The Nurse Practitioner's Place

RN Nursing Graduation

2013-05-04T11:29:00.000-04:00

Last night was my soon to be daughter-in-laws's RN pinning ceremony. It's hard to believe that it was all the way back in 2001 that I received mine. I was so proud and nervous. I had no clue what my career and life would be like as a nurse and now as a nurse practitioner.

I have formed several friendships over the years as a nurse and a nurse practitioner blogger. Surprisingly enough, most have been through the blogosphere. I have always loved surfing through my nursing buddy's blogs and seeing how their careers and lives have been going. Unfortunately, for me, blogging has been put on the back burner for far too long.

So.... I will be making a concerted effort to blog more often. It will still be random, but more often. I also hope to have more time to read and comment more on your blogs. Hopefully, I will start getting more REAL comments instead of all the junk spam that I've gotten in the last few months.

Here I come! Watch for my comments and come back here and leave some again and let's see if we can get the blog roll started again!

Nurse Practitioners Walk The Line

2013-03-22T20:34:00.001-04:00

I often find myself wishing for the good old days when your family doctor was truly a part of your community. Back in the prairie days, docs and teachers would rotate staying in family's homes and often ate dinner with people in their community. People appreciated their care and the medical provider had a vested interest in helping people. Too often, many health care providers don't really know anything about their patients and aspects that influence the decisions they make in life. We are such a litigious society and providers are all about the numbers game. I have socialized with patients outside of taking care of them at work. (My husband and I have gone to the movies with a patient and her daughter, and they have come to our home for dinner) That doesn't mean that I would ever do something for them extraordinarily or outside what the normal care would entail. They know that once I leave work, I don't cross that line again until I clock in the next morning. You have to make hard fast boundaries such as I NEVER write any controls for anyone that I have ever seen outside work. I don't show favoritism in scheduling or callbacks. I don't discuss their healthcare outside of the office. If they need a script for something, they have to see me in the office and it's all documented in their chart.
I work in a very small community and every day people ask me how so and so is doing or that so and so sent me to see you because you take such great care of them and you really listen to their concerns. I find it stupid that I cannot officially acknowledge that fact, due to privacy laws, that I do take care of people here. It's not like they don't know already. They just passed each other in the waiting room for God's sake. Whatever happened to the good old days when people proudly proclaimed that you were their healthcare provider and you didn't have to look around to see if anyone else heard them? I have constantly remind them that if they try to ask me a medical question about their care outside the office, that they are officially breaking their own privacy because it could be overheard by others at the restaurant that I was eating lunch at.
What you do think about it?

Top 25 Websites For Nurse Practitioners & Nurse Practitioner Students

2013-03-15T20:22:00.001-04:00

I love when I find my blog listed as one of the top NP blogs on the net! I am really trying hard to get back to blogging and finding my voice again. The office has been really busy and we still haven't found another MD to work in our small town. I'm getting tired but am hanging on! Enjoy looking through their links and I will be doing it too so I can find some more great NPs to follow myself!

Top 25 Websites For Nurse Practitioners & Nurse Practitioner Students

Speaking about Cold and Flu Differences On The Radio

2013-03-04T22:46:00.000-05:00

Hello to all who are reading my Nurse Practitioner blog! I had a busy week at the office and helping my husband on The Retro Club Show on 96.5 The Jet Saturdays from 1-3. To listen, go to the Retro Replay tab and click on the links. I've been enjoying myself and hope to get some feedback on the website from listeners. I am trying to be totally conversational like I am in the office.

What is your style in the office? Most NPs are interested in the entire patient. This makes me run behind in the office. I guess as long as I'm worth the wait, I will continue to do it. I tell my patients to tap their watch at the beginning of the visit to signal if they are in a particular hurry so I will know.

Medicaid is opening up for the next three years, according to Governor Rick Scott. What does this mean? I'm not really sure, but I hope that it makes it easier to qualify for older patients who aren't old enough for Medicare and can't afford insurance. We will see! I do know that it will make for several more patients in the office that I work in and we need help! Can't seem to find a doctor who wants to work in a small rural town.

Till then, I will keep on working as hard as I can to take care of them all. Cheers!

Geez At The Spam!

2013-02-20T21:02:00.001-05:00

Great Gatsby! I turn my back for a second and my comment box is FULL of spam comments! Doesn't anyone leave legitimate comments anymore? It seems like most of coming from overseas too. Ugh!

Since I haven't personally updated about me in a while, here goes....

I am to be a Noni again soon and it's a girl! My daughter has picked out Virginia Lynn as the name so far. She's due on her brother's birthday.

