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Found 21 results

  1. JuiceBoxHero

    Nurse Practitioner Residencies

    I am wondering; are there any current practicing nurse practitioners who have completed a residency/fellowship who would be willing to share about their experience? Thanks in advance!
  2. I started generally studying for the exam in April, but didn't buckle down and get serious until May. So overall, about 2 to 2 1/2 months of study time. I didn't feel confident because in school I really didn't focus on studying too much (was juggling school, plus working full time and 16-hr clinicals per week, so I really was just trying to make it through the program and pass). I Started with the Leik FNP Book I read through the entire book. Completed the questions. I Purchased the book from amazon and was able to access the book and questions online through the app as well. Read the book again (this time just mainly focusing on areas I wasn't comfortable in) and went through the questions a second time (focusing on the questions I tested wrong on). Next, I also Decided to Do the Hollier FHEA Review I paid for the audio course, in which I listened to lectures and at the end, completed their questions. I also separately paid for two predictor exams from them in which I scored 70% the first time (took that two weeks before the exam), and 78% the second time (took that a week before the exam). Board Vitals Questions I did also purchase some board vitals questions for a month's access in the last month of studying. These were pretty good also but definitely not needed to pass the exam; very wide plethora of questions, however, some of the questions were just too much in detail. Nevertheless, if you just want more practice questions it is not a bad resource. I did this in my spare time when reading became too much. FACT: Both LEIK and HOLLIER resources were excellent. Leik Pros: I would say that Leik's Family Nurse Practitioner Certification Intensive Review had the most bang for the buck. All of the knowledge and information you need and then some. They covered almost everything you can potentially see on the exam. I loved the fact that I could do it on my phone on the go or at home. Also had great study questions I definitely don't think I would've been able to pass the test without this resource. Cons: There were a few discrepancies in the text. However, not enough for me to vote this resource out of the game. Hollier Pros: Hollier's review was also excellent but in a different way. I truly feel that I LEARNED with this resource and understood the why behind the things that were important. ( I do believe that when you understand why things are the way that they are, it is much easier to memorize it for the test) This helped to reinforce the things I had already brushed over from Leik. I have to say I learned more from her than possibly my schooling. Amelie was very entertaining which made it that much easier to listen to the lectures. She told you the things to focus on that she knew for sure would be on the exam. She also told you things that she had a strong feeling wouldn't be on the exam based on her experience (which was helpful, since our brains can only know so much information). Cons: I think this is a great ADDITIONAL review. However, I don't think the audio course alone would be sufficient in passing the test. The topics that they covered (the most important stuff) was GREAT. Her way of memorizing heart murmurs was super easy to understand. But there were many other topics that were not covered. Also, at the end of each audio lecture, they say to focus on these topics to be successful in this area but however, some of those topics weren't covered in the lecture so you do need another study tool. In Conclusion Overall, if you have some cash to spend and want to ensure passing and feeling prepared: Do both the Leik book and Hollier Review + Predictor Exams. YOU will definitely be successful in passing. (Around $400 total) If you are low on cash, do just the Leik book and know the book inside and out and ALSO buy the Hollier Predictor Exams ($50 for two exams). Total Cost: $110 FNP Exam Wasn't bad. Took my exam at noon (don't do an 8 am exam trust me, not a good idea LOL) First 20 questions scared the crap out of me. ( I felt like what are they asking me?? I don't know any of this, oh no! ). If this happens, Just REMAIN CALM and if you don't know the answer make an educated guess, flag it for later, and move on. I revisited many of those questions later on and the answers became very clear to me (which just means it was my anxiety trying to fool me and that I did know the information). IF you truly have no idea the answer, make an educated guess. Odds are you are right. Don't change your answer unless you are sure. Out of 175 questions I "flagged" about 30 that I wasn't all too sure about. These were my tips, Feel free to ask me any questions 🙂
  3. Dear Nurse Beth, I'm 54 y/o female, been a nurse 36 years, currently a RN for 23 years (first 13 as an LPN) working for a geri-psyche facility for about 8 months. I'd like to go for PMHNP after I first get my BSN, single, single source of income, is this something I should pursue at my age? I anticipate working another 20 years at least. I hear so many nurses saying the field is saturated and a good paying job with benefits (which I really need) is almost impossible to find a job. Please advise, I don't want to incur debt to go to school if I may have extreme difficulty getting a job. Dear Don't Want to Incur Debt, There's a lot to thoughtfully consider when going back to school for your PMHNP in your situation. It's true that fifty-four is no longer considered old (in my book) and it's also true that returning to school to become an NP is a costly, time-consuming endeavor. Many nurses who have worked 35+ years want to spend their fifties, sixties and beyond relaxing. There's career longevity to consider. Let's say it takes 2 years to get your BSN and another 3 to get your NP training and land a job. That puts you at right around 60 yrs of age. If you work until you are 74, that's 14 years of practice, and that's probably your best-case scenario. A non-best-case scenario could mean taking 7 years to complete your studies and land a job, and then working until you're 68, which amounts to 7 years of practice-which still may be worth it to you. The tricky part is predicting your health and your predicted burn-out with working in general, but either way, working as an NP is less physically demanding than working as a bedside clinician. Do a cost-benefit analysis. Wages for NPs vary greatly, so it's important to look at what NPs are paid in your area. Your school debt will offset your increased wages. Let's say you make 75K right now (sorry if that's way off, but just as an example) and let's say you'll make 100K as an NP. If your loan payments are 4.5K per year, you'll be taking home 20K per year more than you are now, so around a $750.00 paycheck bump. Which is not nothing, as my dad would say, but only you know what amount is financially motivating. I know the example is overly simplistic, there are taxes, and possible salary adjustments while you're in school if you drop to part-time, but you can still make an educated best-guess. Saturated market. We are told by the United States Bureau for Labor Statistics (BLS) that the need for NPs is so great that openings for nurse practitioners in the U.S. will increase 36 percent between 2016 and 2026, substantially faster than the average 7 percent growth anticipated across all occupations during that time. On the other hand, when you talk to many nurses, there's a strong sense that schools are turning out so many NPs that there will be a surplus. But that's tempered by a shortage of primary care physicians and an aging population. NPs do have a growing market in outpatient care delivery and population health as well as a role in filling primary care and rural access voids. The surplus/sustainability topic is well discussed right here on allnurses on some very interesting threads. https://allnurses.com/we-must-demolish-NP-diploma-t730927/. If you consider this with eyes wide open, and do some soul-searching, then you'll be set to make the best decision for yourself. You could also take some time, and test the waters while you get your BSN. You'll have a better idea if school is for you. Best wishes, Nurse Beth
  4. I am currently a psychiatric nurse. I want to become a psychiatric nurse practitioner and I'm looking into various programs. Any suggestions on a reputable online program that is financially affordable?
  5. Sarah Ihnat

