Research and design by Nursing Schools Site
http://www.rncentral.com/nursing-library/hospital-night-shift
Tuesday, September 27, 2011
What Really Happens on a Hospital Night Shift?
Research and design by Nursing Schools Site
http://www.rncentral.com/nursing-library/hospital-night-shift
"Long Hours for Nurses Affect Patient Mortality" - by Pfeifer, Gail M. MA, RN
AJN, American Journal of Nursing:
April 2011 - Volume 111 - Issue 4 - pp 14-15
Lack of time off is an important factor contributing to injuries and fatigue in nurses, according to a study by Trinkoff and colleagues, which suggested that nurses need time off to rest and recuperate in order to protect their own health. Now that same team of researchers has released a new study that suggests that hospital administrators and policymakers have even more reason to consider nurses' working conditions, finding that extended work schedules among nurses may be linked to a greater risk of patient death, at least when certain conditions are present.
The study surveyed a total of 633 nurses at 71 acute care hospitals in Illinois and North Carolina. In addition to questions about shift length and hours worked, the nurses were asked how often they worked 13 hours or more at a stretch, the amount of time off between shifts, the number of breaks lasting 10 minutes or more, the number of days worked in a row, whether on-call duty was mandatory, and whether they ever worked when ill.
Deaths from pneumonia and acute myocardial infarction occurred more often in hospitals where nurses worked long hours. Along with long work shifts, a lack of time off from the job was strongly linked to patient deaths from pneumonia and abdominal aortic aneurisms.
Patient deaths from congestive heart failure and pneumonia were associated with nurses working while sick.
"This suggests that nurses are not at their best if they have to work while sick. Yet they may have to work because of staffing constraints," said the study's lead author Alison M. Trinkoff, a professor at the University of Maryland School of Nursing, in an interview with AJN.
According to Trinkoff, an ideal nursing work environment should allow nurses to get sufficient sleep and arrive at work well rested. Nurses should be encouraged to take their allotted vacation time and sick days—and be respected for doing so. On-call duties should be kept to a minimum to prevent phone calls from interrupting rest and sleep. Even more crucial, she said, nurses shouldn't be called back to work on their days off.
During long shifts, according to Trinkoff, nurses should be allowed to take naps, preferably away from the unit. Several hospitals have policies allowing naps and areas where nurses can take them.
Electroencephalographic studies show that 15-to-20-minute naps increase alertness, especially in those with partial sleep deprivation. "Naps are very useful," said Trinkoff, adding, "Nurses need to be able to speak up when they are exhausted—without blame—so napping breaks can be implemented in more hospitals."
Trinkoff recommends scheduling relief nurses to cover for full-time staff during peak hours, such as 10 AM to 2 PM, to ensure that nurses receive their work breaks. Meals and break times should be enforced. Relief nurses could also reduce the workloads of older nurses, keeping these experienced staff members at the bedside. In addition, early and late shift starting times should be staggered to help day-shift nurses get adequate rest and maximize efficiency, especially when rotating shifts.
Despite the popularity of 12-hour shifts, which many nurses like because it allows for a three-day workweek, Trinkoff sees benefits in offering shorter shifts. Many nurses aren't suited to 12-hour shifts, and those who can't adapt often leave hospital work. Offering four- or eight-hour shifts could help to attract and retain nurses with young children, older nurses, or those with medical concerns. Nurses with different circadian preferences or sleep disorders or who take medications with peak periods of effectiveness might also prefer shorter shifts. For instance, Trinkoff said, "If a nurse is a morning person, don't put her on nights." Finding ways to reduce fatigue during work hours not only protects nurses, it also protects patients.
—Carol Potera
© 2011 Lippincott Williams & Wilkins, Inc.
"I Answered the Call—Now Please Give Me a Job"- by Reeder, Pamela BSN, RN
AJN, American Journal of Nursing:
April 2011 - Volume 111 - Issue 4 - p 11
When I started nursing school in 2008, a frequent topic of discussion among students was which department we wanted to work in upon graduation. Favorites included the ED, trauma, critical care, labor and delivery, and pediatrics. We saw ourselves reaching for diplomas as eager nurse managers welcomed us onto the units of our choice.
We'd read the articles, listened to the media reports. There was a nursing shortage! So we answered the call, hitting the books, working grueling clinical rotations.
Three years later, most of us can't find jobs.
We understand the reasons—the downturn in the economy, too few nurses retiring, part-time nurses working more hours. Intellectually, it makes sense, but that doesn't pay the bills or student loans. In fact, when my husband and I were considering how to pay for the $45,000 bachelor of science in nursing program to which I'd been accepted, I insisted we not use the money in our 401(k), certain that a hospital sign-on bonus would take care of a hefty chunk of the loan. I view that person from three years ago the same way that I see my adolescent self, and cringe at my naïveté.
Incidentally, my 401(k) savings came in handy during my job search, paying for things like food and shelter—the most fundamental level of need in Maslow's hierarchy, as I learned in my nursing fundamentals class. (Now I can at least understand the basic theory behind my needs not being met.)
The California Institute for Nursing and Health Care (CINHC) launched a much-needed pilot program in the Bay Area last year to help new RNs develop their skills and find jobs. The organization also worked with state nursing and education organizations to survey newly licensed nurses in California, the results of which were made available on CINHC's Web site in early November. These reveal that 85% of respondents would be willing to participate in unpaid internships; in fact, 47% would pay for such an internship. Ninety-three percent said their lack of experience prevented them from finding employment.
Other than more experience and, obviously, a job, what else do recent graduates need?
We need empathy. We need hugs. We need people to listen to our complaints. What we don't need are platitudes. In fact, here's a helpful list of what not to say to a demoralized new graduate:
* "Persistence pays off." We know. We are nothing if not persistent. Just ask the hiring managers we relentlessly pursue.
* "Just take any job." That's what we'd like to do. Please give us one.
* "Have you thought of relocating?" Yes. Where shall we go?
* "It's only temporary." In terms of days, months, or years?
I understand that recent graduates in many fields besides nursing have encountered as much difficulty in finding employment. In addition, recent anecdotal reports show a gradual increase in the number of health care workers being hired. I recently became one of these lucky few nurses. During my seven-month search for a full-time position, I'd taken a job at a rural mountain clinic that required a three-hour, round-trip commute and I'd volunteered every Saturday night for six months in the ED of a major hospital in my city. I credit the latter effort with helping me to ultimately land one of six new-graduate, full-time positions there. More than 640 new nurses had applied.
Many of my friends from nursing school are still searching for employment, and a couple of them have had to take jobs unrelated to nursing. I'm glad they're now employed, but I worry about the future of our profession when enthusiastic new nurses are forced to look elsewhere for employment. There's talk of another nursing shortage due to materialize in 2020. If today's graduates aren't given the opportunity to work as nurses, how much worse will this next shortage be?
© 2011 Lippincott Williams & Wilkins, Inc.
Sunday, July 31, 2011
Tuesday, July 26, 2011
PBS NewsHour: "Are Nurse Practitioners the Solution to Shortage of Primary-Care Doctors?"
Check out this short PBS video!
PBS NewsHour: "Are Nurse Practitioners the Solution to Shortage of Primary-Care Doctors?"
http://video.pbs.org/video/1951907817#
PBS NewsHour: "Are Nurse Practitioners the Solution to Shortage of Primary-Care Doctors?"
http://video.pbs.org/video/1951907817#
Monday, July 25, 2011
Article on Compassion Fatigue
Many people go into nursing because they want to help people and care about them while caring for them. Nursing may not just be physically exhausting, but you have to remember to care for your mental health too. I found this article on Medscape about "compassion fatigue" that you can check out:
"The Online Journal of Issues in Nursing Compassion Fatigue: A Nurse's Primer"
by Barbara Lombardo, RN, MSN, PMHCNS-BC; Caryl Eyre, RN, MSN
Posted: 07/22/2011; OJIN: The Online Journal of Issues in Nursing. 2011;16(1) © 2011 American Nurses Association
http://www.medscape.com/viewarticle/745294
"The Online Journal of Issues in Nursing Compassion Fatigue: A Nurse's Primer"
by Barbara Lombardo, RN, MSN, PMHCNS-BC; Caryl Eyre, RN, MSN
Posted: 07/22/2011; OJIN: The Online Journal of Issues in Nursing. 2011;16(1) © 2011 American Nurses Association
http://www.medscape.com/viewarticle/745294
Tuesday, July 12, 2011
Thursday, July 7, 2011
My Credentials: How do I organize all of the little letters after my name?
***in progress***
I learned in nursing school to write the degree (BSN), the license (RN), then the certification. We were told to list our highest degree, a BSN for us at that point, first because that cannot be taken away from you. Some employers do not do so because an RN is an RN, but they might list the RN first instead. For example, an RN with a BSN would be titled Jane Doe, BSN, RN. Some people might also have a BS instead of a BSN and can use that instead. If you are working after graduating but have not taken your NCLEX, there may be a title in your state since you are a testing applicant (ex. RNA).
Now, NPs seem to have their titles a variety of ways from what I have seen. I am still trying to figure it out because some people don't understand NPs are RNs too, and especially because I want RN to appear somewhere for some of the jobs I apply to. You graduated with some sort of NP, then you are certified by a board and might add C or BC, but some states consider you APRNs so you might have that in your title, and so on. Once you figure out your designated NP title, there is the order and the RN that may or may not fit in there.