Work is a crazy as ever and we are still looking for a physician to join the practice but haven't found any that want to work in a small rural town. Since we are one of two offices that are left, we are getting swamped with new patients. I think that my personal panel is full but we keep accepting more and more. This makes for a crankier me and a more tired me. But, I will prevail.

The hubby is starting a new radio show on Saturdays from 1-3 on 96.5 The Jet called The Retro Club Show and it will include a health tip segment hosted by me and I'm looking forward to it. Feel free to pop on over sometime and check it out.

If you enjoy this blog, please leave a real comment and not some random bullshit link filled spam. Thank you!

Certified Medical Assistants Calling Themselves Nurses

2013-01-15T18:32:00.000-05:00

I was recently seeing a patient in my office and a family member was in during the visit and was asking some very interesting questions. Since she was knowledgeable, I asked if she was in the medical field somewhere. She said that she was a nurse. I asked her what type of nurse she was and she told me that she was a CMA (certified medical assistant). "Ah, I said, you aren't actually a nurse," and I told her to be very careful about giving the impression that she was one without an actual degree as such. I explained, in a nice way, that it is illegal to portray yourself as a nurse when you are not and that you can get into trouble. " As clearly stated on emedicalassistants.com" , a medical assistant calling herself a nurse is not just confusing patients but also committing a crime." I told her it was the same as if I told people that I was a medical doctor rather than a Nurse Practitioner and that I could lose my license.

In fact, it's a pretty hot topic on some nursing forums. Below is a response to the same question by an LPN.
"It's very simple, really. If you are not a licensed nurse--you are not a nurse. The title carries with it a certain level of responsibility and education (not time, but content). A CMA/MA should identify themselves appropriately, and then docs and patients will catch on. I drew blood and ran lab tests but never called myself the lab technician. Same with taking xrays. I am a nurse because I went to school to be a nurse and took my boards and passed, earning my title of RN or Nurse. I have been taught the nursing process as well as disease process. I can function in a doctor's office or a hospital. The same cannot be said for a CMA/MA. CMAs/MAs should be proud of what they do and also be protecting their title as they earned it. Badges should include title so the public is aware of who is caring for them."

Below is the legal definition for this issue:

Title "Nurse" Protection
Restricting use of the title "nurse" to only those individuals who have fulfilled the requirements for licensure as outlined in each state's nurse practice act is a protection for the public against unethical, unscrupulous, and incompetent practitioners. Nurse practice acts describe entry level qualifications such as education, practice standards and code of conduct for continued privilege to practice nursing. Limiting use of the title "nurse" to only those who have satisfied the licensure requirements ensures the protection the public deserves.

At least 37 states are known to have language in their Nurse Practice Act; either explicit in restricting use of the title "nurse" to only those who are licensed or implicit language restricting use of any words implying the individual is a licensed nurse.....
AR, AZ, CA, CO, DE, FL, GA, HI, ID, IL, KS, KY, MD, MN, MS, MO, MT, NE, NV, NM, NY, NC, ND, OK, OR, RI, SC, SD, TN, TX, UT, VA, VT, WA, WV, WI, WY

Standing Guard on the Front Line of your Patient’s Health

2012-12-19T23:33:00.000-05:00

Standing Guard on the Front Line of your Patient’s Health
Not only does a nurse practitioner play a vital role into the wellness of their patients, but also their passion for the field keeps them abreast on the latest and greatest resources that their patients can benefit from. When patients begin the search for a family care physician, knowing the candidates, their personalities, reputations, backgrounds and the amenities and services provided by their hospitals will help nurse practitioners pair patients with the perfect match.
Top of the Class May Be Bottom of the Barrel
Finding a great physician is not as easy as shopping for a new TV with surround sound—you just can’t sit in front of them for 20 seconds and determine if they are a winner. In an article by The New York Times, finding Dr. Right can be a hectic journey pitted with disappointment. The author states that there are very few good quality measures in place to asses individual doctors so that consumers can do research on what they hope to find in a physician they feel comfortably towards. Some patients may want a doctor who was at the top of his graduating class, while others want someone with rave bedside manner reviews. Some patients even look for a doctor who actively publishes and attends seminars as part of his/her continuing education. Knowing the various physicians in your industry will not only be an asset to them, but you will be helping your patients in finding the right doctor by avoiding many hurdles.
Tips for Promoting and Pairing
Of course it goes without saying that you would recommend a patient-physician pairing based on the patient’s individual chart and family life. These days, women are seeking out doctors who are affiliated with a women’s wellness center. Whether they are about to start a family, or they need emotional / psychological health care, women’s wellness centers are becoming increasingly popular. Consider these treatment types and how they play a role into your patient:

·      Fertility treatment

·      Hormone replacement therapy

·      Weight loss

·      Chronic Fatigue treatment

·      Well Woman exams and pap smears

·      Emotional and psychological care

·      Nutrition

Female patients utilize almost all of these preventative and re-occurring therapies. Knowing the doctors and their reputations who offer these services will help you pair your patient to a doctor as if you were selecting the perfect wine to go with that wedge of brie.