    Nurse Practitioner GPA Requirements

    I’m just wondering for all you nurse practitioners, nurse practitioner students what your acceptance GPA was into your NP program?? Also what school & state please. I am at a 3.4 and feel it is not high enough to be accepted into nurse practitioner program.
  6. On May 29th, a Montgomery, Alabama judge sentenced former Nurse Practitioner, Lillian Akwuba to 10 years in federal prison. Akwuba was found guilty on 23 counts of healthcare fraud and drug distribution. However, she wasn’t alone in her acts that caused Judge Sharon Blackburn to tell Akwuba that she was a “ highly educated drug dealer” who wrecked the lives of patients and families to make money. The StoryDr. Gilberto Sanchez, who owned Family Practice in Montgomery, was arrested in 2017 for allegedly running a pill mill. He was indicted along with other staff members from his office, including Akwuba. They were charged with prescribing unnecessary controlled substances, such as hydrocodone, oxycodone, fentanyl, and methadone. Not only did they give these dangerous drugs for no reason, but they also had patients return to their office every month to get their prescriptions. These visits were considered unnecessary and a form of healthcare fraud. According to AL.com Akwuba left Sanchez’ practice in 2016 and opened her own practice, Mercy Family Health Care in Montgomery. She continued to overprescribe the same controlled substances. However, since she was legally required to collaborate with a physician, she broke the law in new ways. Prosecutors reported that she began forging signatures of physicians and faking the collaboration required under Alabama state law. A WSFA News 12 article , reported that Akwuba pleaded for mercy at her trial and stated that her family depends on her for support. She said that she was remorseful. However, the judge pointed out that at no point during her hearing did Akwuba ever comment about the people that she prescribed dangerous drugs to and probably turned into addicts. Blackburn even replied that she didn’t feel that the former nurse practitioner understood the extent of her conduct and just how criminal her actions were. An Assistant United States Attorney, Jonathan Ross was also present for the trial. He told WSFA that Akwuba showed “complete and utter disrespect to her patients and the court by lying under oath during the trial, and disrespect to the doctors who tried to work with her and curb her prescribing habits.” Ross also called Akwuba a “drug dealer.” Ross feels that Akwuba is at higher levels of blame compared to Sanchez, who pleaded guilty to five counts and was sentenced to serve more than 12 years in prison. Akwuba remains detained until her family produces her passport, at which time she could be released on bond before heading to serve her sentence. The DilemmaThere are so many issues in this story. Did Akwuba understand her prescribing actions? How was she able to go for such a long time forging the names of physicians? The state of Alabama only gives nurse practitioners limited authority to prescribe, which means they must have physician collaboration. Did pharmacists in the area not recognize the forgery? Stories such as these can be used as ammunition to support the notion that nurse practitioners should not be given autonomy to prescribe without physician oversight and work independently. However, these stories are few and probably shouldn’t be used to set precedence for future laws. But, we all know what one bad apple can do to an entire bag, right? What do you think should happen to Akwuba, and where did this situation go wrong? Share your thoughts below.
  7. Hello Everyone, I was supposed to graduate in May, but due to the COVID pandemic, my clinical hours took a bit longer to complete. I ended up completing all the requirements for my program in mid-June. I received approval to test and scheduled my exam for about 1 month out. This allowed me to really take the time to focus and study. I studied most days 6-8 hours. I used Fitzgerald FNP Review, I also purchased Fitzgerald's practice questions book, Family Nurse Practitioner Certification Intensive Review by Maria T. Leik (came with an app too), the FNP mastery app, I also had the Kaplan FNP Prep Plus (I went way overboard on the study materials, but I am a very nervous test taker/studier 😂). You definitely do not need as many study materials as I had LOL Fitzgerald FNP Review Audio / Online Version I really liked Fitzgerald's FNP review. I felt she presented a lot of great information and real-life practice scenarios. I have read reviews where people say she goes really too deep into the material. For the boards, I somewhat agree with this statement, but I feel the material she presents you can use for the exam and take it into practice. It's not material you just study for the exam and forget. I had the audio version of the material. I did not do the in-person review. I liked having the capability of learning chunks at a time. I started her review while I was at the end of my program. So I completed the majority of the review prior to my 1-month serious start of studying. Fitzgerald Practice Question Book I purchased this book and at first hated it. It had the questions and then basically a chapter worth reading of the content. The rationales to the questions are not right there to help, you have to go digging. I had set this book aside after purchasing. However, in my last week of studying before taking my exam, I did come back to it and practiced questions from it and read some of the charts and graphs (some were helpful). The questions in the book are also waaaay harder than what was presented on the exam. I don't really recommend this book as a first choice to study with. There are better options. Family Nurse Practitioner Certification Intensive Review by Maria T. Leik Like most students, I really liked this book. I highly recommend it. I went through the entire book and really studied it. It gives an excellent break down of the material. There is also an app called FNP Q&A by Leik. I utilized this app a bunch and highly recommend it. You can do questions anywhere at the store, standing in a line, etc. The app has hundreds of questions (I think they might be the same questions in the back of her book. I saw some duplicate questions from the app to book). The app also has mnemonics and a quick break down of the diseases. So make sure you check those features out as well! FNP Mastery App This app is a subscription app. I purchased 1 month right before I took the exam. I believe it was like 19.99 month to month (don't quote me on that LOL). It was very easy to use, gave great rationales and information, and had a great breakdown of each section. I do recommend this app. I will say the questions were harder than the board questions but it helps with really developing your knowledge and critical thinking skills. Family Nurse Practitioner Certification Prep Plus As an undergraduate nursing student, I utilized Kaplan to help me pass NCLEX boards. I really liked it. So I thought I would give the FNP book a chance. I purchased the book because I liked how easily they had the material broken down, but quickly put it aside to focus on the above materials because I thought it was way too simplified (compared to the other materials). I picked it back up about a week before I took boards; after taking the APEA predictor exam and the PSI predictor exam. After taking these predictor exams, I realized Kaplan actually had it right. The simplified version and the layout really helps you picture the case scenarios the board questions present to you. With that being said if I had to pick two books to really study from I would pick the purple Leik book and the Kaplan book. Leik gives you lots of good snippets of material. Kaplan will give you the entire case scenarios broken down into risk factors, symptoms, differentials, diagnostic tests, and patient education. APEA Predictor Test I purchased 1 APEA predictor test and it came with 50 extra bonus questions. I took the exams a few days before I took boards. I scored 73% on the 150 questions (National average around 68%). I scored 72% on the 50 bonus questions (National average around 68%). If you are super nervous (like I was) I encourage you to take a predictor exam (whether it be from APEA or PSI) to get a feel for the questions. It's definitely not a make or break you if you don't take one, but it does give you an excellent idea of what the questions will look like on the exam. (APEA was a bit harder than the PSI Practice Exam). PSI Predictor Exam These practice exams are $50 each and 75 questions. If you do want to take only one, make sure you select the 2020 exam (It felt it was harder, than the older version). I paid for 2 exams. The first one I took was the FNP-1 version and I scored 90%. The second one I took was the 2020 version and I scored 80%. After taking these practice exam I felt a lot more confident in my in-depth studies. I was shocked to discover the questions I had been doing were way more focused and specific than the predictor exams. The biggest thing is you really need to have a good understanding of the material. I now understand why the study materials say practice questions aren't enough. You have to know really know how the patient presents, risk factors, diagnostic tests, and patient education, etc. The questions could be related to any of those, but they don't tell you what the disease the patient presents with. Make sure you look at ways to break down the questions from your study materials. This will help you to correctly answer what they are asking. Sorry for the super long post, but I hope it helps! I know reading people's posts on their success and the materials used really helped me. Good luck to everyone! Put the time in to really learn the material, don't just wing it, and you will totally rock the test. Best wishes, Emily
  8. simba and mufasa

    Mental Health: A RACE I HAVE TO RUN!

