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CraigB-RN

CraigB-RN MSN, RN

Critical Care, Emergency, Education, Informatics
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ED & Critical Care Nurse, Clinical Educator, Long distance critical care transports, legal nurse consultant. Debating on whether I want to finish EdD.

CraigB-RN's Latest Activity

  1. CraigB-RN

    New Grads in the ICU

    When there is a problem, it generally isnt’t He new grad that is the problem. It’s the lack of solid education based orientation/residency program for them to grow into critical care nurses.
  2. CraigB-RN

    VA proficiency nurse III frustration & appeal

    When you go national you aren’t allowed to add anything. What you’ve got and already submitted is what you’re stuck with.
  3. CraigB-RN

    VA proficiency nurse III frustration & appeal

    One way to see more info is to go to your Intranet and google NRPB and Nurse III. You’ll get to see what other VAs have available.
  4. CraigB-RN

    VA proficiency nurse III frustration & appeal

    There is no “official” cap to the number of nurse IIIs in any given space. Technically all could be.
  5. CraigB-RN

    Nurse Practitioner vs Physician Assistant

    When looking at choosing NP or PA, you need to look at what common and not what's possible. Yes you find NP working as first assistants In the OR but if you looked at the number, although it happens, it's not as common. There are placed that don't allow FNP's to work in inpatient medicine, because it's not included as part of their initial education. Now that is a small percentage, but it is something you need to keep in mind when making that decision. Two of the Children's hospitals I've been affiliated with required their FNP to get their pediatric acute care in order to continue to work. In one facility the FNP's that wanted to maintain their ability to take care of inpatients, were required to get their ACNP. and in one case they were required to get geriatric ACNP. The prime take away from this thread, it to take it all with a grain of salt and do your own homework. There are many variables that you will need to take into account. Things are going to be different in rural KS than in urban Texas or even different between NY city and update NY. To most though the biggest difference is can you afford to take 2 years off to go to PA school full time, if not then a part time NP program may be the best choice. To keep things in perspective. I'm not an NP, but I first assist, I put in chest tubes, A-Lines & central lines. But I work in a different environment than most RN's. Sometimes it's where you are more than who you are.
  6. CraigB-RN

    Nurse Practitioner vs Physician Assistant

    There are many factors that come in to play with choosing PA vs NP. The first one is that PA's are generalist in their basic education. That means they can move from specialty to specialty easier than NPs can. Notice I said easier. Nursing choose the specialty route. As an ACNP you can't take care of kids unless you go back to school (or so duel program in school) If PA's want to change specialties they just have to find someone to hire and train them, They don't have to go back to school. Some places have found that PA's are a bit more prepared to on day one than new grad NP's. Now after a year or so, there isn't any difference. Now this is a generalization here. NP programs make an assumption that you have a certain knowldge base when you get into school. This isn't always true any more. RN's are going right into NP programs with less than a year of experience. I constantly hear NP's complaing that they have to find their own preceptors. Some programs are better at this than others. If you have a certain specialty you want to work, you need to do your homework. In a few of the locations I've worked, the practice has choosen not to hire NP's because of the whole "I'm a Dr now and I can work independently" The practice wich is owned by MD's and didn't want to deal with that, so they hire PA's. At another hospital down the road, all the non MD practitioners are NP's. (notice I didn't say midlevel?). At another facility the PA's did the skills, NPs did planning, teaching and pt management. A good friend of mine in an NP and he runs the unit. He assigns the residents and has the final say over treatment plan. Then there is always the elephant in the room when choosing NP vs PA and that is the Board of Nursing in the state your working in and the specific nurse practice act. To me this is probably the biggist issue. In the majority of the states, a PA can do whatever his/her supervising physician can do and allow him/her to do. It's not an us vs them thing, it's about the best fit for what you want to do. I will say that after almost 40 years, for the most part, the whole nursing practive vs medical practice is a bit of BS. A septic work up is the same no matter if your a PA or an NP. P.s. They take the pance exam every 10 years now. p.s.s. Ex CNE that used to hire both NP's and PA's and faculty for both NP and PA programs.
  7. CraigB-RN