Build Better Relationships
If you are truly fortunate, your workplace will have that family-orientated feel to it where doctors, nurse practitioners, techs and the nursing staff all work together in harmony while providing the best care to their patients. Unfortunately, this is a rarity, as the hierarchal pyramid of entitlement still stands. However, this atmosphere does exist in some places. You can help strengthen ties with your colleagues by taking the time to learn about them and what their patients are saying. When you refer a patient to a doctor, not only are you strengthening that relationship with the patient, you are reinforcing the links that bind you to the physician. It doesn’t take a lot of time to read up on the inner workings of your health care institute, and know the medical roster. By taking the time to do some research, you are standing even firmer on the front line of your patient’s health.
Image source: http://alghad-ls.ly/Images/Nurses.jpg

Signs and Symptoms Of Teen Drug Use

2012-12-19T23:21:00.000-05:00

Unfortunately, I see signs and symptoms of teen drug use in Family practice. It causes so many repercussions that can last a lifetime. One of the biggest ones is the loss of trust between a child and a parent. Once it is figured out that your child is using drugs, you will have a serious issue with being able to trust that person again. Even if they want to start over, it will be difficult for you to tell if they really mean it. This can cause hard feelings on both parts. It's important that you use a professional to help you through the situation. I often tell my patients that it is a two way street and that it will be a long hard road to recover from. But..it CAN be done!
Via: Newport Academy

CT Scan During First Trimester Of Pregnancy

2012-11-16T22:15:00.001-05:00

I just found out that my daughter is 4 weeks pregnant and had a CT scan of her spine (upper and lower) about a week or so ago. Supposedly, she tested negative for pregnancy at the hospital. A few days later she took a home test and it was positive. I told her to come to my office and that I would do another urine test to confirm and it was positive.

She is spotting a little over the last few days and went to the hospital again to make sure that she was till pregnant and they told her that she is approximately 4 weeks and is postive. Now it's a waiting game. I am afraid of the damage that this child may have from the radiation it received at such an early state in the process.

I am feeling a little guilty about this, but I hope that nature takes it course and her body rids itself of the baby if it's severely damaged. She's a great person, but easily frustrated with her oldest who will be five in April. I don't think she's a bad Mom, but I don't think she can handle the resonsibility of a baby who is disabled. We would love the baby no matter what of course and she wouldn't want to have an abortion. (which is a whole other touchy subject!)

I am hoping that others have had this situation with a good outcome. Anyone have any stories good or bad? Let me know...

What I Have Learned About Palliative Care

2012-11-07T20:01:00.003-05:00

The following is a guest post: I have not personally worked in Hospice or Palliative care as a nurse practitioner but I have worked with those types of patients in the hospital setting. I was one of the few nurses that seemed to be able to handle it. It is very difficult to deal with the amount of grief and anger that comes from having a terminal illness.

WHAT I HAVE LEARNED ABOUT PALLIATIVE CAREWhen I decided to be a nurse years ago, it wasn’t based on some romantic preconception of what the job entailed. My maternal grandmother was ill for as long as I could remember. She suffered with Alzheimer's and by the time I was 16, she began experiencing severe and crippling dementia. If you've never seen or experienced either of these things first had, please consider yourself lucky and blessed. When you have to watch the person you love drift away from reality and from themselves, into a tortured mental state, the emotional pain can be truly overwhelming. I took care of her in the last year of her life, and it was this experience that found me choosing nursing as a career. The specific kind of nursing that I specialized in is called Palliative Nursing.