    When I graduated, my first instincts were to work in a MHU, but did not. Over the years, I have gone to many specialties, but still feel as if something is missing. Before COVID-19, I was contemplating on obtaining a post-masters certificate in MH, but was not sure, but thanks to COVID-19, its the green light for me to pursue this dream! DNP/ NP /CRNA, Informatics, Education? Is PhD worth investing in? Midlife crises?, Mental Health NP here I come You are a Pill Pusher Mental Health: Job suitable for retirement Working with the crazy, not my cup of tea You are going to end up like them MHNPs do not work; all they do is write prescriptions! Introduction "There's this stigma or attitude when it comes to the topic of mental health that we aren't supposed to talk about it. We're supposed to ignore "(Grant,2016). According to the World Health Organization, WHO (2008), mental health and substance abuse, both contribute to the second largest cause of disability and disease burden worldwide. Mental health commodities have adverse health outcomes and increased costs for the individual as well as the broader population (2012). Stigma results in adverse health outcomes, furthermore tragic events such as mass shootings, natural disasters, racism, other acts of violence and last but not least, the COVID-19 pandemic, highlight the need to address the stigma associated with mental illness and substance abuse disorders to improve our public mental health system (Mathers, Fat, Boerma, 2008). Background in Mental Health Mental health is a taboo topic in Africa. Growing up in southern Africa, people whispered behind closed doors so that they could not be heard. There was talk of people being mentally unbalanced or being weird in their behavior. After the liberation war, when soldiers came back, they were not the same. Many were withdrawn, abused alcohol and others committed suicide. Suicides were never discussed, they were hushed up and families suffered in silence. In retrospect, people with depression, anxiety, maniac disorders, post-traumatic stress disorder PTSD as the returning soldiers were never treated nor did they get the counseling necessary for their well-being and these were mental health issues that needed treatment and counseling. Near Miss When I graduated nursing many years ago my first choice was to work in a mental health unit, MHU. During my psychiatry rotations, I was inspired and motivated by the nurses’ work ethics and caring attitude. I fell in love with many aspects of mental health. The hospital I wanted to work at that time was in the news, a mental health technician was killed by a patient, as a result, my family was up in arms with this decision, so eventually went to the Medical-Surgical unit instead. Through the years, I have worked in the Intensive Care Unit, Telemetry, adjunct clinical instructor, and lecturer. As I have rotated through these units, I never felt accomplished. I always felt as if there was something missing. I struggled for self-identity as a professional. The thought of being a mental health provider always lingered in my thoughts and I always wondered what it would be like to become one. COVID-19 and Mental Health In March 2020, the world health Organization declared COVID-19 a pandemic(WHO). Since the pandemic many people have lost their jobs and the resulting downturn of the economy has negatively affected many people’s mental health and resulted in new limitations for people with prior history mental illness and substance use disorders (Panchal et. al., 2020). As the virus keep moving to different states, factors such as school closures, social distancing and isolation and financial distress will increase mental health issues such as anxiety. Social isolation and loneliness result in poor mental health and households with older adults and adolescents are at risk for depression and suicidal ideation (Panchal et. al., 2020). Job loss is correlated with increased depression, anxiety, distress, low self-esteem and may result in higher rates of substance use disorder and suicide (Panchal et. al., 2020). Deaths due to drug overdose have increased more than threefold over the past 19 years. Stress, Burnout and Fatigue, PTSD in Healthcare Workers As a healthcare worker on the frontline in New York state, I was stressed and fearful for my life as we did not have enough PPE. I was afraid of bringing the virus to my loved ones. As a nurse in the ICU, the nurse-patient ratio changed from three or four at times. These patients were critically ill and taking care of them was emotionally draining. I have never seen so many deaths at once. Codes and rapid responses were called over the intercom every five minutes, I felt like I was living and playing in a horror movie. I have been having dreams of some of the patients and am sure am suffering from PTSD. Insomnia has set in as well. Most of my fellow nurses have turned to beer or wine to rewind. We have not been given any resources to utilize for coping once the pandemic slowed down. Burnout can eventually lead to mental health issues such as depression and substance use. Choosing Mental Health People newly affected, will likely require mental health and substance use services. Those with prior history will continue using the services but there is a shortage of mental health providers (Panchal et. al., 2020). I chose to be a mental health practitioner, MHNP, so that I can help bridge the gap and provide much needed services as existing ones are overwhelmed due to the pandemic. I also would like to educate my fellow Africans that mental health is a disease that needs attention and that there is nothing to be embarrassed about. I chose to be a MHNP so that I can help frontline employee’s suffering from the effects of COVID-19. I chose mental health so that I can help different people in all age groups. Working at a group home with teenagers with mental issues reinforced my will to be a MHNP. As a nurse, I would take the teenagers for their psychiatric evaluations, we would spend the whole day waiting because there were other people who also had appointments with the same psychiatrist who served many group homes and served the whole county. I would watch the psychiatrist write script after script without properly assessing the patients. As a MHNP, I will take the time to talk to my patients, evaluate the effectiveness of medications before loading them with more pills. Jails have inmates with numerous mental health issues. When released the inmates need proper care, so it is my intention to work with the underprivileged of society and give back as America has allowed me to go beyond my imaginations professionally and improve patient outcomes. The COVID-19 pandemic gave me the green light to pursue what has been in the back of my mind for so long. Sometimes in life, you need a sign to pursue a dream, and I think the pandemic made me open my ears to listen to that inner voice. I plan to use my education to inform and teach people about mental health. I also plan to continue being an educator specializing in mental health. Nursing students’ curriculum includes mental health but there is a shortage of nursing faculty. I will be a great resource when I become a MHNP and as a result, will become proficient in managing mental health improving patient outcomes.
  9. I just graduated on May 17th, 2020 and I passed my AANP FNP board exam on May 23rd (1st-time pass!). When I was studying for this exam, maybe like many of you, I was on this site looking for any helpful tips from successful students on how to pass this exam. First and foremost, you must know that I am the type of person that is NOT a good test taker. I get a lot of anxiety before an exam especially one this big. All the resources I used were helpful in their own way. So here's what I did: Began Reviewing Content March 30, 2020 I started with content review with the Leik book. I read the entire book front to back. Each day I focused on a different topic and then did the questions on the Leik app on my phone based on the topic I reviewed. E.g.: If I reviewed the content on Cardiac health and Pulmonary health, then I did the questions on the app focusing on those topics. Personally, I think this is the best way to grasp a good foundation before you get to the intense question practices. I think the Leik book, in general, was the best source I used while studying. It provides the most information without being too overwhelming. MAKE SURE TO FOCUS ON THE EXAM TIPS ON EACH CHAPTER! I can't express enough how much that helped me the final days of studying in order to pass this exam. This portion of studying took me about 4-6 weeks to complete. I reviewed content for about 2-3 hours per day. Don't feel like you need to study for 10 hours, YOU DON'T. Fitzgerald Live Review There are SOO many live reviews out there and I cannot speak to all of them. I personally chose the Fitzgerald review since I heard through the grapevine that Fitzgerald writes some of the board questions. On May 6-7, I sat at home in front of my computer doing a 2-day live review. Each day was about 8 hours. PRO: This review really dissects the questions so you know how to answer them. Some of the board questions can be tricky on what they are really asking and this review definitely helped me master that. They also provided great mnemonics to use so you remember certain things. CON: SUPER DETAILED!! The content you go over is EXTREMELY detailed. Although most of it is great to know, a lot of the specifics I felt weren't necessary for the exam. After the two day review, Fitzgerald provides you access to the online portion of the review. MAKE SURE YOU DO THE ENTIRE REVIEW. Like I said, there's a lot of info that they provided that they can't cover all in a matter of 2 days so the rest is left for you to finish. At the end of the online portion, there is a practice exam that I thought was VERY helpful. PSI Practice Exams and Board Vitals For the rest of the time being, I was on my own just reviewing content I was weak at and doing practice questions. Every day I did about 50 questions on my board vitals app religiously until the week of the test. NOTE: The questions on board vitals, in my opinion, are much more difficult in general than what the actual questions are on the board exam, however, they were great to use in order to practice how to dissect questions. The week of the exam I did two of the practice PSI tests on their website. There's a total of 3 practice exams now on PSI for FNP but I only did the first two. Each exam is $50 but I promise its the best money spent. These exams consist of "retired" questions from the board exams. These exams related most similar to my actual board exam! End Notes I hope this helps out some of you! Like I said, all my resources helped in their own way but I believe my favorite was the Leik book. Her questions are not that difficult but its good to go through them to just see how much you retained with content review. The board exam is 150 questions and you have 3 hours to complete the exam. I was able to finish in just shy of 2 hours. You will find out your results at the testing center. It is the best feeling in the world!! FACT: The best piece of advice I can give you is ... Believe in Yourself!! We have been nurses and we know our stuff! You will pass! Good luck 🙂
  10. ICUyall