    The Heat is On: Why the Temporal Artery Thermometer Should Be Your "Go-To"

    Comparison of temporal artery thermometer to standard temperature measurements in pediatric intensive care unit patients. - PubMed - NCBI Comparison of temporal artery thermometer to standard temperature measurements in pediatric intensive care unit patients. [h=4]CONCLUSIONS:[/h] Temporal artery and axillary temperature measurements showed variability to rectal temperatures but had marked variability in febrile children. Neither was sufficiently accurate to recommend replacing rectal or other invasive methods. As temporal artery and axillary provide similar accuracy, temporal artery thermometers may serve as a suitable alternative for patients in whom invasive thermometry is contraindicated. In sick septic patients it hasn't been that accurate. 97.8 in triage and then 102.4 in the room. We found it to be reasonably accurate in non sick patients, but pretty useless in trauma and septic patients. J Clin Nurs. 2011 Jun;20(11-12):1632-9. doi: 10.1111/j.1365-2702.2010.03568.x. Epub 2011 Mar 22. [h=1]Is the temporal artery thermometer a reliable instrument for detecting fever in children?[/h]Penning C1, van der Linden JH, Tibboel D, Evenhuis HM. [h=3]Author information[/h] 1Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands. c.penning@erasmusmc.nl [h=3]Abstract[/h][h=4]AIMS AND OBJECTIVE:[/h]We aimed to study the diagnostic accuracy of the temporal artery thermometer vs. rectal temperature in a large group of children with and without fever, aged 0-18 years. [h=4]BACKGROUND:[/h]Many have studied the diagnostic accuracy of the temporal artery thermometer in children compared with a reference method, with contradictory outcomes. No studies have been carried out in a large group of children of all ages. [h=4]DESIGN:[/h]Diagnostic accuracy/validation study. [h=4]METHOD:[/h]Children (0-18 years) with fever (T>38·0°C) were recruited through the emergency department and children with normal temperatures through the day-care department of the Children's Hospital. All children routinely had rectal temperature recordings. Temporal artery temperature was recorded shortly after the rectal recording. The mean absolute difference in temperature, the level of agreement (intraclass correlation coefficient) and the sensitivity and specificity of detecting fever were calculated. [h=4]RESULTS:[/h]A total number of 198 children (121 boys) participated, with a mean age of 5·1 (SD 4·7) years. Of those children, 81 had fever according to the rectal recording. Mean difference between temporal artery temperature and rectal temperature was -0·11 (SD 0·63)°C, with an agreement of 0·812. The sensitivity and specificity of the temporal artery thermometer for detecting fever were 67·9 and 98·3%, respectively. [h=4]CONCLUSIONS:[/h]The diagnostic accuracy of the temporal artery thermometer in detecting fever in children of all ages is low. [h=4]RELEVANCE TO CLINICAL PRACTICE:[/h]We do not recommend replacement of standard clinical thermometers with temporal artery thermometers.
  8. CraigB-RN

    Doctor of Nursing Practice (DNP): My Personal Pro's and Con's

    Actually you'll find a large percentage of nurses going into being APRN not because they had a burning desire to be an APRN but because they hated bedside nursing.
  9. CraigB-RN

    Doctor of Nursing Practice (DNP): My Personal Pro's and Con's

    Yup. Welcome to the world of the APRN. I had faculty members who had never given an insulin shot and they were teaching the APRN students how to do patient education. I had to leave the room so I didn't interrupt. It's not all that bad. It's just those are the ones we remember. But it does make you raise your eyebrows.
  10. CraigB-RN