Palliative nursing or palliative care, is defined by care that is given to patients that are in extreme and constant distress and pain. While this may seem similar to hospice, palliative care is not limited to patients who are considered terminal. In fact, many patients who require palliative care, actually recover from their illnesses and conditions. Why is this care considered a specialty? Because patients who are in constant, extreme, debilitating and sometimes untreatable pain, need more than just medicine. They need more than just drugs to get through their symptoms, because they can affect not only their bodies, but their minds as well. Palliative care has taught me a lot about the medical industry as a whole, and has taught me about my capacity to care as well. Not all nurses can be palliative nurses, in the same way that not all patients who experience pain, require palliative treatment. Here are a couple things I've learnt in my time in this field:

While we nurses are not doctors, we still have to educate ourselves on the latest medicines and alternative treatments that are out there. We can't very well go diagnosing and prescribing things to our patients, but we will be able to have more knowledgeable discussions with them and their doctors. For example, have you ever heard of a product called Limbex? If not, you may want to do some research, and find out from your supervising doctors if it's something that could be integrated into a relevant patient's regimen.
Palliative nursing offers treatment not only to the patients, but to their families as well. This form of nursing embodies both the medical, and spiritual care that people need to overcome great pain and distress. Their families may not be physically afflicted, but they are certainly emotionally afflicted. We have to be able to communicate without being condescending, and always relay care and calm when dealing with family members.

I hope I've given you enough insight and perspective to give palliative nursing a first if not, another look. As I've mentioned, it isn't for everyone, but you never know when someone in your life, or you yourself may need it. Everyone needs a caring hand sometime.

PIC TITLE: WHAT I HAVE LEARNED ABOUT PALLIATIVE CARE PHOTO
PIC SOURCE: mdanderson.org

A Place For Nurses

2012-10-01T19:07:00.001-04:00

A PLACE FOR NURSES

The charge of the nurse is to keep patients comfortable, healthy and safe and many will tell you that it is an exciting albeit exhausting occupation to get into. Nurses are the right hands of the doctors who save and change lives every day with medical expertise but they also impart their own medical knowledge and supplement the instructions that doctors give to patients. To be a nurse not only requires a level of technical acumen and accreditation but your personality has to be conducive to healing, teaching, explaining and care. Long after your doctor moves onto the next patient, your nurse is the one who will attend to your care and administer the medicines you need to get better. Where would we be without nurses?

Nursing was traditionally a female field but over the years it has embraced and welcomed successful male nursing practitioners to the fold, essentially making it a unisex field. Has this impacted the industry at all? Yes - there are now more nurses to go around! While good doctors are always in high demand, qualified and enthusiastic nurses are globally sought after to lend their expertise. If you were to do an online search for careers in nursing you would see that the job market is never saturated. Nurses aren't limited to working with doctors in hospitals or at their private practices. The role of the nurse is a flexible one and nurses adapt to whatever situation needs them. There are several places that constantly need nurses and we've shared a few of them with you below:

1. Rehabilitation centers:
Nurses are needed in drug treatment centers and alcohol rehabilitation clinics constantly because of the level of attention that is required to deal with patients. Those who are substance abusers in treatment facilities often have an askew perception of reality, may be hypersexual, violent and even suicidal and can pose serious harm to themselves, doctors and fellow addicts. Nurses do more than just administer healing drugs to these patients but they also monitor progress in real time while keeping the peace. Sometimes a nurse has to take the role of a bouncer to keep patients physically in line during treatment. They are often in harm's way themselves but they still put patient safety first.

1. Radiology centers:
Some nurses are required to provide more than just care and compassion and in fact they need to have specialized training and education to work with life saving technologies. One such niche technical nursing field is that of radiology. Radiology nurses work well with people (especially children) and can help them remain calm while being scanned by large and often scary sounding/looking machines. People who require diagnostic testing such as MRIs and ultrasounds rely on the nurses often to explain the process and to do the actual testing. Sometimes doctors only act in a knowledgeable but supervisory capacity, while the nurses do the leg work.

No matter where your strengths lie technically, there is a nursing program that fits your skills and interest. We've provided two examples but there are literally hundreds of other categories of nursing that you can contribute to.

Psychotherapy: Life Enhancing Treatment for Cancer Patients

2012-09-23T13:58:00.002-04:00

This following is a guest post submitted to me. Enjoy!

If someone has just been diagnosed with cancer, chances are their life has been on a whirlwind of emotions ranging from concern, fear, panic and hope. Psychotherapy is a common treatments that can help these cancer patients regain some control in their lives. By teaching them healthy coping skills, psychotherapy helps patients respond to their cancer challenges with strength and courage.

What is Psychotherapy? According to the Mayo Foundation for Medical Education and Research, psychotherapy is a general term for addressing mental or emotional health issues. During psychotherapy, patients talk with a psychologist or other health professional. Therapy sessions enable them to learn more about their cancer as well as their thoughts, feelings, moods and behaviors toward the disease. Psychotherapy is known by many different names: counseling, therapy, talk therapy, psychosocial therapy and psychotherapeutic treatment. It offers several different approaches to changing the way patients think, feel and behave. The right approach depends on the individual situation.