    COVID19 and NP school Woes?

    I find myself at a complete loss. I’ve been an ICU nurse for 7 years, and I love what I do. But, I have been on the fence of what to do from very early on in this COVID19 disaster. My hospital system started rationing PPE very early on, and with each passing day it seems a new and seemingly more ridiculous policy emerges about reusing PPE... and it’s never accompanied with a single shred of evidence that makes me feel like it’s actually safe. Whenever questions aren’t asked to the random desk jockeys (managers and all non-bedside staff) seem to try to make it a point to bully the asker into submission without ever answering a direct question. I’m sure many nurses out there can relate to their hospital systems using CDC guidelines as their Bible in a very dishonest fashion... the guidelines explicitly state that they were based on a SUPPLY CHAIN ISSUE, and literally had nothing to do with safety. But I’m then supposed to just pretend like I can’t read and go along with whatever asinine policy my hospital system puts into place? I did make the mistake of voicing my concerns... and, much to my dismay, my desk jockey director had very tow the line commentary in response. Like I get it, I do... I understand that rationed PPE is better than no PPE... but I refuse to act like rationed PPE is adequate or ideal... and I will not pretend like a lack of adequate PPE somehow negates and changes everything we know about infection control— because it just doesn’t. My hospital system has actually taken the stance that certain people are allowed to refuse COVID19 assignments, which is more generous than most.. and I had considered it, but ultimately decided that I’m much safer taking care of actual COVID19 patients where I’m allowed to have an N95, as opposed to unknowingly being exposed. And that went fine for about a month, until I developed symptoms of COVID19 myself. When I called to report my symptoms (low grade temp 99.5-99.9, GI symptoms, and chest tightness) my hospital system was literally not willing to lift a finger for two reasons: 1) my temp wasn’t 100.4, AND 2) there wasn’t a documented exposure (because apparently reusing PPE AND working directly with COVID patients doesn’t count?? Not only would they not test me, but they weren’t even willing to just take me off the schedule for that week based on my symptoms, which I feel is highly inappropriate. So, I’m glad I learned early on that I’m risking my life on a Monday for a hospital system that will do absolutely nothing to protect me when I get sick on a Thursday. I was able to be tested by a location only testing first responders, thankfully. And, unlike my hospital system, they felt I 1) should be tested and 2) should self-quarantine at home until I received results. Twelve days later I did receive my results, and it was negative. But considering I have had a low grade temp for two weeks, continue to have GI symptoms, and have now had a cough for about 8 days, I’m not convinced. I’m still self-quarantining, and I did locate a place to do antibody testing for me. When I showed up they didn’t have any butterfly needles, and after three sticks they weren’t able to draw blood— so I now have to wait for appropriate supplies. While I did feel safer in a COVID19 unit where at least everyone is being careful because we know what we are dealing with... what I was shocked by, was that nurses are literally the only ones really being put at risk I’m the ICU. The doctors and RTs aren’t even routinely entering the patient rooms to do their own assessments, and the nurses are doing all of the RT’s treatments... and again, I feel like I’m the only one who is asking WHY is this being allowed? I’m tentatively registered for NP school starting in May, but I seriously find myself questioning the wisdom of doing that at this point. Will I reach the point in my program where I am at a standstill due to clinical placement issues?? And, based on what I’m experiencing now, I’m not sure I even want to continue being a nurse. What do y’all think?
  11. Brian S.

    Nurse Practitioners, we want your input

    If you're a Nurse Practitioner, allnurses.com wants your input. We want your insights regarding a few issues which are facing the Nurse Practitioner community. If you could spare a minute, please click on the button below and complete the brief survey so that we can help to shed some light on the issues which Nurse Practitioners and all nurses are facing. Take the Quick Survey!
  12. FLOATnureCO

    Nurse Practitioner- Job Outlook

    Hi, Assuming I get accepted, I will start FNP School in a few months. We all know how expensive it can be and I have a family...and well, a lot of questions that I'm having a hard time finding the answer to. For one, I don't see myself as a primary care provider and I feel like this is the most common job for FNP graduates. I chose FNP to be more versatile than specializing... but I would rather work someone like a cardiology office/heart failure clinic/ in-patient cardiology/ derm NP/ trauma surgery NP... Like do these things even exist for an NP? I've tried searching for jobs but the market around here is a bit saturated at the moment and I see mostly primary care jobs. Another thing I've been thinking about is how I would want to be part- time until my kids are a bit older. I kinda suspect this will be difficult but I'm not sure? Insight, anyone? I live in Colorado if that makes a difference. Thanks!
  13. heatherhammy

    Proper salutation for a NP?