How Do I Sign My Name (http://fhea.com/certificationcols/sign_name.shtml) on the Fitzgerald website is helpful for NPs.
Wikipedia is helpful if you are wondering what some different credentials mean and when to use some of them, just check out the Nursing Credentials and Certifications article (http://en.wikipedia.org/wiki/List_of_nursing_credentials). For NPs, you can check out the Nurse Practitioner page (http://en.wikipedia.org/wiki/Nurse_practitioner).
I learned in nursing school to write the degree (BSN), the license (RN), then the certification. We were told to list our highest degree, a BSN for us at that point, first because that cannot be taken away from you. Some employers do not do so because an RN is an RN, but they might list the RN first instead. For example, an RN with a BSN would be titled Jane Doe, BSN, RN. Some people might also have a BS instead of a BSN and can use that instead. If you are working after graduating but have not taken your NCLEX, there may be a title in your state since you are a testing applicant (ex. RNA).
Now, NPs seem to have their titles a variety of ways from what I have seen. I am still trying to figure it out because some people don't understand NPs are RNs too, and especially because I want RN to appear somewhere for some of the jobs I apply to. You graduated with some sort of NP, then you are certified by a board and might add C or BC, but some states consider you APRNs so you might have that in your title, and so on. Once you figure out your designated NP title, there is the order and the RN that may or may not fit in there.
How Do I Sign My Name (http://fhea.com/certificationcols/sign_name.shtml) on the Fitzgerald website is helpful for NPs.
Wikipedia is helpful if you are wondering what some different credentials mean and when to use some of them, just check out the Nursing Credentials and Certifications article (http://en.wikipedia.org/wiki/List_of_nursing_credentials). For NPs, you can check out the Nurse Practitioner page (http://en.wikipedia.org/wiki/Nurse_practitioner).
Helpful Medical Sites:
***coming soon***
A list of a couple of helpful reference sites by disease or system. These are for healthcare professional and may be great resources for patients. I may go back at some point and add brief descriptions. I have more resources in my older blog posts also.
General:
Cancer:
Diabetes:
Pediatrics:
Infectious Disease:
Cultural Competence:
A list of a couple of helpful reference sites by disease or system. These are for healthcare professional and may be great resources for patients. I may go back at some point and add brief descriptions. I have more resources in my older blog posts also.
General:
- MedlinePlus: http://www.nlm.nih.gov/medlineplus/
- Medscape: http://www.medscape.com/nurses
- Medscape eMedicine: http://emedicine.medscape.com/
- Medicine Net: http://www.medicinenet.com/
Cancer:
- National Cancer Institute: http://www.cancer.gov/
- American Cancer Society: http://www.cancer.org/
Diabetes:
- American Diabetes Association: http://www.diabetes.org/
- National Diabetes Education Initiative: http://www.ndei.org/
- National Diabetes Clearinghouse: http://diabetes.niddk.nih.gov/
- National Diabetes Education Program: http://ndep.nih.gov/
Pediatrics:
- American Academy of Pediatrics: http://www.aap.org/
- Text: Harriet Lane Handbook
- ACOG: http://www.acog.org/
- The Federal Government Source for WHI: http://www.womenshealth.gov/
- OBGYN.net: http://hcp.obgyn.net/home
Infectious Disease:
- CDC: http://www.cdc.gov/
Cultural Competence:
Wednesday, July 6, 2011
Continuing Education
Some states require nurses or APRNs to participate in CEUs/CMEs to maintain licensure. It's also a great learning opportunity. You can attend conferences, teach, lecture, but also do them online for free. I know the AANC also lets you save everything to your profile. Here are some sites where you can earn credits for free:
- *Medscape Education (CME and Other Learning Activities): http://www.medscape.org/nurses
- *CME Corner: http://www.cmecorner.com/
- *Baylor College of Medicine: http://www.baylorcme.org/
- *Cleveland Clinic: http://www.clevelandclinicmeded.com/online/
- AHC Media: http://www.freecme.com/gindex.php
- CE Medicus: https://www.cemedicus.com/
- MD Anderson Cancer Center (UT): http://www.mdanderson.org/education-and-research/resources-for-professionals/professional-educational-resources/i-care/earn-free-cme-credit-online/index.html
- Health CMI: CA approved. http://www.healthcmi.com/
Saturday, July 2, 2011
Overhauling Nursing Education by Laura A. Stokowski, RN, MS
Overhauling Nursing Education
Nursing education is a sizzling hot topic right now. Maybe this is fitting, for 2010 was the centenary of Florence Nightingale's death, and she was the founder of the formal nursing school. The whole profession of nursing is under the microscope, as hundreds of experts and stakeholders study where nursing fits in and where it's going in the era of healthcare reform. However, the foundation of any profession, including nursing, is how its newest members are educated. This article will explore several questions about nursing education, and discuss the recommendations from the recent Future of Nursing reports[1,2] to address these issues.
This, or something very like this, was how nurses were "trained" at the beginning of the era known as "modern nursing." Nursing education followed an apprenticeship model, wherein students took care of patients under the supervision of more senior nurses.
Nursing education received a much-needed boost in 1917 when the National League for Nursing Education published their first standard curriculum for schools of nursing.[4] A more recognizable nursing curriculum, it was organized around the familiar categories of medical nursing, surgical nursing, obstetrical nursing, nursing care of children, and so forth. Student nurses would still have to learn cookery, hospital housekeeping, and massage, but they would also receive classes in ethics, psychology, professional issues, and history of nursing, and could take electives in public health or administration. The underlying theme of the curriculum was that nursing was a profession.
With the appearance of college-affiliated nursing programs and the baccalaureate degree, nursing students had the benefit of an entire university or college with which to supplement their education. For the most part, however, the core nursing curriculum continued to revolve around the traditional medical specialties of medicine, surgery, obstetrics, pediatrics, and mental health.
It did not succeed. During the ensuing 25 years, under the auspices of "reform," nurse educators essentially re-arranged and updated the curriculum without changing the substance of the curriculum itself or the educational paradigm.[6] In 2003, the NLN once again advocated a transformation of nursing education, via the creation of innovative pedagogies that will be effective in helping students learn to practice in rapidly-changing environments.[6] Graduating nurses would be leaders in health promotion and disease prevention, function in complex and unpredictable environments, demonstrate critical reasoning and flexibility, and execute a variety of roles throughout their nursing careers. The old and tired clinical placement model would give way to an approach that has relevance for the increasingly community-based, multidisciplinary patient care delivery systems of the future.
We now come to 2009. An initiative known as the Future of Nursing (FON), a joint project of the Institute of Medicine and the Robert Wood Johnson Foundation, began its critical review of the nursing profession by holding 3 national forums, one of which focused on nursing education. This forum was led by Michael Bleich, RN, PhD, Dean of the Oregon Health & Science University School of Nursing. Participants in this forum considered needed innovations in what to teach (ideal future nursing curricula), how to teach (methodologies and strategies), and where to teach (venues and locations for nursing education).
The recommendations that came out of this forum were driven by 4 realities (1) more nurses are working outside of hospitals as care shifts formally and informally into communities; (2) evidence that could inform practice is growing rapidly, but is not well-integrated into either education or practice; (3) the need for nurses to effectively work in and lead teams is increasing; and (4) numbers alone will not fill the widening gap between the supply of nurses and the growing need for their services -- additional research and new knowledge will be required.
"Nothing is inherently wrong with the intent of what nursing education is trying to achieve now," explained Dr. Bleich. "We just know more now about how people learn best, knowledge in our field is expanding, and the patients are becoming more complex and challenging to manage. Nurses are being asked to care for more people with complex multiple geriatric syndromes, and this involves more than keeping these patients alive -- it's helping people live their lives to the fullest extent possible. The healthcare organization also expects nurses to perform at a higher level, to participate and contribute to the quality and safety agenda of the organization."
"It's more than knowing how to perform tasks and procedures," continued Dr. Bleich. "It's how to be a more effective player on the healthcare team and navigate clinical systems, and that's not traditionally taught in a classroom. That's a set of experiences that must be added to the way we educate. We need to address concepts within populations of patients, and shift from the medical diagnosis model or the task and procedures model to competence in applying critical concepts to multiple patients with multiple diagnoses."
The Future of Nursing Education report also identifies diversity as a missing element among current nursing student applicants. More racial-ethnic and gender diversity must be actively pursued so that a workforce is created that is better able to meet the demands of a diverse population across the life span, and nurses are better able to provide culturally-relevant care.[1]
"Nothing is inherently wrong with the intent of what nursing education is trying to achieve now," explained Dr. Bleich. "We just know more now about how people learn best, knowledge in our field is expanding, and the patients are becoming more complex and challenging to manage. Nurses are being asked to care for more people with complex multiple geriatric syndromes, and this involves more than keeping these patients alive -- it's helping people live their lives to the fullest extent possible. The healthcare organization also expects nurses to perform at a higher level, to participate and contribute to the quality and safety agenda of the organization."
"It's more than knowing how to perform tasks and procedures," continued Dr. Bleich. "It's how to be a more effective player on the healthcare team and navigate clinical systems, and that's not traditionally taught in a classroom. That's a set of experiences that must be added to the way we educate. We need to address concepts within populations of patients, and shift from the medical diagnosis model or the task and procedures model to competence in applying critical concepts to multiple patients with multiple diagnoses."