Benefits of Psychotherapy - Psychotherapy cannot cure cancerous tumors, nor can it replace conventional medical treatments. The American Cancer Society says no research can demonstrate that it improves the cancer survival rate. Nevertheless, psychotherapy can be very helpful for treating mental health problems whether someone is facing malignant mesothelioma or treatable skin cancer. The most important benefit for cancer patients is the ability of psychotherapy to improve their quality of life. Studies have shown it to be highly effective for reducing the anxiety, depression and fear that often accompanies physical cancer symptoms. Psychotherapy teaches patients to cope with their emotions and other changes that occur along the cancer journey. It helps them find the inner strength they need to fight their disease and enjoy a fuller life. This is important whether a patient is undergoing skin cancer treatments or palliative care for advanced mesothelioma.

Psychotherapy Approaches- Many patients seek individual therapy for the one-on-one relationship they develop with a therapist. Others prefer couples or family therapy, which helps everyone affected by cancer. Group therapy allows several patients to meet together to discuss their common experiences and concerns. It is important to note that psychotherapy groups are not self-help support groups. Professional therapists who guide the discussions and teach coping skills manage them. However, group therapy is like a support group in that it provides help and encouragement for a close group of patients as they learn to manage their individual cancer experiences.

Psychotherapy Risks - According to the Mayo Clinic, there is very little risk involved in psychotherapy. The treatment can make some patients uncomfortable at times since it often explores painful emotions. However, the coping skills taught in psychotherapy can help patients manage their cancer as well as other situations that may arise in the future. Although psychotherapy cannot cure cancer, it can potentially bring a patient some piece of mind during a trying time. If talking to a specialist can ease some worry whether it may be during your mesothelioma treatment, breast cancer diagnosis or even while you are battling your leukemia chemo, why not give it a shot? Talk to someone who not only cares but can help you and keep on fighting.

NPs Saves Lives Worst Habit EVER!

2012-09-23T13:28:00.001-04:00

I am one of the worse procrastinators EVER. In school, I always waited until a deadline to finish a project because I worked better under pressure. It has also followed me into professional practice. I wait until the pile is almost totally overwhelming before I finally tackle it. This ends up in even more stress than if I had just sat down and "did the deed" in the first place.

I asked myself why I do this and there are two main reasons:

1. I would rather talk to my patients and educate them about their disease processes. They, in turn, enjoy coming to see me since they feel that they are more than a number. While this is a great thing, it's causing me to see more and more patients which is backfiring on me. (Causing me MORE paperwork).

2. I HATE PAPERWORK! It's the boon of my existence. In fact, blogging right now is keeping me from doing some paperwork right now. I swear that I think that it multiplies every time I leave my desk. Don't get me wrong. My nurses are the bomb and keep this process moving right along but I know that they are tired too.

How to fix this problem? I stay at work after hours where it is quiet and no Facebook capability per company policy for about an hour each day. I STILL find myself having to work on the weekends finishing the details. My co-worker seems to be able to get her notes done, but we practice differently. She doesn't talk to her patients as much. I have figured out that my chattiness is never going away so I have to resolve to thee ever growing piles.

What do you do to help speed up your processes? Chime in!

Nurse Practitioner Burnout

2012-09-10T20:45:00.002-04:00

How crispy am I? Let me count the ways.

Don't get me wrong. I do really love being a nurse practitioner. I just don't love the paperwork and the tedious part of my job. Most people say that I should just suck it up because I knew what I was getting into when I signed up for my job. True, to a point. I understand the awesome responsibility of my position and the stressors that would ensue. I would just love to have a way to make my job less tedious and more streamlined. Unfortunately, I am not the owner of my practice so I have to follow the herd and make sure that all of the boxes are checked and t's are crossed. We have to not only make sure that we are giving great care but also great education. All of this in your allotted 15 minutes. Actually, the nurse gets the first 5-10 so I get what's left to determine why your abdomen is painful (which can be very time consuming). Lunch usually consists of me stuffing in a frozen dinner of some kind while I chart or try to make phone calls that I can't get to during the day. If I make myself actually go to lunch, I feel like the pile grows like the Gremlins and I will never get out from underneath. The patients bang on the front door pretty much the entire lunch break time and get aggravated that we even close for lunch. There are great things about being a NP too. The ahh ha! moment when a patient understands how a disease process can effect their lives. The look of determination when a patient finally decides to quit smoking after all of the pep talks. The times that you can get a child to take their medicine when no one else can. Watching a teenager grow up into a young adult. Hearing a child say that they want to be just like me when they grow up. Seeing the light come back on after watching the despair almost cause them to commit suicide. The ability to tell a patient that they don't have cancer. These are the things that I live for and put up with the crappy side of medicine.