    I'm sorry if this is a random question-but I figured this would be the best place to ask! Is there a special salutation for NP? I know a doctor I would refer to as Dr. Whoever, but I wasn't sure about a nurse practitioner... Would it still be Ms/Mrs/Mr or use Dr.? Thanks!
  14. Jul 1 - apply to AANP, transcript + RN license Dec 10 - get AANP letter stating eligible to test Dec 12 - last day of semester Dec 13 - graduation Dec 15 - get ATT, schedule exam for Dec 30 Dec 30 - PASSED AANP EXAM! I studied throughout my clinical courses but really got down to the nitty gritty my last semester and ESPECIALLY after I finished my clinical hours in early November. When it came to the actual test I am not gonna say it was easy because it wasn't. There were a few questions I really wasn't sure about. Some I had a faint thought about. Many that I got down to 2 answers. And several that I knew I nailed. STUDY MATERIALS Leik - Intensive Review Very to the point. Easy to get a lot of good information quickly. Some typos and inconsistencies (since when does vitamin K prolong bleeding time on a Coumadin patient??) as others have stated but overall a good $30-40 to spend. 600+ test questions in back also. I scored around 80% on those AFTER I finished my program (read book throughout semester and after) Hollier/APEA 2014 Review CD's LOVED these. She made information so easy to remember and I finally mastered the murmurs. I listened to them 3-4 times through (depending on that particular CD's content). Sometimes I used the syllabus too. Often times I just listened in the car. I hated to spend the $420 on these but man...I think they are worth it. Plus you can always sell them to a classmate afterwards and make a bit of the money back. ANCC Book I bought this a year or so before graduation. It is pretty good but I liked and used other materials more. This one has some wasted space as some of the information is repeated (symptoms and findings often just repeated each other). If you're taking ANCC this may be of more use but I didn't really use it and wish I hadn't spent the money (I didn't realize AANP existed when I bought this). Familynpexams.com I bought a 20 test bundle. They were OK and helped me realize the subjects I was weaker in but some of the questions had typos, weren't clear, repeated, had blatantly obvious wrong answers ("airway" is NOT something that may happen after a lung injury), etc. So these are cheaper than any other practice exams and again they do help you in some ways. But they could use improvement. I scored 60-low 70's in the beginning but by the end was scoring mid 70's consistently. Also even though I chose AANP I still got several non clinical questions each exam I took. It also asked several questions about nursing diagnoses which we never even discussed in my MSN program... Lastly an issue I found with these is that they may only give you a brand name of a med. I'm sorry I don't know the several brands of lisinopril but I do know LISINOPRIL. Everything I have read about the exams is that they give you a brand name and generic so sometimes I'd totally look up the brand name to give myself a dang chance with the question. My exam did have brand AND generic thank goodness. APEA Practice Exam I used the Black Friday code so took the practice exam for about $27. I did like the variety of questions and the breakdown at the end. I scored 79% at the end of my last semester. Physician Assistant Exam Review podcast This guy gives fairly short podcasts (15-30 minutes) giving brief reviews of topics on the PA exam. He doesn't go into a lot of detail but does go over symptoms, brief etiology at times, diagnostics, and some treatment options. It is meant to be brief as he reminds listeners but I really enjoyed it. It helped me better understand some topics by getting to the point. Sometimes his intros are kind of long on older episodes so I just fast forward through those. Dunphy and Brown practice questions book THIRD edition I went with an older edition to save money. I could tell by some of the "correct" answers. Some of these questions were very small details of knowledge also so didn't seem exactly "entry level" in some ways. Wasn't bad. Just wasn't great. On these questions I scored low to mid 60's. IF I COULD REWIND: I would get practice CD's my last semester and listen to them repeatedly. All of the CD sets out there have their fans and I'm sure much of the material overlaps. Personally I would not hesitate to recommend Hollier. Even though I listened to the CD's 4 times through I didn't get bored enough to want to dig out my eardrums....not gonna miss them though LOL. I would also get Leik again despite some of the issues her book has. Overall it's an awesome value and had some topics I didn't even remember from my program but I DID see on exam. I would listen to the PA Review podcast because it is absolutely free and did help me differentiate some processes. The last couple of months before my exam I'd get Q Bank. I liked the APEA practice test and considering the Q Bank has thousands of questions that's a pretty dang good deal. A couple of months of that = $60. Not bad. Then counting the 600+ questions in Leik you're doing pretty well. I'd also maybe get another good practice question book when I start clinical courses because it is nice to practice questions as you go through each body system in class. I'd be happy to answer questions the best I can and good luck to all future test takers! We will survive!!
  15. shibaowner