The Future of Nursing Education report also identifies diversity as a missing element among current nursing student applicants. More racial-ethnic and gender diversity must be actively pursued so that a workforce is created that is better able to meet the demands of a diverse population across the life span, and nurses are better able to provide culturally-relevant care.[1]
The nursing diploma. Once the most popular route to becoming a nurse, the hospital-based nursing diploma program has been all but phased out in the United States. Among still licensed RNs, 20% received a hospital diploma for their initial "nurses training," but this number is steadily declining.[7] Only 3.1% of registered nurses who graduated after 2004 were educated in a diploma program.
It is believed that diploma programs should be phased out over the next 10 years and, their resources consolidated with schools providing AD or preferably, BS degrees.[1]
The associate's degree in nursing. As of 2008, the Associate's Degree in Nursing (ADN) was still the most common initial nursing education degree, earned by 45% of all licensed registered nurses.[7] A common misconception exists that the AD is a 2-year degree; whereas, in nursing, the ADN usually takes at least 3 years to complete because of course prerequisites.[1] In the United States, 21% of nurses who initially earn an ADN go on to earn higher nursing degrees.[7] Many rural and other medically underserved communities would not be able to staff their hospitals, clinics, and long-term care facilities without ADN prepared nurses.
I asked Dr. Bleich if the ADN degree will still have a place in the hierarchy of nursing education. He explained that "it's an important entry point for many nurses, a portal to get into nursing as a career, but it shouldn't be a terminal degree. We did address the role of the ADN nurse, but were more focused on the public's need for expanded nursing competencies and this translates into nurses obtaining higher education and not stopping at the associate's level. The need for education and development of the nurse if far greater -- we need more advanced practice nurses, more faculty, more nursing leaders."
Healthcare organizations need to step up and encourage nurses with ADN (and diploma) degrees to enter baccalaureate nursing programs within 5 years of graduation by offering tuition reimbursement, creating a culture that fosters continuing education, and providing salary differentials and promotion opportunities.[1]
Hand-in-hand with the future of the ADN degree is the future of nursing education in community colleges. In rural and medically underserved areas, most nursing education takes place in these settings. The Future of Nursing initiative believes that community colleges must either join an educational collaborative or develop innovative and easily accessible programs that seamlessly connect students to schools offering the BSN and higher degrees, or if possible, develop their own BSN programs.[1]
The bachelor's degree/baccalaureate. Only approximately 34% of nurses (in 2008) had received their initial nursing education in a bachelor's program, but 50% of licensed nurses eventually earned a bachelor's degree.[7] Despite an average gap of 10.5 years before nurses with an AD or diploma earned their bachelor's degrees, this reflects the recognition on the part of many nurses that higher degrees are important for professional and career development.
The goal established by the Future of Nursing initiative is to increase the proportion of nurses with a baccalaureate degree to 80% by the year 2020.[2] Furthermore, at least 10% of these baccalaureate graduates must matriculate into a master's or doctoral program within 5 years of graduation.[1]
Increasing the percentage of nurses with a BSN degree is in line with what the public needs from nurses in terms of growing expectations for quality, and as the settings where nurses are needed proliferate and become more complex.[1] More BSN nurses will be necessary to expand competencies in areas such as community and public health, leadership, systems improvement and change, research, and health policy; and to provide a pool of potential candidates to move on to master's and doctoral education in nursing.
The American Organization of Nurse Executives and the American Association of Colleges of Nursing have called for a mandated baccalaureate degree as a point of entry to nursing practice.[8] Studies demonstrate better patient outcomes in hospitals staffed by a greater proportion of nurses with baccalaureate degrees to those with associate degrees.[8]
The master's degree. Currently, 13.2% of licensed registered nurses hold a master's, or higher, degree.[7] These nurses work in a variety of roles, including clinical nurse specialist, nurse practitioner, nurse midwife, and nurse anesthetist. Master's degrees prepare RNs for leadership roles -- in administration, clinical, or teaching -- or for work in other advanced practice roles, and serve as a springboard to doctoral pursuits.
The fate of the master's degree depends in part on whether consensus is reached on requiring the doctoral degree for entry into advanced practice. At this time, however, the Future of Nursing Education group did not think that the evidence was sufficient to require the doctoral degree for entry into advanced practice nursing.[2] Therefore, other than increasing the numbers of nurses who earn a master's degree, no specific recommendations were made about the master's degree in nursing.
The doctoral degree. The current goal is to double the number of doctorally prepared nurses by 2020. Two primary degrees in nursing at this level are the PhD and the DNP (doctor of nursing practice). The latter has been increasing in popularity throughout the last decade. A shortage of nurses prepared at the highest levels of education and working in primary care, education, and research is viewed as a barrier to advancing the profession of nursing and improving the delivery of care to patients.[1]
Dr. Bleich spoke about the concern that the rise in numbers of nurses obtaining a practice doctorate (rather than the PhD) will influence the growth of nursing research, and if we will have enough PhDs to sustain and expand nursing research? "Newly emerging data suggest that this is not the case," replied Dr. Bleich." It's true that nurses who seek the DNP usually don't want to be researchers, but anecdotally, through their education, some are becoming attracted to the PhD. The DNP is engaging nurses in research and inquiry."
"It starts with one's personal desire to develop oneself -- investing in oneself is a fundamental tenet of a professional. We live in a time when knowledge is exploding, technology is adding complexity to our work, and there are more opportunities for nurses to work in more settings than we've ever known in the history of nursing (Table). Many organizations are expecting more highly educated nurses. The public also wants nurses to be more knowledgeable and more adept. This is part of the nurse's reality."
Table. Nontraditional Nursing Careers
From Olmstead J. Nurs Manage. 2009;40:52.[9]
"Nursing roles must change to meet the public's demand for us in the future. The public wants to know that the nurses who are providing care are competent." explains Dr. Bleich. "There is a tsunami of people coming into the healthcare system at the upper echelons of age, with multiple diagnoses and chronic conditions. We need to reshape the healthcare system so that we can intervene outside of the traditional sick care system. We just have to know more."
Posted: 01/28/2011
http://www.medscape.com/viewarticle/736236Nursing education is a sizzling hot topic right now. Maybe this is fitting, for 2010 was the centenary of Florence Nightingale's death, and she was the founder of the formal nursing school. The whole profession of nursing is under the microscope, as hundreds of experts and stakeholders study where nursing fits in and where it's going in the era of healthcare reform. However, the foundation of any profession, including nursing, is how its newest members are educated. This article will explore several questions about nursing education, and discuss the recommendations from the recent Future of Nursing reports[1,2] to address these issues.
- What's missing in nursing education?
- Are there better ways of teaching/learning?
- What does future hold for nursing degrees (including the associate's degree)?
- Does nursing education prepare nurses for practice?
The Rise of "Modern Nursing" Education
If you had just been accepted to nursing school near the end of the 19th century, your nursing courses would be designed to teach you these fundamentals of nursing care:- The dressing of blisters, sores, burns and wounds; the application of fomentations, poultices, cups, and leeches;
- The administration of enemas;
- The management of trusses and appliances for uterine complaints;
- The best method of friction to the body and extremities;
- The management of helpless patients: making beds, moving, changing, giving baths in bed, preventing and dressing bedsores, and changing positions;
- Bandaging -- and making bandages, rollers, and splints;
- Preparing, cooking, and serving delicacies for the sick;
- Practical methods of supplying fresh air, warming and ventilating sick-rooms;
- Keeping all utensils perfectly clean and disinfected; and
- Making accurate observations and reports to the physician of the state of secretions, expectoration, skin, pulse, appetite, temperature, delirium or stupor, breathing, sleep, condition of wounds, eruptions, formation of matter, effect of diet or of stimulants or medicines.
This, or something very like this, was how nurses were "trained" at the beginning of the era known as "modern nursing." Nursing education followed an apprenticeship model, wherein students took care of patients under the supervision of more senior nurses.
Nursing education received a much-needed boost in 1917 when the National League for Nursing Education published their first standard curriculum for schools of nursing.[4] A more recognizable nursing curriculum, it was organized around the familiar categories of medical nursing, surgical nursing, obstetrical nursing, nursing care of children, and so forth. Student nurses would still have to learn cookery, hospital housekeeping, and massage, but they would also receive classes in ethics, psychology, professional issues, and history of nursing, and could take electives in public health or administration. The underlying theme of the curriculum was that nursing was a profession.
With the appearance of college-affiliated nursing programs and the baccalaureate degree, nursing students had the benefit of an entire university or college with which to supplement their education. For the most part, however, the core nursing curriculum continued to revolve around the traditional medical specialties of medicine, surgery, obstetrics, pediatrics, and mental health.
Curriculum Revolution
In 1988, the National League for Nursing (NLN) attempted to shake nursing schools loose from the hold of the traditional, content-laden, lecture-and-test approach to nursing education. In Curriculum Revolution: Mandate for Change,[5] nursing leaders called for an overhaul of nursing education that would change the way nursing was taught and learned.It did not succeed. During the ensuing 25 years, under the auspices of "reform," nurse educators essentially re-arranged and updated the curriculum without changing the substance of the curriculum itself or the educational paradigm.[6] In 2003, the NLN once again advocated a transformation of nursing education, via the creation of innovative pedagogies that will be effective in helping students learn to practice in rapidly-changing environments.[6] Graduating nurses would be leaders in health promotion and disease prevention, function in complex and unpredictable environments, demonstrate critical reasoning and flexibility, and execute a variety of roles throughout their nursing careers. The old and tired clinical placement model would give way to an approach that has relevance for the increasingly community-based, multidisciplinary patient care delivery systems of the future.