Paralysed man in tears after losing right-to-die ruling

2012-08-18T20:10:00.001-04:00

Paralysed man in tears after losing right-to-die ruling: Tony Nicklinson sobbed in his wheelchair after losing a High Court fight for the legal right to end his life. Deborah Gembara reports.

There are many different opinions regarding assisted suicide. Some say that it is against their religion because suicides cannot go to heaven. Some say that there is a slippery slope of once we start allowing people to kill themselves, at what point do we draw the line? If people can choose to end their lives due to an end stage diseases, should they be able to kill themselves due to severe depressions once it's determined that no medicines work?

Our oath is to do no harm. We are programed to save people. But what if they don't want to hang around trapped in a state that leaves them dependent on machinery to live. I believe that it's not really living. I know that I would not want to be trapped unable to interact with others, unable to put my arms around my loved ones, unable to express my wishes etc.

I have been asked by past patients "why can we take our beloved animals to the vet and have them euthanized, but humans have to suffer?" "Can't you just close the door and put the pillow over my head or give me too much pain medicine and let me out of my misery?" I am sure that I am not the only one who's been approached. I think that some health care providers and nurses have "pacts" with others to help them end it when the time comes or have some suicide plan for themselves if it gets "past the point of acceptability."

What say you?

History of Nurse Practitioners

2012-07-26T22:06:00.001-04:00

Doctor Charged In Neglect Case

2012-07-26T16:14:00.000-04:00

Doctor charged in Ohio teen's malnutrition death

Jul 26, 2012

The doctor of a 14-year-old girl who had cerebral palsy and weighed 28 pounds when she died in southwest Ohio has been charged with failing to report child abuse or neglect in the death.
Montgomery County's prosecutor says Dr. Margaret Edwards was charged Wednesday with three counts of the misdemeanor in juvenile court in Dayton.
The prosecutor says Edwards was Makayla Norman's doctor from July 2010 until the girl's March 1, 2011, death from nutritional and medical neglect complicated by her chronic condition.
Edwards was required to report any abuse, Mathias Heck, Jr., the Montgomery County prosecutor said, according to the Dayton Daily News.
The girl's mother pleaded guilty to involuntary manslaughter and endangering children and was sentenced to nine years in prison. Three nurses have pleaded not guilty in the case and await trial.
"As with the other defendants, the defendant utterly ignored her responsibilities and failed to report the obvious signs of neglect of Makayla," he told the paper.
The Dayton Daily News reported that Makayla weighed 28 pounds at her death and she had open bedsores and she was infested with lice, among other things.
Edwards has declined to comment.

The above story is heartbreaking but there is another issue involved. I have tried to contact child's services myself to report an unfit mother and was told that unless there were signs of physical abuse (burns, bruises, broken bones) that having head lice or being dirty was not a crime. I hope that they documented that they tried to report as it may be their only defense. Children should be taken care of to the maximum ability and beyond. The child was only in the doctor's care for 8 months. How many times did her ever lay eyes on this patient? How many times did the nurses see this patient? The Mother of this child should be the first to be charged and then go down the list. What say you?

We Need Uniform Prescriptive Authority

2012-07-21T20:17:00.000-04:00

Please consider signing this petition in order to help NPs get uniform prescriptive rights. It's difficult to provide the proper care for patients when we can't do our jobs due to restrictions that are not necessary. Thanks for your support!

Change.org|Online Petition Template

Immature Women Having Children

2012-07-08T19:16:00.000-04:00

It's been a while since I've ranted a little so here goes. I have been inundated with young women from the ages of 15-24 that have been popping out children left and right and not having a CLUE on how to take care of them. Before you start wondering, yes I do give birth control options at most young women's visits. I also speak to the young men who come into my office too. Equal opportunity there folks!
The grandparents are pulling out their hair because these young parents are abandoning them for them to raise and sometimes keep them overnight when they aren't too busy running around with the boyfriends or girlfriends. Half don't have jobs and so the grandparents are supplying the diapers, foods and medicines for these kids.
One girl has 5 kids and told her mother that she just likes being pregnant and doesn't like to take care of them. WTF? My head spins and the urge to slap the crap out of them is very difficult to control. The grandparents love these kids so they won't deny their care but it is at a huge risk to their health and sanity. It's pretty sad when I have to give the grandparents Prozac in order for them to cope with the stress of this situation.
The big issue is the fact that these kids are in the middle and are torn between who the parent really is. The Mom shows up when she feels like it and gets angry when the children call Grandma "Mommy". She will keep one or two at the time and never give G-ma a break totally. Often, G-ma gets the call at 1:00 am to come get them because they are getting on her nerves.
It boggles my mind! How to we change this mindset in our young adults? Any suggestions beyond telling the grandparents try to get sole custody because they won't sign them over. Being a shitty parent isn't enough to involve DCF because they kids aren't being beaten, just neglected.
Ready? GO!