    Nurse Practitioners: Shortage or Surplus

    This controversial topic has been hotly debated, and is of great interest to current and future NPs, so I conducted some research to help our community. So, is there a surplus or a shortage? It depends. (Note: this article is not in perfect APA format). The Case for an NP Surplus In 2014, Edward Salsberg published an analysis of the NP pipeline in Health Affairs. Based on data provided by AACN and the National Organization of Nurse Practitioner Faculties (NONPF), Salsberg reported new NP graduation rates had "increased from 6,611 in 2003 to 16,031 in 2013, an increase of 142 percent (Salsberg, 2014)." [He also noted that not all of these graduates would actually become practicing NPs - so estimates of new NPs entering the workforce have been rounded to 15,000 in some analyses], In addition, "the number of newly certified PAs went from 4,337 in 2003 to 6,607 in 2013, an increase of 52 percent. The annual number of new PAs will certainly continue to grow (Salsberg, 2014)." Salsberg reports that while there is currently a shortage of NPs, he is concerned that the high growth rates in NPs and PAs could lead to a large surplus by 2020. He gives two examples of similar phenomenon: the nurse shortage and the MD shortage. "In the early 1980s and 1990s, the nursing job market became saturated and new RNs had a very difficult time finding jobs; as a result, applicants and enrollment plummeted significantly over a 5 to 7 year period. Some programs ended up closing. This in turn contributed to new rounds of [RN] shortages." There was also a boom and bust cycle in physician supply. There was an MD shortage from 1950-1980, then an MD surplus from 1980-2000, and then another shortage persisting to the present. "However, [these cycles do] not necessarily mean that the forecasters got it wrong: in some cases, the educational community not only responded, but over-responded (Salsberg, 2014)." A 2013 HRSA projection, updated in 2016, also raised fears of an NP surplus by 2020 (note the HRSA projections are only for primary care😞 The supply of primary care NPs is projected to increase by 30 percent, from 55,400 in 2010 to 72,100 in 2020. The supply of primary care PAs is projected to increase by 58 percent, from 27,700 to 43,900 over the same period. Assuming that NPs and PAs provide the same proportion of services in 2020 that they did in 2010, the combined demand for NPs and PAs would increase by only 17 percent (HRSA, 2016a). HRSA also published state-level projections of the primary care provider workforce in 2016. This report indicates a current shortage of NPs and PAs, but also projects a possible future surplus of primary care NPs and PAs by 2025. The surplus or shortage would vary by state. "In 2025, no state is projected to have a shortage of primary care NPs. Projected surpluses range from less than 100 FTE NPs (4 states and the District of Columbia) to 5,350 FTE NPs (Texas). Thirteen states are projected to have a primary care NP surplus in excess of 1,000 FTEs in 2025 (HRSA, 2016b)." A less dire situation is projected for primary care PAs: "Differences between each state's 2025 primary care PA supply and its 2025 PA demand range from a projected shortage of 560 FTE primary care PAs in Ohio to a projected surplus of 2,260 FTE PAs in California. A total of nine states are projected to have a primary care PA shortage in 2025, while five states are projected to have a surplus in excess of 1,000 FTEs (HRSA, 2016b). After reading these reports, it is reasonable to conclude that there is cause for concern over an NP surplus in the near future. The Case for an NP Shortage Currently, there is high demand for NPs on a national level. In a 2017 report on healthcare recruiting, Merritt Hawkins found that PAs and NPs (combined) "represent Merritt Hawkins' third most requested search in the 2017 Review, up from fifth in 2016. This is the highest position PAs and NPs have held on the list, though neither was in the top 20 singly or combined six years ago. PAs and NPs are playing a growing role in team-based care (many were trained in this model), in some cases handling 80 percent or more of the duties physicians perform, allowing doctors to focus on the most complex patients and procedures . . . PAs and NPs provide the bulk of care at the growing number of urgent care and retail centers and also have been a fixture at FQHCs for years. Given these considerations and the continued physician shortage, demand for PAs and NPs can be expected to accelerate. A significant recruiting challenge is arising in this area as many PAs and NPs are choosing to specialize though demand remains pronounced in primary care (Merritt Hawkins, 2017)." All of the projections reviewed in the NP surplus section above indicated a current shortage of NPs and PA, especially in primary care and in locations such as inner cities, smaller cities and town, and rural areas, but raised concerns over possible future surpluses. However, all of these sources included important caveats and limitations to their surplus projections, which can be grouped into the following categories: Inability to predict full impact of ACA and any future healthcare policy changes Inability to predict future changes in scope of practice for NPs and PAs (more states are likely to authorize full practice authority for NPs) Estimates of an NP and PA surplus did not factor in greater utilization of NPs and PAs to offset the primary care MD shortage For example, while projecting a future NP surplus, Salsberg concluded: "If these practitioners [NPs and PAs] are fully integrated into the delivery system and allowed to practice consistent with their education and training, this growth can help assure access to cost effective care across the nation." The 2013/2016 HRSA and 2016 HRSA reports, while raising concerns over a future NP and PA surplus, also points out that "If today's system for delivering primary care remained fundamentally the same in 2020, there will be a projected shortage of 20,400 primary care physicians." The report concludes Under a scenario in which the rapidly growing NP and PA supply can effectively be integrated, the shortage of 20,400 physicians in 2020 could be reduced to 6,400 PCPs. If fully utilized, the percent of primary care services provided by NPs and PAs will grow from 23 percent in 2010 to 28 percent in 2020. Physicians would remain the dominant providers of primary care, only decreasing from 77 percent of the primary care services in 2010 to 72 percent in 2020 (HRSA, 2016a). A 2013 Rand study hypothesized the future NP and PA surplus will help offset MD shortage: New roles for nurse practitioners and physician assistants may cut a predicted shortage of physicians by about 50%, according to a new study released Monday. The surge in new patients covered by health insurance that will be sparked by the Affordable Care Act has led to predictions that there will be a shortage of 45,000 primary care physicians by 2025, about 20% less than the predicted demand, said David Auerbach, a policy researcher at the Rand Corp., a non-profit policy think tank that conducted the study published Monday in the journal Health Affairs (Kennedy,2103). A new report presented at a 2017 American Association of Medical Colleges provides additional insight from a different perspective. Instead of numbers of providers, the researchers analyzed labor supply and demand in terms of visits and full-time equivalent hours because many NPs and PAs are currently handling work typically assigned to doctors. "Researchers applied the FutureDocs Forecasting Tool, showing a 15% increase in physician FTE labor from 2013-2030 and 18% increase in number of physicians. They found an 11% increase in demand for visits per 10,000 and -- evaluating physicians only -- a shortage of 4,700 visits per 10,000 by 2030 (based on an average 2,500 visits entertained per each physicians). The authors concluded: "The continuation of recent surges in nurse practitioner and physician assistant workforces could alleviate much of the potential overall physician shortage in the U.S., [but] . . . the researchers' projections still forecast shortages of primary care labor in rural areas and too few available provider hours to treat conditions such as those in the nervous system (a shortage of 21 million visits overall)." Conclusion Studies agree that there is currently an NP shortage at a national level (this may not be true of all locations), but that we may be heading into an NP surplus period. However, these same studies agree this could change if NPs were successfully integrated into the medical environments and utilized at a greater level. Other projections indicate that NPs and PAs could successfully be used to offset the primary care MD shortage, thus reducing or eliminating any NP/PA surplus. In other words, we don't know for sure if there will be an NP surplus in the future, due to countervailing factors. My personal advice to NP students and new grads is to be flexible with regard to location. Research the areas with the greatest demand for NPs and don't overlook a job search on these locations and populations. "Prime" areas like the major cities also have NP opportunities, but there will be more competition for these positions. Of course, top notch candidates will still get jobs in such areas. References NP, PA Workforce Growth Could Address Physician Shortage | Medpage Today Projecting the Supply and Demand for Primary Care Practitioners Through 22 | Bureau of Health Workforce State-level projections of supply and demand for primary care practitioners: 2013-2025. Doctor shortage may not be as bad as feared, study says Physician Salary Surveys and Articles: Average Salaries by Specialty, Physician Compensation and Physician Practice Data Sharp Increases In The Clinician Pipeline: Opportunity And Danger Bibliography Interesting Forbes article: Nurse practitioners are more in demand than most physicians as states allow direct access to patients for these increasingly popular health professionals. This is the Merrit Hawkins report referenced in the Forbes article. It is provides a wealth of information on MD, NP, and PA compensation. Use this link and then select "2017 Review of Physician and Advanced Practitioner Recruiting Incentives" Physician Salary Surveys and Articles: Average Salaries by Specialty, Physician Compensation and Physician Practice Data This is an excellent resource to identify areas with a primary care or mental health provider shortage. HPSA Find This a good resource for California NPs - you can find shortage areas in the state Best states for NPs Fascinating article on how there can seem to be both a shortage and surplus of labor in an industry, based on queuing theory, in STEM professions: STEM Crisis or Surplus