We now come to 2009. An initiative known as the Future of Nursing (FON), a joint project of the Institute of Medicine and the Robert Wood Johnson Foundation, began its critical review of the nursing profession by holding 3 national forums, one of which focused on nursing education. This forum was led by Michael Bleich, RN, PhD, Dean of the Oregon Health & Science University School of Nursing. Participants in this forum considered needed innovations in what to teach (ideal future nursing curricula), how to teach (methodologies and strategies), and where to teach (venues and locations for nursing education).
The recommendations that came out of this forum were driven by 4 realities (1) more nurses are working outside of hospitals as care shifts formally and informally into communities; (2) evidence that could inform practice is growing rapidly, but is not well-integrated into either education or practice; (3) the need for nurses to effectively work in and lead teams is increasing; and (4) numbers alone will not fill the widening gap between the supply of nurses and the growing need for their services -- additional research and new knowledge will be required.
What Is Missing in Nursing Education?
I had the opportunity to ask Dr. Bleich to summarize the Future of Nursing participants' views on some of the initiative's recommendations to solve the current deficiencies in nursing education."Nothing is inherently wrong with the intent of what nursing education is trying to achieve now," explained Dr. Bleich. "We just know more now about how people learn best, knowledge in our field is expanding, and the patients are becoming more complex and challenging to manage. Nurses are being asked to care for more people with complex multiple geriatric syndromes, and this involves more than keeping these patients alive -- it's helping people live their lives to the fullest extent possible. The healthcare organization also expects nurses to perform at a higher level, to participate and contribute to the quality and safety agenda of the organization."
"It's more than knowing how to perform tasks and procedures," continued Dr. Bleich. "It's how to be a more effective player on the healthcare team and navigate clinical systems, and that's not traditionally taught in a classroom. That's a set of experiences that must be added to the way we educate. We need to address concepts within populations of patients, and shift from the medical diagnosis model or the task and procedures model to competence in applying critical concepts to multiple patients with multiple diagnoses."
The Future of Nursing Education report also identifies diversity as a missing element among current nursing student applicants. More racial-ethnic and gender diversity must be actively pursued so that a workforce is created that is better able to meet the demands of a diverse population across the life span, and nurses are better able to provide culturally-relevant care.[1]
What Is Missing in Nursing Education?
I had the opportunity to ask Dr. Bleich to summarize the Future of Nursing participants' views on some of the initiative's recommendations to solve the current deficiencies in nursing education."Nothing is inherently wrong with the intent of what nursing education is trying to achieve now," explained Dr. Bleich. "We just know more now about how people learn best, knowledge in our field is expanding, and the patients are becoming more complex and challenging to manage. Nurses are being asked to care for more people with complex multiple geriatric syndromes, and this involves more than keeping these patients alive -- it's helping people live their lives to the fullest extent possible. The healthcare organization also expects nurses to perform at a higher level, to participate and contribute to the quality and safety agenda of the organization."
"It's more than knowing how to perform tasks and procedures," continued Dr. Bleich. "It's how to be a more effective player on the healthcare team and navigate clinical systems, and that's not traditionally taught in a classroom. That's a set of experiences that must be added to the way we educate. We need to address concepts within populations of patients, and shift from the medical diagnosis model or the task and procedures model to competence in applying critical concepts to multiple patients with multiple diagnoses."
The Future of Nursing Education report also identifies diversity as a missing element among current nursing student applicants. More racial-ethnic and gender diversity must be actively pursued so that a workforce is created that is better able to meet the demands of a diverse population across the life span, and nurses are better able to provide culturally-relevant care.[1]
Nursing Degrees: What's in Their Future?
Nursing is unique among the healthcare professions in the United States in that multiple educational pathways lead to an entry-level license to practice.[1] A key recommendation of the Future of Nursing initiative was that all nursing schools should offer defined academic pathways that promote seamless access for nurses to higher levels of education.[1]The nursing diploma. Once the most popular route to becoming a nurse, the hospital-based nursing diploma program has been all but phased out in the United States. Among still licensed RNs, 20% received a hospital diploma for their initial "nurses training," but this number is steadily declining.[7] Only 3.1% of registered nurses who graduated after 2004 were educated in a diploma program.
It is believed that diploma programs should be phased out over the next 10 years and, their resources consolidated with schools providing AD or preferably, BS degrees.[1]
The associate's degree in nursing. As of 2008, the Associate's Degree in Nursing (ADN) was still the most common initial nursing education degree, earned by 45% of all licensed registered nurses.[7] A common misconception exists that the AD is a 2-year degree; whereas, in nursing, the ADN usually takes at least 3 years to complete because of course prerequisites.[1] In the United States, 21% of nurses who initially earn an ADN go on to earn higher nursing degrees.[7] Many rural and other medically underserved communities would not be able to staff their hospitals, clinics, and long-term care facilities without ADN prepared nurses.
I asked Dr. Bleich if the ADN degree will still have a place in the hierarchy of nursing education. He explained that "it's an important entry point for many nurses, a portal to get into nursing as a career, but it shouldn't be a terminal degree. We did address the role of the ADN nurse, but were more focused on the public's need for expanded nursing competencies and this translates into nurses obtaining higher education and not stopping at the associate's level. The need for education and development of the nurse if far greater -- we need more advanced practice nurses, more faculty, more nursing leaders."
Healthcare organizations need to step up and encourage nurses with ADN (and diploma) degrees to enter baccalaureate nursing programs within 5 years of graduation by offering tuition reimbursement, creating a culture that fosters continuing education, and providing salary differentials and promotion opportunities.[1]
Hand-in-hand with the future of the ADN degree is the future of nursing education in community colleges. In rural and medically underserved areas, most nursing education takes place in these settings. The Future of Nursing initiative believes that community colleges must either join an educational collaborative or develop innovative and easily accessible programs that seamlessly connect students to schools offering the BSN and higher degrees, or if possible, develop their own BSN programs.[1]
The bachelor's degree/baccalaureate. Only approximately 34% of nurses (in 2008) had received their initial nursing education in a bachelor's program, but 50% of licensed nurses eventually earned a bachelor's degree.[7] Despite an average gap of 10.5 years before nurses with an AD or diploma earned their bachelor's degrees, this reflects the recognition on the part of many nurses that higher degrees are important for professional and career development.
The goal established by the Future of Nursing initiative is to increase the proportion of nurses with a baccalaureate degree to 80% by the year 2020.[2] Furthermore, at least 10% of these baccalaureate graduates must matriculate into a master's or doctoral program within 5 years of graduation.[1]
Increasing the percentage of nurses with a BSN degree is in line with what the public needs from nurses in terms of growing expectations for quality, and as the settings where nurses are needed proliferate and become more complex.[1] More BSN nurses will be necessary to expand competencies in areas such as community and public health, leadership, systems improvement and change, research, and health policy; and to provide a pool of potential candidates to move on to master's and doctoral education in nursing.
The American Organization of Nurse Executives and the American Association of Colleges of Nursing have called for a mandated baccalaureate degree as a point of entry to nursing practice.[8] Studies demonstrate better patient outcomes in hospitals staffed by a greater proportion of nurses with baccalaureate degrees to those with associate degrees.[8]
The master's degree. Currently, 13.2% of licensed registered nurses hold a master's, or higher, degree.[7] These nurses work in a variety of roles, including clinical nurse specialist, nurse practitioner, nurse midwife, and nurse anesthetist. Master's degrees prepare RNs for leadership roles -- in administration, clinical, or teaching -- or for work in other advanced practice roles, and serve as a springboard to doctoral pursuits.
The fate of the master's degree depends in part on whether consensus is reached on requiring the doctoral degree for entry into advanced practice. At this time, however, the Future of Nursing Education group did not think that the evidence was sufficient to require the doctoral degree for entry into advanced practice nursing.[2] Therefore, other than increasing the numbers of nurses who earn a master's degree, no specific recommendations were made about the master's degree in nursing.
The doctoral degree. The current goal is to double the number of doctorally prepared nurses by 2020. Two primary degrees in nursing at this level are the PhD and the DNP (doctor of nursing practice). The latter has been increasing in popularity throughout the last decade. A shortage of nurses prepared at the highest levels of education and working in primary care, education, and research is viewed as a barrier to advancing the profession of nursing and improving the delivery of care to patients.[1]
Dr. Bleich spoke about the concern that the rise in numbers of nurses obtaining a practice doctorate (rather than the PhD) will influence the growth of nursing research, and if we will have enough PhDs to sustain and expand nursing research? "Newly emerging data suggest that this is not the case," replied Dr. Bleich." It's true that nurses who seek the DNP usually don't want to be researchers, but anecdotally, through their education, some are becoming attracted to the PhD. The DNP is engaging nurses in research and inquiry."
Why Go Back to School?
I asked Dr. Bleich why, considering the expense and time commitment, should nurses go back to school for another degree? For example, if I have an associate's degree, why do I need to get my bachelor's?"It starts with one's personal desire to develop oneself -- investing in oneself is a fundamental tenet of a professional. We live in a time when knowledge is exploding, technology is adding complexity to our work, and there are more opportunities for nurses to work in more settings than we've ever known in the history of nursing (Table). Many organizations are expecting more highly educated nurses. The public also wants nurses to be more knowledgeable and more adept. This is part of the nurse's reality."