Nurse Practitioner Laments The Flood Damage in Columbia and Suwannee Counties

2012-06-29T20:39:00.001-04:00

It's been horrible watching my neighbors sandbag their homes against the Tropical Storm Debby over the last week. Patients here in this area are pretty resilient and are used to flooding near the river. The ones hit the hardest were the ones flooded in areas that never hold standing water. Our home was spared as we are on the higher end of the subdivision. We bought our home right after the season of three back to back hurricanes several years ago. We toured different home sites in our area and it was one of the only ones that remained dry. It was one of the smartest things I learned as a kid. Look hard before buying things because they may not be what they seem.

I also had to miss two days of work due to being able to get to work in any direction. It's the first natural disaster that has forced me to miss work in my career. I have missed a few days here and there due to illnesses. I did have my computer at home so I was able to do some things via that and telephone to my nursing staff. I have an awesome group of people who work with me and keep things running smoothly.

How's your work going?

Top Ways for Nurse Practitioners to Unwind

2012-06-02T01:17:00.001-04:00

This post is written by Erica Moss, who is the community manager for the masters in nursing online program at Georgetown University. She’s also passionate about photography and meeting new people.

"Child Positioner in Black"

As a nurse practitioner, you deal with a tremendous amount of on-the-job stress on a daily basis. To avoid burning out, it's important to find ways to relax and de-stress during your off hours. As tempting as it may be to pour a big glass of wine and veg out in front of the television after an exhausting day at work, engaging in meaningful activities will have a far greater impact on your overall happiness and well-being.

Here are some of the best ways for nurse practitioners to relax, recharge and rejuvenate after a demanding day spent helping others:

● Visit the gym. The thought of exercising after work may seem overwhelming, but exercise is one of the most effective de-stressors. Besides improving your fitness level and stamina, exercise has the added benefit of releasing feel-good endorphins. If vigorous exercise is not your thing, enroll in a relaxing yoga class.

● Listen to a story. Audiobooks offer a great escape from everyday worries. Most libraries offer free digital audiobook downloads. Listening during your commute home will help you leave work issues at work.

● Spend time with pets. The undemanding devotion of animals can really help put a bad day behind you. Many nurse practitioners are animal lovers and find that spending time relaxing with their pets is one of their favorite ways to unwind.

● Give your feet a treat. If you spend long hours on your feet, soak your feet in essential oils or pamper yourself with a foot massage and pedicure.

● Explore your creativity. Art therapy is frequently used in hospitals and clinics to promote emotional and mental well-being. Purchase some inexpensive art or craft supplies and enjoy some creative self-expression!

● Cook a healthy meal. Instead of opting for fast food or something frozen, take a little extra time to prepare a simple meal using fresh ingredients. Enjoy the cooking process and relish the sight and taste of your meal.

● Work in your yard. Digging, planting, watering and tending to plants is a great way to relieve stress. Avoid ruminating about work and focus instead on the warmth of the sun and the task at hand. You'll feel more in harmony with nature and even yourself after spending some time working outdoors.

● Get organized. This may sound like work, but may people find that taking a few hours to get organized is a good way to relieve anxiety. You'll feel more relaxed when your home is in order and will spend less time searching for items that are lost in clutter.

● Get a good night's sleep. Never underestimate the power of sleep. You'll be better prepared for your next shift if you're thoroughly rested. Even if work is piled up at home, relax in a hot bath, then hit the sheets early.

● Don't sweat the small stuff. You can avoid some stress by controlling your focus. Instead of trying to do everything perfectly, take the long view and save your energy for the things that really matter. Recognize that the pressures of your job can be enormous and learn to identify what you can and can't control. When faced with insurmountable challenges, look for ways to get around them instead of trying to blast your way through.

Questions For A Nurse Practitioner

2012-03-15T16:40:00.001-04:00

I recently had a two comments on a previous post by Colin who had a lot of questions for me so I decided to break them up into separate posts. I hope that they help you to make up your mind about becoming a Nurse Practitioner or will help you to understand what we actually do for a living. So here goes!

How long were you on the floor?
I worked on a Med/Surg floor at a local hospital for seven years while I completed my Master's Degree. It was not my first choice while I was studying in nursing school but "decided to do my time" and get some experience before I moved to another type of nursing and got comfortable and stayed.

