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WestCoastSunRN BSN

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  1. WestCoastSunRN

    State of the Nation Regarding APRN Practice

    Great information! Thanks for posting.
  2. WestCoastSunRN

    Are We Too PC?

    Ah.... good catch --- I have to admit I did not know what SJW meant. That said -- when I say it's about ideology -- I am referring to extreme swings of the ideological pendulum. And I *think* that the whole PC thing mirrors those swings... and I *think* the animal farm comment a poster made awhile was very thoughtful. Many moons ago, I had a professor in college say, "In fighting the monster we need to be careful we don't BECOME the monster". This never left me... I think about that a LOT... because I have seen that one can be, on the surface, quite "PC", and yet, at the same time be quite morally corrupt (even by their own stated standards -- and speaking in a very universal sense, ie. not a religious one). I have seen power shifts, and the truth is .... power corrupts. As far as an everyday application of the idea of political correctness? My own personal rules are sort of: 1. Think before acting/speaking, but don't overthink... overthinking ends up being a very egocentric, narcissistic activity and is not good for mental health. 2. Apologize if you do #1, and it turns out you should have put more thought into what you said/did than you did. 3. Be curious about people and always be kind and want the best for another person. I moved to a very sensitive part of the country. I quickly learned words and actions that were the norm in my home culture were unacceptable to many people in this part of the country. Sometimes I understand why, but often I do not. It matters not -- if it's going to offend I will try to remember not to say/do it. Probably I won't be best-friends with these people I must censor myself with -- and that is OK. Sometimes though -- friendships grow over time despite differences in culture and people can really be themselves with each other (this is a beautiful thing), but this is earned, over time, in a friendship built on mutual respect. 4. Don't be easily offended. I do #'s 1-3, but do not always have them done unto me. It happens. It needs to be water off a duck's back..... most often, it is not worth the time and energy to "educate" someone else on how they could have treated me better. Maybe this is laziness, or whatever.... I'm just being honest. Now if it is someone else -- I have and will (pretty much a sure thing) speak up and educate. I can't stand bullies -- even if it's just out of ignorance. But that's just me. You (whoever's reading) do you.
  3. WestCoastSunRN

    Are We Too PC?

    Yes, yes, and yes. You have a very cogent arguement here.. I hope others will take the time to really read what you are saying. This is an ideology issue...
  4. WestCoastSunRN

    Reducing Re-Intubation Rates - One Protocol....

    This is a great topic, TraumaRUs! Deciding when to extubate can be tricky. I think there is definitely a case to be made for steroid use in the peri-extubation period. I like the idea of having a more systematic approach to extubation.
  5. WestCoastSunRN

    Care for the Older Adult: ICU or Not?!

    In a perfect world, the whole team will be trained in and willing to talk to patients and families. As this fabulous article pointed out, nurses are, by definition of their role and proximity, in a position to take leadership in these discussions. In my experience, many providers are truly uncomfortable in these waters ... and I mean no disrespect in that statement. Nursing simply involves much more intimate hands-on holistic care than does medicine, and so nurses are trained (either by theory or fire) to interact with patients in these most vulnerable times. I think it's wonderful if a patient and family know ahead of time they do not want the 'ICU experience'. However, I almost never see that happen with critically ill, hospitalized patients. Therefore, the ICU needs to be a place where transition of goals of care is really a possibility. Even if that transition happens rather quickly in the hospital course. ICU nurses are by no means hospice, but they can be remarkable clinicians for transitioning patients to end-of-life care all the same. These transitions almost necessarily must take place in a critical care setting, so it's imperative that nursing staff is empowered to lead these transitions. I would like to see nurses more formally take on leadership in the area of bringing in palliative care. It is frustrating for patients, families, nursing staff and palliative medical providers to be thwarted by well-meaning (or sadly sometimes lazy or simply resistant) surgeons, for instance. This is one of those examples where we can see that it is, in a way, possible for a medical provider to practice outside his/her scope of practice (practically, not legally speaking). And the results can be very sad, indeed. Thanks so much for bringing up this topic.
  6. Great article and discussion! I love the brainstorming feel of discussions like these. Shibaowner, you say you have found MDs wanting to hire NP's with no RN experience over those WITH RN experience? Hmmmm. If that's the case in your area, I have to wonder if is more of a money issue. Experienced RN's make good money compared to a new grad NP when you are talking about the level of responsibility, liability and hourly wage. -- These nurses are more likely, I would think, to need a higher wage to do the work of an NP. This is an interesting aspect when discussing RN experience that I don't think gets enough air time in discussions like this. But also, in my experience (I am not an NP yet, haven't even started school, but I know and work with physicians and other employers...), employers favor an NP with RN experience. I can see why. You say that acute care experience would have no effect on primary practice? But how can that be? I have spent years at the bedside assessing patients and having their treatment plan change and flex based on those assessments. It's true I don't prescribe the treatments, but I certainly can anticipate what should be ordered and am often (teaching hospital) in a position to recommend specific orders. There's no doubt I have a ton to learn about primary care and advanced assessment and pharmacology, but I have NO doubt I will be a better NP BECAUSE of my RN experience and not in spite of it. I see the same El Banna and Briggs article over and over used here as some kind of proof that RN experience doesn't matter. I think we need a LOT more statistically relevant studies to prove such an assertion. In the meantime it's certainly something to think about. If we want NPs with no RN experience then lets give them a pathway similar to the PA to get there (my .02). I know mine is not a popular stance on the subject, and I imagine such an opinion can be hard to swallow from NPs without the RN experience. I mean no disrespect and truly there are very competent NPs without RN experience. But I think that phenomena begs for more investigation ... as does the idea of standardizing NP education. I think one thing we all agree on is that the pathway to NP should not be "easy" or "quick".
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