Table. Nontraditional Nursing Careers
| Transitional Care Nurse |
| Care Manager/Coordinator |
| Telehealth Nursing |
| Nursing Informatics |
| Forensic Nurse |
| Legal Nurse Consultant |
| Hospice Nurse |
| Palliative Care Nurse |
| Nurse Epidemiologist |
| Occupational Health Nurse |
| Travel Health Nurse |
| Cruise Ship Nurse |
| RN Operating Room First Assistant |
| Wound Care Nurse |
The Imperative to Change the Educational Paradigm
As a profession, nursing is moving beyond the objective of simply increasing its numbers, to positioning itself in a healthcare environment that is being transformed to meet the needs of society for higher quality, safer, more affordable and more accessible healthcare. The emphasis on health promotion, illness prevention, and provision of care to diverse populations throughout the lifespan must be incorporated not only into practice, but also into education."Nursing roles must change to meet the public's demand for us in the future. The public wants to know that the nurses who are providing care are competent." explains Dr. Bleich. "There is a tsunami of people coming into the healthcare system at the upper echelons of age, with multiple diagnoses and chronic conditions. We need to reshape the healthcare system so that we can intervene outside of the traditional sick care system. We just have to know more."
References
- Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine; Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington DC: National Academies Press; 2011.
- Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. A Summary of the February 2010 Forum on the Future of Nursing: Education. Washington DC, National Academies Press, 2010. Available at: http://www.nap.edu/catalog.php?record_id=12894 Accessed January 21, 2011.
- Schryver GF. A History of the Illinois Training School for Nurses, 1880-1929. Chicago, IL: The Board of Directors of the Illinois Training School for Nurses, 1930. Available at: http://libsysdigi.library.uiuc.edu/OCA/Books2009-06/historyofillinoi00schr/historyofillinoi00schr.pdf Accessed January 21, 2011.
- National League for Nursing Education. Standard Curriculum for Schools of Nursing. Baltimore, Md: Waverly Press; 1919. Available at: http://www.archive.org/details/standardcurricul00natiiala Accessed January 21, 2011.
- National League for Nursing. Curriculum Revolution: Mandate for Change. New York: NLN Publications; 1988.
- National League for Nursing. Innovation in Nursing Education: A Call to Reform. New York: NLN Publications; 2003. Available at: http://www.nln.org/aboutnln/positionstatements/innovation082203.pdf Accessed January 21, 2011.
- US Department of Health and Human Services. Health Resources and Services Administration. The registered nurse population. September, 2010. Available at: http://bhpr.hrsa.gov/healthworkforce/rnsurvey/2008/nssrn2008.pdf Accessed January 21, 2011.
- Benner P, Sutphen M, Leonard V, Day L. Educating Nurses: A Call for Radical Transformation. Hoboken, NJ: Jossey-Bass; 2009.
- Olmstead J. The road less traveled: nontraditional nursing careers. Nurs Manage. 2009;40:52.
- Candela L, Bowles C. Recent RN graduate perceptions of educational preparation. Nurs Educ Perspect. 2008;29:266-271. Abstract
Thursday, June 30, 2011
Review Courses:
**coming soon***
There are tons of books, discs, guides, online lectures, and courses out there to help you review. I have a list of books in some of my older posts I can work on reviewing. There are also websites that can help you. A great resource is always the website that makes up the exam. They usually have test content information, sample questions, some tips, and more. Plus, they have a break down of topics on the latest test that changes.
NCLEX:
I had books before my NCLEX exam but I never much used them. We had some for school and completed sections for a class. The more practice questions, the better. I also took the Hurst Review course. It was great for me because I got a book and could go more than once for a one-time price. I didn't try any of the online content. I bought a Kaplan book also because it helped with test taking strategies. Also, I watched the Drexel videos on You Tube.
Here are some of the review courses available. They usually provide a book but usually offer more. They may have discs with questions and online review or lectures available too.
YouTube actually has a few videos available. Some may be a little old but they don't hurt.You can check out my YouTube profile, MyNursingLounge and see what I have subscribed to!
**********************************************************
Nurse Practitioner/CNS:
For my FNP exam, I took the Fitzgerald Review course. NP/CNS review courses are more limited based on specialty. As an FNP, I also had two options for who I wanted to take the exam with receive my certification through.
............coming soon...........
There are tons of books, discs, guides, online lectures, and courses out there to help you review. I have a list of books in some of my older posts I can work on reviewing. There are also websites that can help you. A great resource is always the website that makes up the exam. They usually have test content information, sample questions, some tips, and more. Plus, they have a break down of topics on the latest test that changes.
NCLEX:
I had books before my NCLEX exam but I never much used them. We had some for school and completed sections for a class. The more practice questions, the better. I also took the Hurst Review course. It was great for me because I got a book and could go more than once for a one-time price. I didn't try any of the online content. I bought a Kaplan book also because it helped with test taking strategies. Also, I watched the Drexel videos on You Tube.
Here are some of the review courses available. They usually provide a book but usually offer more. They may have discs with questions and online review or lectures available too.
- NCSBN Extension Learning: http://learningext.com/groups/880ce6ef50/summary
- Hurst Review: Live, online, and DVD options. http://www.hurstreview.com/
- Kaplan: Classroom, classroom anywhere, on demand, and comprehensive online resources http://www.kaptest.com/NCLEX/Home/index.html
- Princeton:
- Sylvia Rayfield & Associates: Live and online. http://www.sylviarayfield.com/nclex_review.php
- Nursing Education Consults, Inc: http://www.nursinged.com/
- Review for Nurses: eBook, video, mobile review, DVD: http://nclex.reviewfornurses.com/
YouTube actually has a few videos available. Some may be a little old but they don't hurt.You can check out my YouTube profile, MyNursingLounge and see what I have subscribed to!
- NCLEXEXCEL: Drexel NCLEX Review: http://www.youtube.com/user/NCLEXEXCEL
- nelc2009: Nurses' E-Learning Center: http://www.youtube.com/user/nelc2009
- dearnurses: SESSIONS for Nurses - Advancements in Clinical Nursing: http://www.youtube.com/user/dearnurses
- agonsho: Pharmacology. http://www.youtube.com/user/agonsho
- suepix: http://www.youtube.com/user/suepix
- NCLEX Test Review: http://www.nclexinfo.com/
- Test Prep Review: http://www.testprepreview.com/nclex_practice.htm
**********************************************************
Nurse Practitioner/CNS:
For my FNP exam, I took the Fitzgerald Review course. NP/CNS review courses are more limited based on specialty. As an FNP, I also had two options for who I wanted to take the exam with receive my certification through.
............coming soon...........
Portrayal of Nurses on TV and in Movies:
***coming soon***
Center for Nursing Advocacy: http://www.nursingadvocacy.org/news/2009/jun/discuss.html
Nurse Jackie
HawthoRNe
Grey's Anatomy
ER...
House
Center for Nursing Advocacy: http://www.nursingadvocacy.org/news/2009/jun/discuss.html
Nurse Jackie
HawthoRNe
Grey's Anatomy
ER...
House
Monday, June 27, 2011
Mal-Practice Insurance:
***COMING SOON***
Can I get sued? YES, absolutely!
Types:
1.)
2.)
Should you have your own?
Resources:
Can I get sued? YES, absolutely!
Types:
1.)
2.)
Should you have your own?
Resources:
- Nurses, Neglect, and Malpractice by Eileen L. Croke: http://www.nursingcenter.com/library/journalarticle.asp?article_id=423284
- http://www.burke-eisner.com/practice-areas/medical-malpractice/Nurse_Malpractice.html
Ph.D vs. DNP:
***More to come!*** I am publishing my draft so you have an idea of where this might be going and can go ahead and comment so I can get some input or opinions.
Ph. D:
DNP:
Originally, nurses had to get a doctorate in other areas such as sociology and psychology before it was an option in nursing.
The DNP was started in
Ph. D:
DNP:
Originally, nurses had to get a doctorate in other areas such as sociology and psychology before it was an option in nursing.
The DNP was started in
Nurse Practitioner vs. Physicians Assistant what's the difference?
***Haven't quite finished. ***
If you Google the topic, "np vs pa", you come up with several discussions that basically leave an NP offended or with nothing. You'll read that PAs don't even have a clue. PAs are referred to as "mini-doctors" and "doctor wannabes" and NPs, well, a nurse is some sort of nurse...Being an NP, maybe I am a little bias, but the patient's well-being is #1.
Overview:
Nurse Practitioner (NP): An NP is an "advanced practice RN" in the nursing world and a "mid-level provider" (sorry AANP) in the medical world. The Board of Nursing regulates NP licenses and certifications in specialties are through different organizations. There are several types of NP certifications such as family, adult, pediatric, women's health, and so on. Laws vary from state on what NPs can do, prescribe, and whether or not they have to have a collaborative agreement with a physician to practice. NPs can diagnose, prescribe some medications, perform some procedures... They general see less acute patients. NPs are generally trained to be more focused on patient education. Nurses also have some other options for post-grad degrees!
Physician Assistant (PA): PAs are also mid-level providers but they are regulated by the Board of Medicine. They have one national exam to pass. They always practice under a supervising physician.
*Mid-level provider (MLPs): Sorry, AANP. There are three types: NPs, PAs, and CRNAs (Certified Registered Nurse Anesthetists). They almost always have a supervising physician (NPs in some states may not).
