiable Risk Factor – Or Is It? What is direct-to-consumer genetic testing?
  10. Lane Therrell FNP, MSN, RN

    Should 40 year old mom become a psych NP?

    I'm going to echo the sentiments here that if your employer is supporting you, go for it, and never look back. There's an incredible increasing demand for psych NPs. You'll find creative ways to manage your time for the kids and studying. BTW - Congratulations on finding your calling.
  11. Lane Therrell FNP, MSN, RN

    Avoiding Antibiotic Resistance: What to Tell Your Patients

    You are absolutely right that we as providers need to take a long hard look at ourselves in the mirror and ask how we are contributing to the problem. One of my nursing instructors was fond of reminding students and patients alike that, "This is a hospital, not the Holiday Inn." We can translate the spirit of that idea into any healthcare setting by empowering our patients more, not less. Just like what you're doing by building trust and writing a prescription that your properly-educated patient can choose to fill or not. Good for you. Good for your patients. And ultimately good for everyone.
  12. Lane Therrell FNP, MSN, RN

    Avoiding Antibiotic Resistance: What to Tell Your Patients

    KatieMI said it all about why stricter prescriptive guidelines aren't the answer, but you're right that creating "superbugs" has the potential to outpace the opioid crisis as a public health menace. The only answer I can come up with around this is patient education. And I mean REAL patient education. Not the diagnose-from-the-door, there's-no-time-for-that, quote-statistics-and-memorized-rhetoric kind, but the kind where we speak to the patient's experience and help them come up with viable solutions for their real (busy, full, and difficult) lives. Like KatieMI being willing to reduce "productivity" in the name of taking the time to explain what the deal is, and then empowering the patient to do something about it-- for themselves.
  13. Lane Therrell FNP, MSN, RN

    Avoiding Antibiotic Resistance: What to Tell Your Patients

    You make an excellent point about making sure the patient hears the same message repeatedly-- from different sources. And you're right about patient education-- ideally, a properly educated patient will also be a satisfied one. Unfortunately, it can take time and skill to educate individuals, and our healthcare infrastructure seems to be skewed toward managing populations and "bulk-processing" as many patients as possible per unit of time.
  14. Lane Therrell FNP, MSN, RN