How helpful was that time in your transition to your current practice?
I feel that my time spent on the hospital floor was invaluable as a background. You cannot trade hands on experience, especially learning how to tell when a patient is not doing well. I am a very visually cued person and often I still describe a patient's condition as "You don't look right to me." I don't really know if it can be truly learned or if it's a natural ability. I would love to hear from other health care providers on this subject!

About how much does malpractice insurance run you? I work for a Federally Qualified Health Care office so I don't pay out of pocket for my malpractice insurance. It's covered under Federal Tort Law. I still practice like it is on my shoulders. I am not infallible and I'm sure that sometime in my practice I will miss a diagnosis and I hope that all of my "catches" make up for it. That's a worry that we all go to sleep with nightly. I don't think that patients realize the amount of second guessing that goes through our minds.

What parts of the job do you find frustrating?
Ahhh! There are a few parts of my practice that frustrate me. One is the ENDLESS amount of paperwork that never seems to end. If a patient is out of work for more than three days, there is FMLA paperwork. Every Workman's Comp visit has a particular form. Since I work in a Federally funded office, there are audits that are taken in order to make sure that their grants are being used appropriately with patient quality indicators such as hypertension and diabetic control. You always feel like you are under the gun as far as time constraints. There are only so many slots that you can put patients into and more keep showing up! They get upset when they have to wait. Cranky patients make the front desk stressed and it feeds down the line. The main thing even after all that is having to do the "drug seeker dance". Not being my own practice makes it hard because I have to play nice to the ones that I know are feeding me a load of crap and won't take no for an answer which pushes me behind. I have just gone into starting the visit by saying outright that I will NOT be writing those meds and let's not waste time from the get go. Of course, in a nice way! Sigh...

Please feel free to leave any comments and I will work on the next set!

Nurse Practitioner Opinion On New Recommendations Regarding Cervical Cancer Screeings

2012-03-15T15:49:00.000-04:00

Update of Previous USPSTF Recommendation

It seems that just about the time that we get patients educated about the recommendations regarding Paps, they change it. When I was younger, it was expected to have the test done on a yearly basis if you were sexually active. You played, you paid! No one likes having the test done of course.
There are some valid points to the new study regarding the fact that we may be more aggressively treating the cervix by doing invasive studies and damaging women's reproductive potential. The time frame is being recommended to push to three year increments for screening if there is no particular history of issues. I am still not quite sure about the recommendation of pushing to 5 years though. I feel that there is a higher risk of missing vulvular cancers if we go that far out, especially in older women. They already feel that once they get beyond the age of 65 the need for an exam is over.

Do you think that insurance companies are pushing this in order to keep from paying out for procedures they feel is unnecessary? What about the women that have aggressive cervical cancer that may have been detected and wasn't? Should we be better safe than sorry? Read the below recommendations and tell me what you think?

This recommendation updates the 2003 USPSTF recommendation on screening for cervical cancer. It differs from the previous recommendation in that it recommends cytology screening every 3 years among women age 21 to 65 years. In addition, this recommendation includes more guidance on the appropriate age ranges and frequency of screening, including a new recommendation that women younger than age 21 years not be screened because the evidence shows no net benefit. The previous recommendation suggested that most of the benefit of screening could be obtained by beginning screening within 3 years of onset of sexual activity or age 21 years (whichever comes first) and screening at least every 3 years. This recommendation reaffirms the previous recommendations against screening in adequately screened women older than age 65 years and in women who have had a total hysterectomy with removal of the cervix. The current recommendation includes new evidence on the comparative test performance of liquid-based versus conventional cytology that indicates no substantial difference in test performance (that is, relative detection or absolute sensitivity or specificity) for detection of CIN2+/CIN3+. It also includes more guidance on the appropriate use of HPV testing in cervical cancer screening, including a new recommendation that women younger than age 30 years not be screened with HPV testing. The USPSTF found new evidence that addressed the gaps identified in the previous recommendation and allowed the USPSTF to recommend HPV testing combined with cytology as an acceptable screening strategy for women age 30 to 65 years who prefer to lengthen their screening interval beyond 3 years.

Nurse Practitioner Radio Interview

2012-03-10T12:45:00.001-05:00

I had a great time doing the interview at 96.5 The Jet this morning. Here's the link to the show so you can listen and leave me a comment. One thing I did notice is the amount of times I say "um". It's an annoying habit but overall, it wasn't a bad process. We need to look for different sources to bring out issues to the forefront. I will be interested in your feedback and questions or suggestions. Enjoy!