Education:
Nurse Practitioners: The majority of NPs have an MSN, since now it is an MSN program. Programs are usually 1.5-2 years. NP programs require you be an RN (except accelerated programs where you have a BS and get a BSN, RN, and MSN in one year). A BSN might be required, but a BS in another area may be fine. The amount of required and type of experience may vary based on school and program.
Some NPs may have a doctorate degree. Nurses have the option of a DNP, Doctorate of Nursing Practice, in addition to the traditional Ph.D option now. The DNP is more clinically oriented, rather than going the academic/research route. This is another discussion for later.
Physician Assistants: PAs go to school at least 2 years post-grad with classroom and clinical training. Typically, the admission requirements seem to involve taking certain undergrad science classes, or a certain number of natural science classes (chemistry, physics). They are not required to have any previous medical training, however, some sort exposure to healthcare may be required. I believe they generally are exposed to more clinical areas than NPs, due to NP program specialties.
Duke calls itself "The birthplace of the PA profession". They report that:
Acceptance by MDs into practice:
So, that is a fun topic...I am still working on this article but for now, my opinion: Doctors who have worked with NPs, seem to love them, but PAs are more widely accepted in the medical world by physicians.
My father is an MD, so he gets all these wonderful free journals and newsletters my mom (a CRNA) and I can read! The Board of Medicine in my state has had this on-going idea that NPs are not worthy providers and that they are trying to get more freedom and expand their scope pf practice, which absolutely cannot be tolerated. So, those are always interesting articles to come across.
There are some areas you may typically see PAs but NPs can certainly fill those positions too.
The importance of mid-level providers to healthcare:
If 30 million Americans would be in need of a primary care provider (PCP), should we all receive healthcare, how are we going to handle that when we already have a PCP shortage? We have a major shortage in rural areas already. Plus, have MLPs are cheaper than MDs or DOs (that difference is easier to look up).
Resources:
NPs:
PAs:
MLPs:
If you Google the topic, "np vs pa", you come up with several discussions that basically leave an NP offended or with nothing. You'll read that PAs don't even have a clue. PAs are referred to as "mini-doctors" and "doctor wannabes" and NPs, well, a nurse is some sort of nurse...Being an NP, maybe I am a little bias, but the patient's well-being is #1.
Overview:
Nurse Practitioner (NP): An NP is an "advanced practice RN" in the nursing world and a "mid-level provider" (sorry AANP) in the medical world. The Board of Nursing regulates NP licenses and certifications in specialties are through different organizations. There are several types of NP certifications such as family, adult, pediatric, women's health, and so on. Laws vary from state on what NPs can do, prescribe, and whether or not they have to have a collaborative agreement with a physician to practice. NPs can diagnose, prescribe some medications, perform some procedures... They general see less acute patients. NPs are generally trained to be more focused on patient education. Nurses also have some other options for post-grad degrees!
Physician Assistant (PA): PAs are also mid-level providers but they are regulated by the Board of Medicine. They have one national exam to pass. They always practice under a supervising physician.
*Mid-level provider (MLPs): Sorry, AANP. There are three types: NPs, PAs, and CRNAs (Certified Registered Nurse Anesthetists). They almost always have a supervising physician (NPs in some states may not).
Education:
Nurse Practitioners: The majority of NPs have an MSN, since now it is an MSN program. Programs are usually 1.5-2 years. NP programs require you be an RN (except accelerated programs where you have a BS and get a BSN, RN, and MSN in one year). A BSN might be required, but a BS in another area may be fine. The amount of required and type of experience may vary based on school and program.
Some NPs may have a doctorate degree. Nurses have the option of a DNP, Doctorate of Nursing Practice, in addition to the traditional Ph.D option now. The DNP is more clinically oriented, rather than going the academic/research route. This is another discussion for later.
Physician Assistants: PAs go to school at least 2 years post-grad with classroom and clinical training. Typically, the admission requirements seem to involve taking certain undergrad science classes, or a certain number of natural science classes (chemistry, physics). They are not required to have any previous medical training, however, some sort exposure to healthcare may be required. I believe they generally are exposed to more clinical areas than NPs, due to NP program specialties.
Duke calls itself "The birthplace of the PA profession". They report that:
Working interdependently with physicians, PAs provide diagnostic and therapeutic patient care in virtually all medical specialties and settings. They take patient histories, perform physical examinations, order laboratory and diagnostic studies and develop patient treatment plans. In all states, including North Carolina, PAs have the authority to write prescriptions. Their job descriptions are as diverse as those of their supervising physicians, and include patient education, team leadership, medical education, health administration and research.
One-third of graduate PAs provide primary health care services, especially in family and general internal medicine. About 40% of graduate PAs work in hospital settings. About one-fourth of all clinically active PAs work in surgery and its subspecialities.
Acceptance by MDs into practice:
So, that is a fun topic...I am still working on this article but for now, my opinion: Doctors who have worked with NPs, seem to love them, but PAs are more widely accepted in the medical world by physicians.
My father is an MD, so he gets all these wonderful free journals and newsletters my mom (a CRNA) and I can read! The Board of Medicine in my state has had this on-going idea that NPs are not worthy providers and that they are trying to get more freedom and expand their scope pf practice, which absolutely cannot be tolerated. So, those are always interesting articles to come across.
There are some areas you may typically see PAs but NPs can certainly fill those positions too.
The importance of mid-level providers to healthcare:
If 30 million Americans would be in need of a primary care provider (PCP), should we all receive healthcare, how are we going to handle that when we already have a PCP shortage? We have a major shortage in rural areas already. Plus, have MLPs are cheaper than MDs or DOs (that difference is easier to look up).
Resources:
NPs:
- Nurse Practitioner by International Foundation of Employee Benefit Plans, Inc. (2003): http://www.ifebp.org/pdf/harker/Nurse_Practitioners.pdf
PAs:
- Duke University School of Medicine: Physician Assistant Program: http://paprogram.mc.duke.edu/PA-Program/
- US Dept of Labor, Occupational Outlook Handbook 2010-11: http://www.bls.gov/oco/ocos081.htm
MLPs:
"Midlevel Providers Fill Primary Care Doctors' Shoes" by Julie Rovner: http://www.npr.org/templates/story/story.php?storyId=129398647
Sunday, June 26, 2011
Government Health Resources:
***more to come***
General:
Public Health:
Women's Health:
Specialties:
Friday, June 24, 2011
Thursday, June 23, 2011
What do you want to know?
In case anyone reads and hopefully enjoys my blog, what would you like to know?
My goal is to help people out because I have been there and wish I had some help. Teachers are great and so knowledgable but sometimes they haven't been in your place for a while. Since I am a fairly recent grad, maybe I have some good advice. I believe I am a resourceful person, so I am trying to share that with people.
Wednesday, June 22, 2011
Internships and Externships:
My experience:
The summer before my senior year of nursing school, I did an paid externship at my school's medical center in the Peds ER and loved it! The requirements for when you can apply are different based on the time of nursing program. Some of the programs do require you to be enrolled in a BSN program or some may accept a BS. There are different specialty areas and it might be set up where participating units might take one or two students.
This is where I worked:
I could apply before my senior year with a 4yr BSN program.They had the option of an internship where you are paid, but you pay for college credit and could do anything within the RN scope of practice. The externship option limited what you could do, such as you could not administer medications, but you get to see and learn a lot. New graduates did a nurse residency. You basically follow the schedule of a preceptor. We did have some students that were in an accelerated BSN program taking classes at the same time. Many of the students stayed on as techs after the summer ended and some worked as nurses there after graduation. So, it can really get you in the door.
During the externship we had computer training and orientation. I believe we met certain scheduled days to discuss and learn. The rest of the time we were with our preceptors.
You do get paid but some also offer a stipend or even help you find a place to stay if you are from somewhere outside of the area. Each hospital uses different names so make sure to keep checking their employment opportunities or call HR when spring rolls around.
Some terms:
Internship: May be during school for college credit. Or may be for new graduates.
Externship: May be during school or in the summer. Usually nursing students before their last semester or year.
Nurse Residency: I see this as a program used for new graduates and sometimes experienced nurses that are going to be starting out in a new clinical area.
Other examples: The Mayo Clinic calls it "Summer III" and other places have their own titles.
The process:
I applied to three different internships. First there was the application; all of mine were online. Then the interview. And lastly, the offer or rejection. (I am doing this from memory; it's been 5 years.) ALWAYS CARRY YOUR RESUME!!!
Then I was selected to interview at all three hospitals...fun. Hospitals are very into behavioral interviewing, so please check out the links below and look it up!!! They basically give you a scenario and want you to respond with what o would do in that situation.
At all three you had brief interview with different areas I was interested in. 1.) One place had it set up where you speak with HR then interview with 2 or 3 nurse managers and wait to hear back. 2.) Another place (CHOP: Children's Hospital of Philadelphia) had you come in (they had people from all over) and spend time in the auditorium learning about the hospital, taking a tour, and sign-up for a few areas where you would like to interview. 3.) Finally, where I worked (my school's medical center) we went and and listened to HR. We made a list of a certain number of areas we wanted to meet with. Then they had nurse managers in various rooms and went to the ones on our list when we could. We had brief interviews and hoped for the best.