    Doctor of Nursing Practice (DNP): My Personal Pro's and Con's

    Although I do have to say, I have a hard time believing your really going to recoup your investment if you spend $$$ going to a prestigious ivy league nursing school for your DNP vs the state school. I laugh at my colleagues from Vandy and Hopkins that have 4 times the dept that those who went to state schools. It adds one heck of a burden when looking for that first school, and I can say that for the majority of the jobs out there. It' s not the school that you graduated from. Notice I said majority, there are jobs where having the DNP from Hopkins or Vanderbilt or the like will get you in the door, but the majority. Not so much.
  11. CraigB-RN

    Doctor of Nursing Practice (DNP): My Personal Pro's and Con's

    I'm fortunate that I work in an environment that HAS LOTS APRNs. Thursday afternoon I had lunch with about 75 of them. A reasonable mix of degrees. FNP, ACNP, MSN, PHD, DNP and one DNP/PharmD/JD. I asked what they felt. I know not exactly a scientific study. Only 6 said the Program/DNP made a difference in how they thought/practiced, etc. Now what I did hear was "it forced me to think and justify my current practice choices", "Im glad Uncle Sam paid for it, because it got me nothing but a few extra letters after my name", "the faculty had 1/4 the experience I had", How could I take it seriously when m classmates were 20 something's who had never worked as nurses", "Well it forced me to study, which I hadn't really been doing once I hit the work force" not a a single one who could call themselves Dr Nurse did so, unless they were in academic or publishing environment. plus there were a bunch of negative comments about people getting DNP to avoid the work of PhD, 100% said if it was cost effective, and you were going to be able to get a $ return on your investment, it wasn't a wast. 100% said the problem wasn't the concept, it was the implementation, poorly thought out, politically motivated, and ego driven, not evidence and science based. That all pointed to the CRNA and stated that they got it right the first time. the discussion pretty much fortified my thoughts. DNP/MSN for your APRN, doesn't really matter. It's what YOU put into that is going to make a difference. That BIG name reputable school make no difference other than increasing your cost again it's what YOU put into it. (New grad 26 yo DNP from prominent NE nursing school, kept writing Insulin orders " give IM" when I asked she told me that was how you gave insulin.). I've watched DNP students doing clinical standing there watching and MSN students jumping in and trying everything. to the post that started most of the discussion, IGNORE everything you read in the thread. All our posts are based on OUR own prejudices. If your in a place that offered a DNP and you can get admitted and afford it, go for it. If the local MSN/APRN is more cost effective, go for that. It's what works best for YOU! If you put in the work, you'll do fine and be a good provider. my prejudice is I choose the EdD route and not the nursing route because it works best for ME.
  12. CraigB-RN

    Doctor of Nursing Practice (DNP): My Personal Pro's and Con's

    I'd have to ask were you an NP already when you got your DNP or did you have a "generic" MSN?
  13. Actually Social Media can help you. For example, Pretty much all of my professional organizations have face book presence. Twitter can be a way to communicate and network with nurses and health care providers from all around the world and help keep current on medical and nursing practice. The key is to use it responsibly. It's a bit naïve to expect that they won't figure out who you are if you don't use your name. It's not uncommon to hear of people who have been found out. When I've been looking to hire people, I've looked at online presence. I've not hired people because of it, but I've also hired people. The last nurse I hired had a thoughtful discourse on her growth as a while in nursing school. The one that had nothing but pictures of her drunk with friends, well lets just say she didn't get a call back. So to me social media isn't bad or good, it's a tool and it's how you use it. Sites like Pintrest and YouTube have TONS of medical and nursing education content.
  14. CraigB-RN

    Surveyor: The First Week

    Reading your post brings back memories. I thought I had it all in my pocket because I had done IG inspections when I was on active duty. I had no clue. Keep your head up. :)
  15. CraigB-RN

    The Insanity That Is APA in Nursing School

    The other curve with this is if you plan on publishing? Guess what, unless your a psych nurse, no one uses APA. Again another waste of time in nursing school.
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