  16. Nicole was by all accounts a competent, caring Nurse Practitioner. Her patients loved her and her coworkers spoke highly of her. She was also the proud mother of Remy, short for Remington. Nicole and her husband had tried for 15 years to conceive and they were overjoyed when they had Remy, now 21 months old. Coworkers said she loved to show them photos of little Remy. By all accounts, Nicole was a loving, responsible parent. In the morning of June of 2018, Nicole was working at Evergreen Family Medicine in Roseburg, Oregon. That morning, she drove into the clinic’s parking lot as usual. She got out, locked her car, and went to work her shift at the very busy clinic- as usual. In doing so, she left her 21 month old baby, Remy, in the car where Remy remained for hours until Nicole returned at 4:30, when her shift was over. Nicole discovered Remy unconscious and blue. Nicole screamed for help and attempts were made to revive the toddler, but she was pronounced dead. Supporters and Haters The community quickly divided into supporters and haters. What happened to little Remy is almost too horrific to contemplate. Sides were taken. Both sides felt empathy- empathy for the mother and the suffering she would never escape from. Empathy for Remy, a vulnerable child who suffered a horrible death. The supporters felt ‘This could happen to me”. An understanding that “There, but for the grace of God, go I.” They found room for forgiveness and compassion. The haters responded with “She isn’t competent to be a mother”. Some called for Nicole to be punished. Initially charges of second degree manslaughter were filed but they were dropped. How could this happen? As we understand more how the brain works, we understand better how mistakes can happen. To anyone. She Was Out of Routine Usually Nicole’s husband dropped Remy off at daycare, but he had worked night shift as an EMT and Nicole wanted him to sleep. Thankfully, being out of routine usually results in errors such as remembering to bring in a journal to work but forgetting to take your lunch. I forgot to lock my car! I always lock my car. Oh, right, I was waving at my neighbor when I got out and walked across the street to talk to her. She Was Distracted Nicole no doubt was thinking of her shift ahead of her at the clinic. There was a lapse in temporal memory. Her brain was filled and looking forward. Maybe she was wondering who the medical assistant would be on duty that day, or if the antibiotics she prescribed the day before had helped her patient. She had to remember to ask her boss if she could order large size disposable BP cuffs and she had to renew her license soon. Did she have enough CEs? There was no trigger to cause her to look in the back-facing car seat, where Remy was soundly asleep. No visual reminder. No audible alarm. I was interrupted by my phone during med pass and thought I unclamped the secondary tubing for the antibiotic. She Was on Autopilot In the police affidavit, Nicole said “I thought I dropped her off at daycare this morning”. I thought I took my birth control pill this morning. Or was that yesterday? Called inattentional blindness, we all have operated on autopilot. Memory experts tell us that the basal ganglia takes over and suppresses the prefrontal cortex for many reasons, including when we are tired, as in the case of new parents. Kids in Heated Cars Kids do not do well in heated cars. Approximately 30-40 children each year succumb to death in overheated vehicles. Some were forgotten in cars, others accidentally locked themselves in. Babies and young children are particularly sensitive to the heat as they have larger surface areas and less efficient cooling mechanisms. A child’s temperature rises faster than an adult’s, up to 3-5 times faster. The temperature in a car can rise to 125 degrees in just a few minutes. The prevalence of back facing car seats accounts for the young age, as infants and small children can easily be asleep or not able to communicate. Rear-facing car seats look no different whether or not there is a baby or toddler inside. Conclusion What happened to Nicole can happen to anyone. It will happen again this summer, when the death toll from kids in cars typically rises. What would prevent this? Jailing Nicole would not prevent this. Maybe educating parents similar to education around infant co-sleeping and the use of seat belts. Public service announcements. Supporting initiatives to increase awareness such as Look Before you Lock and occupant detection systems. Perhaps placing a necessary item in the back seat next to the child, such as a purse or cell phone. Kids and cars.org even suggests placing your left shoe in the back seat. Most of these suggestions are to trick the brain out of autopilot and the brain state that allows these accidents in the first place. Mistakes are not intentional but prevention and compassion are. Related Articles When Nurses Make Fatal Mistakes Nurse Gives Lethal Dose of Vecuronium Best wishes, Nurse Beth Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!
  17. As a healthcare field we are stressed to get enough patients in for the day, phone calls, follow up labs, charting and on I could go. When providers see a teenager/young adult wellness exam on their schedule a sigh of relief and a time to "catch up" is felt. Though, I tend to take this time to educate and help a teen know that healthcare providers are here to listen. I go through the routine typical wellness exam topics. We discuss food choices, exercise, sports, bullying, vaccinations and mental health. One of the things that I try to emphasize in emotional health is safe sex , safe alcohol use and avoiding drug abuse. I am not condoning sex or alcohol use for teenagers at all, but I want those that may partake in such an escapade to be safe. Being a teenager is a journey we all must remember. Alliances with friends, fitting in and "experimenting" are all part of the teenage rite of passage. I start off with letting the patient know that birth control does not "mean the person is clean". The use of condoms is a better option because "ain't nobody got time for the drip." STD's or STI's are around and even though a person is "clean" does not mean they have been tested. Most are asymptomatic. I talk about chlamydia, gonorrhea, trich, then mention syphilis and HIV. With a special shout out regarding warts and "the herp." Most are curable but some are forever. You don't want to make your first "forever" to be an STD. Most teenagers at this point are laughing and nodding their head. Some have questions regarding the different STD's and the best ways to help prevent transmission. If time permits, I also show pictures of common manifestations of STD's to help facilitate discussion, though this can backfire if using a Google search engine and click on images. I suggest having paper handouts or previously saved images when venturing to show pictures. I also mention safe drinking. I do not condone drinking in underage but advise that when they do turn 21 years old that there should be some safe practices. There should always be a sober person in the group. Regardless if driving or not. Poor decisions are made when inebriated. Having that sober person to help others make better decisions is always welcomed the next morning. Again, "ain't nobody got time for the drip." This is a time I also bring up the HPV vaccination. Along with safe drinking and a sober person I emphasize the trend of young adults walking home alone at bar close and ending up dead in a river. This may sound harsh but I am always overcome with sadness when I hear of young adults drowning when on their way walking home, alone, after a bar crawl or a party. Please do not drink. If drinking, drink with a sober person, do not walk home alone and let others know where you are. I tend to conclude with "you don't want to end up dead in a river with chlamydia." Most teens/young adult are laughing and more open by the end of the visit. I tend to get more questions and "real" conversations with the patient after going through my speech. Next time when a teenager/young adult wellness exam happens on your schedule take the time to help gain some trust with the patient. Time to develop a strong working foundation for a future healthy adult. I have had many teens/young adults in my office say "my mom made me come." Emphasize the wellness aspect, discuss the routine but make sure to mention sexuality and drugs. Parents do look to healthcare providers to help instill these ideas also.
  18. Lane Therrell FNP, MSN, RN