Links:
The summer before my senior year of nursing school, I did an paid externship at my school's medical center in the Peds ER and loved it! The requirements for when you can apply are different based on the time of nursing program. Some of the programs do require you to be enrolled in a BSN program or some may accept a BS. There are different specialty areas and it might be set up where participating units might take one or two students.
This is where I worked:
I could apply before my senior year with a 4yr BSN program.They had the option of an internship where you are paid, but you pay for college credit and could do anything within the RN scope of practice. The externship option limited what you could do, such as you could not administer medications, but you get to see and learn a lot. New graduates did a nurse residency. You basically follow the schedule of a preceptor. We did have some students that were in an accelerated BSN program taking classes at the same time. Many of the students stayed on as techs after the summer ended and some worked as nurses there after graduation. So, it can really get you in the door.
During the externship we had computer training and orientation. I believe we met certain scheduled days to discuss and learn. The rest of the time we were with our preceptors.
You do get paid but some also offer a stipend or even help you find a place to stay if you are from somewhere outside of the area. Each hospital uses different names so make sure to keep checking their employment opportunities or call HR when spring rolls around.
Some terms:
Internship: May be during school for college credit. Or may be for new graduates.
Externship: May be during school or in the summer. Usually nursing students before their last semester or year.
Nurse Residency: I see this as a program used for new graduates and sometimes experienced nurses that are going to be starting out in a new clinical area.
Other examples: The Mayo Clinic calls it "Summer III" and other places have their own titles.
The process:
I applied to three different internships. First there was the application; all of mine were online. Then the interview. And lastly, the offer or rejection. (I am doing this from memory; it's been 5 years.) ALWAYS CARRY YOUR RESUME!!!
Then I was selected to interview at all three hospitals...fun. Hospitals are very into behavioral interviewing, so please check out the links below and look it up!!! They basically give you a scenario and want you to respond with what o would do in that situation.
At all three you had brief interview with different areas I was interested in. 1.) One place had it set up where you speak with HR then interview with 2 or 3 nurse managers and wait to hear back. 2.) Another place (CHOP: Children's Hospital of Philadelphia) had you come in (they had people from all over) and spend time in the auditorium learning about the hospital, taking a tour, and sign-up for a few areas where you would like to interview. 3.) Finally, where I worked (my school's medical center) we went and and listened to HR. We made a list of a certain number of areas we wanted to meet with. Then they had nurse managers in various rooms and went to the ones on our list when we could. We had brief interviews and hoped for the best.
Links:
- The Complete Guide to Successful Interviewing for Nursing Student and Alumni by Johns Hopkins University: http://www.son.jhmi.edu/resources/career/center/documents/interview_guide.pdf
- Mastering Behavioral Interviews in Nursing: http://nursinglink.monster.chttp://www.blogger.com/post-edit.g?blogID=3066623067249726963&postID=8421437792852801753om/benefits/articles/3406-mastering-behavioral-interviews-in-nursing
- Nursing Interviews Questions & Answers: http://www.best-job-interview.com/nursing-interview-questions.html
- What is a behavioral interview?: http://careerplanning.about.com/od/jobinterviews/a/beh_int_lng.htm
Reflective Journals:
In nursing school we would have to write reflective journals weekly for clinicals to turn in or post in a discussion thread on Blackboard. For a while it seemed to be just more homework on top of everything else we had to worry about finishing. At some point I finally realized how important it was when classes and clinicals started to come together more.
It helped process how we used what we were learning in class and what we needed to learn. Instead of being involved and wrapped up in the moment, you can now sit back and make sense of everything you saw.
"Why did you do this?" "Why couldn't you do that?" "I can't believe what I saw without vomiting." "I need to read up on this disease."
What can also be helpful is keeping track of types of patients you worked with and what you did. Just remember not to use any identifying information. Then you have an idea of what diseases you may need to read up on more, age groups you have worked with, and skills you have used for when you look for you first nursing job.
Sample:
It helped process how we used what we were learning in class and what we needed to learn. Instead of being involved and wrapped up in the moment, you can now sit back and make sense of everything you saw.
"Why did you do this?" "Why couldn't you do that?" "I can't believe what I saw without vomiting." "I need to read up on this disease."
What can also be helpful is keeping track of types of patients you worked with and what you did. Just remember not to use any identifying information. Then you have an idea of what diseases you may need to read up on more, age groups you have worked with, and skills you have used for when you look for you first nursing job.
Sample:
Tuesday, June 21, 2011
Some Helpful Articles for Job Hunting:
Check out sites like Monster and browse the career center sections.
Check professional organization site career center sections.
HEALTHeCareers Network: Sign up for the very helpful e-mails. http://www.healthecareers.com/5
Clever Ways to Get a Job Using Social Media: http://mashable.com/2011/06/19/get-job-using-social-media/
Looking for more of me? Check out MyNursingLounge!!!
You can check out, subscribe, follow, join, or whatever MyNursingLounge profiles:
Actually, I started out on Facebook with a group, probably around the end of 2006 or beginning of 2007. I started a Twitter account where I am follow helpful nursing tweeters. Also, I subscribed to YouTube where you can check out my profile so you can see the channels I am subscribed to and favorites. Maybe I can eventually upload some of my own content!
- Twitter: @MyNursingLounge
- YouTube: http://www.youtube.com/user/MyNursingLounge
- Facebook Group: The NCLEX is Coming but Nursing School is Sucking the Life Out of Me. http://www.facebook.com/group.php?gid=2225862587
- My Nursing Lounge Facebook Page: http://www.facebook.com/pages/My-Nursing-Lounge/219192898103459
Actually, I started out on Facebook with a group, probably around the end of 2006 or beginning of 2007. I started a Twitter account where I am follow helpful nursing tweeters. Also, I subscribed to YouTube where you can check out my profile so you can see the channels I am subscribed to and favorites. Maybe I can eventually upload some of my own content!
Mobile Resources:
Considering I am addicted to phone applications, I thought I would try to share a list of a few that I have that might be useful to healthcare professionals. I have an iPod Touch but my phone uses Android. Before I had a phone with Palm OS, which has since done away with supporting Epocrates, sadly. I also have a Palm Pilot with several references. Of course, if you are a smart phone user and a nurse, there are a few that everyone should be aware of, such as Epocrates.
I only use the free apps on my phone and iPod, but there are plenty of others you can purchase should you need any. Some of them require you sign up for a free membership, but you get some helpful e-mails from it. There are some that only give you limited free content, like Skyscape, but better than none.
My Phone:
Gmail-Google Docs: Have a Gmail account is great! One great feature, besides my blog, is Google Docs. You can create documents, presentations, and spreadsheets that you can edit. Also, you can upload documents like your Word docs, Power Points, and pdfs (like article) from your computer. Everything you need if in one place, so you can access it anywhere with internet access. You can even share your docs with others and even have the option to let them just view or edit them.
Picture Gallery: One application I use that everyone has is my picture gallery. I have a separate folder in my phone gallery for medical pictures. I save algorithms, various charts like for insulin types, lab values and anything I can find. Plus, you don't need internet access to use. You could also sync pictures with your computer using Google's Photo feature.
PDFs: Similar to using the gallery, I also download pdf files for my phone.You can search within the documents and access them even when the web is not available as well.
Bookmarks: I am also obsessed with bookmarks on my mobile web browser. You can bookmark sites for just about anything and when you need it, just search for some keywords. It's also great when websites have their own mobile version so it is even easier to access information. You can also save some books on Google that are free to read; even exerts can be useful.
Remember: You can not always trust the content in all of the applications available, just like you can't trust everything you find on the internet.
I only use the free apps on my phone and iPod, but there are plenty of others you can purchase should you need any. Some of them require you sign up for a free membership, but you get some helpful e-mails from it. There are some that only give you limited free content, like Skyscape, but better than none.
My Phone:
Gmail-Google Docs: Have a Gmail account is great! One great feature, besides my blog, is Google Docs. You can create documents, presentations, and spreadsheets that you can edit. Also, you can upload documents like your Word docs, Power Points, and pdfs (like article) from your computer. Everything you need if in one place, so you can access it anywhere with internet access. You can even share your docs with others and even have the option to let them just view or edit them.
Picture Gallery: One application I use that everyone has is my picture gallery. I have a separate folder in my phone gallery for medical pictures. I save algorithms, various charts like for insulin types, lab values and anything I can find. Plus, you don't need internet access to use. You could also sync pictures with your computer using Google's Photo feature.
PDFs: Similar to using the gallery, I also download pdf files for my phone.You can search within the documents and access them even when the web is not available as well.
Bookmarks: I am also obsessed with bookmarks on my mobile web browser. You can bookmark sites for just about anything and when you need it, just search for some keywords. It's also great when websites have their own mobile version so it is even easier to access information. You can also save some books on Google that are free to read; even exerts can be useful.
Remember: You can not always trust the content in all of the applications available, just like you can't trust everything you find on the internet.
Thursday, June 16, 2011
Helpful Blogs!
I am trying to start a list of helpful nursing blogs such as I did for my other nursing resources that began in 2006. I am trying to "follow" any I can with my blog, so you can check those out too.
YouTube:
YouTube is also not a bad place to check out videos and subscribe to channels. I am actually starting a user account where I'll subscribe to some useful channels. Please visit me at MyNursingLounge!!!
This is a work in progress, so please keep checking back.