    Avoiding Antibiotic Resistance: What to Tell Your Patients

    Antibiotic resistance is an ongoing problem in healthcare. Many of our institutional quality assurance and performance improvement measures are linked to infection control and different forms of reducing antibiotic resistance. And that's a great place to start. But I can't help thinking we can do more to prevent antibiotic resistance, especially when it comes to patient education. All too often, the things that seem obvious to us as nurses with all our specialized training, can seem like babble in a foreign language to a patient. We see this all the time if we're paying attention: The patient's eyes glaze over while we're talking to them. They nod knowingly, but the lesson gets lost in mid-air, and the desired outcome never materializes. A revealing 2018 study published in JAMA Internal Medicine analyzed thousands of telemedicine visits, to show that patients tend to consider their visits successful when they receive prescriptions for antibiotics, whether the medication is medically necessary or not. When you consider the power of patients' expectations paired with heavy institutional emphasis on patient satisfaction scores, prescribers have a strong disincentive for prescribing antibiotics appropriately. This study made me think about the difference between patient expectations and patient education. Do patients truly understand the problem of antibiotic resistance? My musings seem to be in line with the CDC's public education materials on antibiotic resistance prevention, which suggest that patients do not fully understand what antibiotic resistance is, or how they might be contributing to the problem by expecting, demanding, and taking antibiotics when they don't really need them. Note: The CDC's educational brochure, "Antibiotics Aren't Always the Answer" is free to download here. Targeted, specific, patient education helps patients and healthcare professionals partner together to reduce antibiotic resistance. Here are some thoughts for nurses at all levels on improving patient education about antibiotic resistance. Four Key Concepts Patients must understand at least four key concepts in order to understand antibiotic resistance. First, not all diseases are caused by bacteria. Second, not all bacteria are bad. Third, antibiotic resistance happens in bacterial cells, not in the human body's cells. And fourth, the overuse of antibiotics will render them ineffective over time. First, patients must understand there are many other types of disease-causing microbes besides bacteria- such as viruses, parasites and protozoa just to name a few. This distinction matters in the world of antibiotic resistance because antibiotics are specifically designed to target bacteria-not other microbes. So if the patient's illness is being caused by something other than bacteria, an antibiotic won't work, and the patient shouldn't be taking one. Second, not all bacteria are bad. Help patients understand the human body requires good bacteria to survive and function properly. It's the "bad" or pathogenic bacteria that cause infections and illnesses. Resistant bacteria are like pathogenic or "bad" bacteria with superpowers. Third, clarify that the resistance part of antibiotic resistance is something that happens in the cells of the bacteria, not the cells of the human body. Patients who have familiarity with the concept of drug tolerance may mistakenly conflate this concept with the idea with antibiotic resistance. Helping the patient understand that antibiotic resistance is all about the bacteria's own drive to survive in the presence of the antibiotic that's trying to kill it can help the patient see the problem in a new light. When patients realize how taking antibiotics makes them a part of the "war on bugs" rather than the "war on drugs," they become more motivated to take the full course of antibiotics as prescribed. Fourth, the overuse of antibiotics, including using them when they're not necessary, means more bacteria have more time and opportunity to develop resistance. New antibiotics aren't being developed as quickly as bacteria develop resistance, which means the antibiotics we have now could eventually become useless. Using antibiotics judiciously and appropriately is necessary if we want to continue using them. Managing Patient Expectations If antibiotics are NOT prescribed, it's important to say the right things to reassure the patient that their needs are being met. A speaker at the American Association of Nurse Practitioners (AANP) conference in 2015, Kim McGinn-Perryman, DNP, shared the acronym, PEARLS, as a strategy for managing patient disappointment when expectations and appropriate antibiotic use practices don't match. While this acronym is especially useful for NPs who find themselves in the position of NOT prescribing antibiotics to someone who is expecting them, all nurses can use aspects of this approach to reinforce their patient education messages throughout the workflow in clinics or any environment where oral antibiotics are prescribed. P - Partnership. Acknowledge that you are working in partnership with the patient, toward a goal of resolving the problem. Example: "Part of my job is to help you manage this." E - Empathy. Express empathy for the patient's situation. Example: "I understand you're feeling terrible." A - Apology. Offer an apology. Example: "I'm very sorry you're not feeling well." If you know the patient is upset about not receiving antibiotics, you might consider taking the conversation a step farther so the patient can sort out their feelings with you instead of taking out their frustration in a rating system or on social media. "I'm sorry you're not getting a prescription for antibiotics today. Do you understand our explanation on why?" R - Respect. Show respect for the patient, including their beliefs, intentions, goals, and actions: "You did the right thing coming in to get this checked out today." L - Legitimize. Legitimize the patient's thought process: "I can definitely see how you might think an antibiotic would help your symptoms." S - Support. Offer actionable support. "I know you want to feel better as soon as possible. Let me give you some treatment suggestions you can use instead of antibiotics." The bottom line is that nurses at all levels must work with their patients to provide adequate patient education about appropriate antibiotic use. It's not enough to simply direct a patient to take their antibiotics as prescribed. They won't if they don't appreciate why it matters. We must use our patient education skills to ensure they have a clear understanding of antibiotic resistance. Sources and Resources: Antibiotics Aren't Always the Answer Association Between Antibiotic Prescribing for Respiratory Tract Infections and Patient Satisfaction in Direct-to-Consumer Telemedicine | Infectious Diseases | JAMA Internal Medicine | JAMA Network Patient Satisfaction Ratings May Be A Factor In Doctors' Prescribing Behavior : Shots - Health News : NPR Using PEARLS to reduce unnecessary antibiotics - The Clinical Advisor
  15. Lane Therrell FNP, MSN, RN

    The Grinch of allnurses.com

    You are absolutely right when you stated, "Christmas starts tooooooo early. At Halloween, fully two months before the actual date..." I strenuously object to Thanksgiving getting lost in the commercialism shuffle. And I also object to my early December birthday getting lumped in with Christmas. Thank goodness my husband is totally ok with putting up the tree up on Christmas Eve and then leaving it up til January 6 (aka "Old Christmas" in my family of origin). I like to "do holidays" on my own terms. I suppose that makes me a Grinch in some people's eyes, but I prefer to think of it as effective stress management.
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