    The Future of Nursing: Reflections of a Nurse Educator

    Download allnurses Magazine Golden thread and soft skills The future of nursing parallels the future of medicine, which is bright with technological innovations. From robotics, telemedicine, smart sensors, artificial intelligence, gene editing and more, the game-changing technological advances available now and on the horizon promise incredible improvements in healthcare across the board. It’s an exciting time to work in the biosciences. And it’s also a time when clinicians and caregivers must remain vigilant in recalling the reason healthcare exists: To improve the lives of human beings. Communication is the golden thread that ties future to present and past, and connects individuals to one another. Communication involving digital screens and online connections creates convenience and leverages time and money but it also changes the nature and dynamics of human connections. I believe technology has created a real and relevant need for genuine human contact, a revival of the art part of nursing. In recent years other professions including medicine have formally acknowledged the value of “soft skills,” which include interpersonal communication. That’s because interpersonal communication skills really aren’t that “soft” after all. Communication skills are powerful, and mastering them can be just as rigorous, difficult, and demanding as learning other clinical nursing skills can be. There is an academic and technical rigor associated with communication skills that too often remains unrecognized in nursing. Nursing must treat soft skills as clinical skills that are worthy of development. My perspective Before I get too carried away, let me clarify my perspective. I entered nursing at midlife after a successful 20-year career in public relations for agriculture. I hold two master’s degrees in two very different areas of inquiry—rhetoric and nursing—which gives me a truly multidisciplinary academic background. I bring a mature, holistic, mindset to my practice that embraces a full spectrum of thought and ideas. My perspective matches the ideals of advanced practice nursing and offers the kind of outside perspective that exposes insular thinking and promotes innovation. And because I’ve been academically trained to deliver instruction in communication and leadership, I can teach people how to communicate more effectively. My diverse experience in classrooms and clinics has shown me that better communication translates into better nursing care. It has also brought to light a great opportunity, as I see it, for nurses at all levels of practice to improve their interpersonal communication skills. The Patient-Centered Illusion Patient. Centered. Care. Those three words when used together capture the essence of why I became a nurse. Yet, without effective interpersonal communication, patient-centered care is merely an illusion. In nursing, we perpetuate the illusion by failing to communicate effectively. Three ways this can happen are: 1) treating numbers instead of patients; 2) using words that separate patients from their health; 3) establishing plans of care for our patients instead of with our patients. Treating numbers At its core, patient-centered care is built on individual conversations between patients and providers of care. These conversations allow us to treat the patient, not the numbers. Too often, though we become so heavily invested in counting quality measures or improving patient satisfaction scores, that we forget to check in with the actual patient. We even get tempted to use lab results alone to develop care plans, short-circuiting full patient assessment. Delivering care that is truly patient-centered means addressing the needs of the individual in front of you, not blindly following an algorithm. Ultimately, no matter how advanced the technology becomes, the best way to discover what is going on with our patients is through careful assessments, focused conversations, and critical thinking. Disempowering words Consider how we use our medical vocabulary. Indeed, medical terms have a place, and we must communicate accurately and collaborate effectively with our highly educated colleagues. But we also must use words with our patients that are appropriate and easy to understand. Words that are unfamiliar or unsupportive to our patients can create and perpetuate gaps in understanding, and contribute to feelings of helplessness and lack of control. Any type of disempowering language in a clinical setting leaves patients disconnected from their health and disengaged from their health behaviors. Planning in a vacuum Too often we are guilty of establishing plans of care for our patients instead of with our patients. If the plan of care is not relevant to the patient, and they’re not invested in it, they won’t honor it. This goes beyond “teach back” all the way to buy-in. If the patient can’t tell you step by step what he’s going to do to honor the plan between now and when you see him next, he likely won’t. As an educator, I work hard to make abstract concepts relevant to my students. I tell them why it matters, and relate it to something they already know so they can remember and “own” the information. We must all do the same with our patients if we want them to engage and comply with their plans of care. The teaching aspect of patient education is not about reciting massive amounts of information to patients, it’s about making any new concepts and information relevant to their daily lives so they can own the plan and take appropriate informed action for themselves between visits. But we’ll never know what’s relevant to the patient if we don’t have a meaningful conversation first. Barrier, value, and taking action The biggest barrier to improving interpersonal communication in nursing is thinking we’ve already mastered it. We talk about effective communication a great deal, and we’re communicating all day every day, so we think we already know how to do it. But are we doing it well? Most of us are blind to the fact that we’re not being effective. And we’re missing an opportunity to teach interpersonal communication as a skill in nursing. Effective communication is so much more than delivering information to a patient in their native language, following APA style to the letter when writing a term paper, or composing a persuasive letter to a legislator. All of this is important, but interpersonal communication skills are worthy of close academic scrutiny. To break the barrier, nursing must value interpersonal communication as a skill and teach it as one. It’s not that we don’t value interpersonal communication at all in nursing, it’s that we don’t formally recognize it as a skill to be taught. If we did, we’d have communication labs the same way we have health assessment labs. What if nursing did treat interpersonal communication skills with the intellectual and clinical practical heft I think they deserve? I believe nursing would thrive, improve, and facilitate the delivery of true patient-centered care in an age of booming technology. The bottom line is: Communication skills are as important as clinical nursing skills. Without them, empathy cannot be expressed, ethics cannot be honored, and a true patient-centered environment cannot be created. What are we doing to support nursing students’ mastery of the skills underlying our target competencies and course objectives? Effective communication is the unnamed skill that supports virtually all the advanced practice competencies. And yet, who is teaching these fundamental skills to nursing students actively and experientially? Future benefits Advances in biomedical science are happening faster than the slow-moving wheels of academia and clinical practice can turn. Fortunately, effective interpersonal communication happens in real time and moves at the patient’s pace. Effective interpersonal communication is the single best mechanism I know for meeting patients where they are on their individual continuum of change. From that perspective, what could be more patient-centered than engaging in interpersonal communication? The best strategy for keeping healthcare patient-centric in response to technological integration is improving interpersonal communication skills. Communication skills improvement has great potential to improve outcomes in primary, pediatric, and geriatric care, among cancer survivors, and in any situation that involves patients with multiple chronic comorbidities. It is a topic that nursing scholars and doctoral candidates may wish to tackle. Nursing is both art and science. While our education and industry may be biased toward science, it’s the art part that keeps us focused on our purpose and our patients. I infuse this ideal into all my interactions with students, patients, and clients. And I leverage my background in communication to do so. I celebrate nursing for the connections it allows me to create with others. And as professionals, we can strengthen those connections by improving our communication. I challenge my fellow nurses to begin valuing communication more highly for the good of the future of nursing, and for the good of the patients we serve. No matter what technology emerges in the future, there will always be a need for nurses to connect with patients as they deliver quality care. The future of nursing holds great possibilities and opportunities which we can embrace by integrating effective interpersonal communication into everything we do. Article Sources: 5 Key Trends for the Future of Healthcare Communication in Nursing Practice Effective Communication Skills in Nursing Practice Effective Interpersonal Communication: A Practical Guide to Improve Your Life Integrating the Art and Science of Medical Practice: Innovations in Teaching Medical Communication Skills Nursing Students’ Perceptions of Soft Skills Training in Ghana The Most Important Soft Skills Employers Seek The Art and Science of Nursing: Similarities, Differences, and Relations What are the NP Core Competencies?
  19. DysrhythmiaRN11

    Failed AANP Then...Passed!

    Hi I just wanted to give back and provide support to anyone out there looking for answers on passing their NP boards. I want to start by saying I took my boards in July and failed. I recently just took them today, 9/8 and passed. So to start, I graduated in May and decided to relax and have fun versus jumping right in. I just needed a break. I vacationed and did fun things for about a month. I purchased an online review course by Amelia Hollier. I loved it versus in person reviews because it was at my own pace and I studied as I had time. With my schedule it took me a few weeks to get through the review. It was great and I really learned a lot such as diagnosing murmurs and interpreting hematological disorders, and a lot of different intricates as such. It was a great review and Hollier said at the end of the review to take a few weeks to go through each system on your own which I didn't do. Next, I purchased Fitzgerald mp3 player that came with her book. I was happy because I felt like I could listen to it during my free time at work and really get a good study in. I also had the Maria Leik book which by this point I was too worn out to take my time to go thru it and study it. I glanced through it and then I did something unimaginable.... I moved my board exam up by 3 weeks and guess what.. I failed it. I was so upset and sad and it took me just a little bit to get myself together and figure out what to do next. I scrolled the internet for similar situations that could help me and realized I wasn't alone. I immediately started doing my CEUs that same day thanks to reading a bunch of similar situations because AANP doesn't give you a true breakdown of what to focus on, so I did random CEU topics. I finished that in a day then resubmitted my application and was approved within few days. My letter came like 2 weeks after that of areas to focus on which was useless. Preparing the 2nd time.... I had this imaginary thought that I would retest in 2 weeks.....but I didn't, I retested 2 months later.. I already had the Leik book and decided to update it to the new edition since it came with an app. Once it came, I hit the books hard... planned out in my calendar each lesson... took my time, had a notebook, wrote down everything important by system and would refer to my notes to study that particular system and answering questions from Leiks online app to correlate... I read the entire book and at the near end of my readings, I found out that Hollier had an excellent question and answer book that was great for practice for the boards. I did not retake that exam until I totally understood everything because the exam is so random that you just don't know what's on it.. I had the information down packed this time... I learned with this exam that you have to KNOW the information and understand it... cramming will not help you at all. I went over my notes until I was blue in the face and I answered questions like crazy the second time around... when I took the exam again I thought it was so easy because I could rationalize and think out the obvious thanks to Hollier's question and answer book, and Maria Leik's review book.... I was able to ace the exam with my knowledge I had acquired. I have a youtube link that can further give you what I did to pass and some advice on the boards... there are many people who look to the internet for help and I would like to say don't give up... you can do it.. just take your time and do it... one little bit of advice... don't purchase too many books... or reviews..it can overwhelm you.... choose a review of your choice... ... Amelia Hollier is a great review and online is convenient and just as good as in person.. Fitzgerald offers too much information for me and its overload for the exam and her style of questioning gave me anxieties... I personally did not like this as a review for boards but will use it to review for my actual NP practice.... she has alot of knowledge.. Stick with Maria Leik review book definitely and I would buy Hollier questions and answer book...
  20. As future CNM, and possible FNP, I was wondering how patients address you? You are not a Dr., but you taking the same role. You're not playing to traditional hospital nurse role. So, my question, is how do you introduce yourself? What do you expect to be called by the patient? I'm curious.
  21. Just curious about what the proper way to address an NP would be. I'm always a little unsure about if I'm supposed to address them as Mr./Mrs. so and so, Nurse practitioner so and so, or what. I certainly wouldn't want to offend anyone, so I thought I'd ask the NP's here how they are comfortable being addressed by patients and ancillary staff. Thanks in advance for clearing this up for me.