List of Nursing Blog Lists:
Nursing Student Blogs:
New Grad Nursing Blogs:
Nursing Blogs:
Nurse Practitioner Blogs:
Other Fun Nursing Blogs:
YouTube:
YouTube is also not a bad place to check out videos and subscribe to channels. I am actually starting a user account where I'll subscribe to some useful channels. Please visit me at MyNursingLounge!!!
This is a work in progress, so please keep checking back.
List of Nursing Blog Lists:
- Top 25 Nursing Blogs (By the Numbers): http://noedb.org/library/features/top-25-nursing-blogs-by-the-numbers
- 50 Best Nursing Blogs You Aren't Reading Yet: http://www.mastersofnursing.org/50-best-nursing-blogs-you-arent-reading-yet.html
- The Nursing Site Blog: http://www.thenursingsiteblog.com/
Nursing Student Blogs:
New Grad Nursing Blogs:
Nursing Blogs:
- Nurse Connect: https://www.nurseconnect.com/Community/Blogs.aspx
- Advance Healthcare POV: http://community.advanceweb.com/bloggroups/22/home.aspx
Nurse Practitioner Blogs:
- A Nurse Practitioner's View: http://npview.blogspot.com/
Other Fun Nursing Blogs:
Tuesday, June 14, 2011
Resumes, CVs,Cover Letters, and losing my mind.
Resume:
I like the About.com's Career Planning definition of resume: "A resume is a written document that lists your work experience, skills, and educational background. It is used as a marketing tool for job seekers". Employers spend an average of 10 seconds reviewing a resume so keep it short and sweet. I know there is "resume food" but it is just so much information to pile into 1-2 pages.
CV/Curriculum Vitae:
You also have something called a CV or curriculum vitae. This is a bit more detailed than a resume. It may include your publications, research, and some more accomplishments. It is usually used when applying for academic or research positions.
Cover Letter:
A cover letter may accompany your resume and highlights some of the skills that better qualify you for that position. This gives you a chance to stand out. Every time you submit a cover letter, you need to tailor it to fit that particular position you are applying for.
Resources:
There are more than enough resources available on the internet to guide you. Try to use a template specific to your profession. Just remember to use more than one. College website career centers are always helpful too. Job sites like monster.com and careerbuilder.com also have pages. Don't forget to check out professional organization websites. Other sites more specific to healthcare like healthcareers.com also have some great articles and information.
Finding a job:
Online: So many jobs these days have online applications so it is a challenge making a first impression on "paper" or the computer so work on your resume and cover letters. Use your cover letter as your chance to make a good first impression and stand out.
The search: Searching for jobs is overwhelming. You can narrow down your search criteria, but you still have to read all of the descriptions to see you would even meet the qualifications. Sign up for e-mail notifications if possible. Remember to check professional organization and specialty websites, like the American Nurses Association, for opportunities too. Join a job website like monster.com or careerbuilder.com. Begin by applying to jobs that you are interested in and not everything all at once; some sites do have limits too.
Networking: Attend events that will give you a chance to meet people. Talk to former employers and co-workers that might know someone. Join a social networking site like Linked In. It's also great to attend conferences and maybe meet people, and if you are a student you may get in free or get a discount. Check out this article: 5 Clever Ways to Get a Job Using Social Media.
Career fairs: You could also attend career fairs and meet some recruiters and/or managers in person and make a lasting impression. Always have copies of your resume readily available. Advance for Nurses hosts some online career events as well.
Follow-up: They have lots of applications. If you don't hear back, why not give them a call? Show them you are interested, but don't bug them too much. Some organization sites let you check the status of your application online too. I have been told in the past to call if you do not hear anything in two weeks, but I have also been told that they will only contact you if they are interested in you.
Always do your homework prior to your interview:
Do your homework. Do not go into an interview without researching the company you are interviewing with. There is a chance they will ask you what you know about the organization and you should always come prepared with information and also any questions you might have. Review their website and you may also look on hospital ratings websites, for example, for information on number of beds and accreditation. For example, I always like to know about the orientation process. Be prepared with questions ahead of time so they know you are interested. Plus, both of you know what to expect from each other. Be enthusiastic!
Know your background information from your former schools and employers. For example, I have been asked about the number beds in both the hospital and the unit where I have worked. Now I have index cards with that information that I can always refer to.
Communication etiquette:
You most likely will have contact via telephone, e-mail, or in person. Always be professional and use your manners. Plus, always use spell check and check your grammar. Do not use abbreviations like you would in a text message or posting on someone's wall. If you leave a voicemail, be professional and include briefly why you are calling and all of your callback information clearly.
Be careful what you post:
Social networking is everywhere. Even our moms are on Facebook now.
My opinions:
To me, looking for a job is pretty much like applying to college. Prior to applying, you research the school and decide if it would be a good fit for you; do your research on your potential employers too. You have the application like everyone else. In school you might have been an "over-achiever" with your extracurricular activities. You have a chance to include some of your accomplishments in your resume too, such as memberships, community service, and certifications. You have a transcript and references like everyone else. Some resume templates give you the option of including your gpa too. And you have a personal essay, which would be your cover letter in the job world, like everyone else. Your personal essay is what gives you the chance to stand out and show them a little bit of who you are and what you have to offer the school.
I just want to say, in my experience, recruiters are like the gate keepers. They see if your skills and experience meet the required job qualifications for the position you have applied for, then if you pass they forward your application to the hiring manager. I believe it is really helpful if the recruiter is a health care professional. Sometimes it really is who you know.
I like the About.com's Career Planning definition of resume: "A resume is a written document that lists your work experience, skills, and educational background. It is used as a marketing tool for job seekers". Employers spend an average of 10 seconds reviewing a resume so keep it short and sweet. I know there is "resume food" but it is just so much information to pile into 1-2 pages.
CV/Curriculum Vitae:
You also have something called a CV or curriculum vitae. This is a bit more detailed than a resume. It may include your publications, research, and some more accomplishments. It is usually used when applying for academic or research positions.
Cover Letter:
A cover letter may accompany your resume and highlights some of the skills that better qualify you for that position. This gives you a chance to stand out. Every time you submit a cover letter, you need to tailor it to fit that particular position you are applying for.
Resources:
There are more than enough resources available on the internet to guide you. Try to use a template specific to your profession. Just remember to use more than one. College website career centers are always helpful too. Job sites like monster.com and careerbuilder.com also have pages. Don't forget to check out professional organization websites. Other sites more specific to healthcare like healthcareers.com also have some great articles and information.
Finding a job:
Online: So many jobs these days have online applications so it is a challenge making a first impression on "paper" or the computer so work on your resume and cover letters. Use your cover letter as your chance to make a good first impression and stand out.
The search: Searching for jobs is overwhelming. You can narrow down your search criteria, but you still have to read all of the descriptions to see you would even meet the qualifications. Sign up for e-mail notifications if possible. Remember to check professional organization and specialty websites, like the American Nurses Association, for opportunities too. Join a job website like monster.com or careerbuilder.com. Begin by applying to jobs that you are interested in and not everything all at once; some sites do have limits too.
Networking: Attend events that will give you a chance to meet people. Talk to former employers and co-workers that might know someone. Join a social networking site like Linked In. It's also great to attend conferences and maybe meet people, and if you are a student you may get in free or get a discount. Check out this article: 5 Clever Ways to Get a Job Using Social Media.
Career fairs: You could also attend career fairs and meet some recruiters and/or managers in person and make a lasting impression. Always have copies of your resume readily available. Advance for Nurses hosts some online career events as well.
Follow-up: They have lots of applications. If you don't hear back, why not give them a call? Show them you are interested, but don't bug them too much. Some organization sites let you check the status of your application online too. I have been told in the past to call if you do not hear anything in two weeks, but I have also been told that they will only contact you if they are interested in you.
Always do your homework prior to your interview:
Do your homework. Do not go into an interview without researching the company you are interviewing with. There is a chance they will ask you what you know about the organization and you should always come prepared with information and also any questions you might have. Review their website and you may also look on hospital ratings websites, for example, for information on number of beds and accreditation. For example, I always like to know about the orientation process. Be prepared with questions ahead of time so they know you are interested. Plus, both of you know what to expect from each other. Be enthusiastic!
Know your background information from your former schools and employers. For example, I have been asked about the number beds in both the hospital and the unit where I have worked. Now I have index cards with that information that I can always refer to.
Communication etiquette:
You most likely will have contact via telephone, e-mail, or in person. Always be professional and use your manners. Plus, always use spell check and check your grammar. Do not use abbreviations like you would in a text message or posting on someone's wall. If you leave a voicemail, be professional and include briefly why you are calling and all of your callback information clearly.
Be careful what you post:
Social networking is everywhere. Even our moms are on Facebook now.
My opinions:
To me, looking for a job is pretty much like applying to college. Prior to applying, you research the school and decide if it would be a good fit for you; do your research on your potential employers too. You have the application like everyone else. In school you might have been an "over-achiever" with your extracurricular activities. You have a chance to include some of your accomplishments in your resume too, such as memberships, community service, and certifications. You have a transcript and references like everyone else. Some resume templates give you the option of including your gpa too. And you have a personal essay, which would be your cover letter in the job world, like everyone else. Your personal essay is what gives you the chance to stand out and show them a little bit of who you are and what you have to offer the school.
I just want to say, in my experience, recruiters are like the gate keepers. They see if your skills and experience meet the required job qualifications for the position you have applied for, then if you pass they forward your application to the hiring manager. I believe it is really helpful if the recruiter is a health care professional. Sometimes it really is who you know.
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