Friday, November 3, 2017

The Nurse Practitioner Will See You Now


In case you haven’t noticed, health care is changing.

By 2019 will lead to 25 million more primary care visits across the country. That’s nothing compared to the 75 million baby boomers aging into advanced care, and the 50 million among them who will need to be treated for multiple chronic conditions.

Altogether, as a nation, we face a seemingly incalculable sum of provider sweat equity hours needed to care for our people, and how we accomplish that depends on how we evolve our health care system. One major shift has been the role of nurse practitioners in the quest for more affordable, high quality, patient-centered care at a time when the nation is searching for an antidote to today’s health care challenges.

Nurse practitioners have been around for more than 50 years, and in that time, their role has evolved tremendously to meet the demands of our fluctuating health care system. Now nurse practitioners are embracing their biggest health care challenge yet. Here’s a look at what’s changing.
  1.  The numbers. Yes, there’s a provider shortage, but nurse practitioners are bringing reinforcements. Last year, primary care nurse practitioner graduates outnumbered primary care medical school graduates by more than three times, and projected job growth for nurse practitioners exceeds 30 percent (almost three times the average of other professions). In the next seven years, we will add almost 55,000 providers to an otherwise shrinking health care workforce, and the next generation is more educated, ethnically diverse and younger than ever before.
  2. Specialization. Nurse practitioners must have a master’s degree or a doctorate degree, pass a national certification exam and be licensed in their state. In addition to primary care, nurse practitioners are going further in their education to specialize in areas like oncology, gerontology, psychiatry and neonatology.
  3. Our purpose. Nurse practitioners are trained to have a holistic, preventative approach to personalized care, which comes in handy when system fragmentation overwhelms patients and providers. One of the biggest challenges to primary care, is the ability to coordinate the care patients receive from specialists, ER teams and follow-up on home health to ensure patients do not fall through the cracks and to avoid duplicative appointments and unnecessary readmissions. From diagnosing critical conditions and prescribing life-saving medicines to teaching patients how to flush a tube or properly dress a wound, nurse practitioners have training that spans the entire care spectrum. Because of this unique skillset, nurse practitioner leadership to help coordinate a seamless continuum of care for better patient outcomes creates improved patient outcomes and cost savings.
  4. Autonomy. Nurse practitioners are working at the top of their license in 22 states plus the District of Columbia, practicing independently without the need for costly physician oversight or prescription sign-off. Increased practice rights have created new opportunities in retail clinics, onsite corporate health clinics and in-home health care companies, and they have paved the way for nurse practitioners to open their own independent practices, which is especially important in urban and rural areas where provider shortages are affecting access to care. More states are expected to pass similar legislation in the next few years, filling voids in service and providing an affordable alternative for patients looking for more personalized care
  5. Demand. Demand for nurse practitioners increased 320 percent in just three years, and today we are the fifth most sought after medical specialty (for reference, six years ago we didn’t even make the list). U.S. News ranked nurse practitioner second on its list of the 100 best jobs – naming formidable salaries, job security and increased practice rights as enticements for students weighing health care professions. The notoriety is paying off – more people are choosing the nurse practitioner career track and capitalizing on the tremendous job opportunities to jump-start their medical career.

Nurse practitioners today play a very different role than they did in 1965, and we are still in the process of defining our full potential. Trends in job growth and demand reflect what patients, providers and now legislators have been realizing for some time – that nurse practitioners are vital to our health care delivery system and that they must play an integral role in the future of care. As more states pass legislation granting nurse practitioners full practice authority, and as more opportunities emerge to capitalize on our skilled and rapidly growing workforce, look for nurse practitioners to dramatically change our care delivery system for the better in the next 50 years.

Joyce M. Knestrick, PhD, APRN, CFNP, FAANP, is President of the American Association of Nurse Practitioners (AANP).




Many thanks Joyce for this great insight into the NP today!!!

Friday, October 27, 2017

Book Review: Physician, How Science Transformed the Art of Medicine

In his book, Physician, How Science Transformed the Art of Medicine, Dr. Rajeev Kurapati, MD, MBA, a hospitalist at St. Elizabeth Healthcare in Northern Kentucky (a member of the Mayo Clinic Center) examines the history and evolution of medicine from mystics trying to heal the ills caused by angry gods to today’s evidence based holistic care. The book is forthcoming from River Grove Press.

Sandwiched between historical aspects of medicine, Dr. Kurapati shares stories of some of his own patients and how his philosophy of care has evolved over the span of his career. As he has spent years treating patients and dealing with family members who wanted only to keep their loved one hanging on until a miracle could be found, Dr. Kurapati has found the art of medicine to be beneficial and evidence-based. He resolves that even with the continuing scientific findings and inventions, treating the whole patient is at the center of quality patient care.

As a priest once told him, healing without cure can be the best possible outcome. And listening to his patients can be the most important tool he can provide. In a lesson learned on board an airplane at 30,000 feet with only a broken stethoscope and sphygmomanometer, Dr. Kurapati had to rely on listening to his patient’s wife’s accounting and history of symptoms to determine that perhaps his patient was experiencing low blood sugar. To treat those symptoms was his best option. Fortunately, the patient recovered.

“Sometimes patients may be seeking something more than tests, procedures, medications, or referrals to another specialist. Perhaps, in conjunction with these things, they want the opportunity to be heard by a professional. But as physicians who have invested in years of highly specialized training, we’re brainwashed into thinking that something tangible—to order a test, perform a surgery, or prescribe a drug—is what we always ought to be doing. For certain patients, simply listening can be a treatment—or at least a key part of it. To go beyond the provision of “standard” medical care to become a patient’s trusted advocate provides an immeasurable service.”

I found this book to be fascinating and heartwarming all at the same time. Nursing has always been about combining the science of medicine with the art of caring. This is what has always made nursing such an essential part of patient care and the successful outcomes. If Dr. Kurapati can influence physicians to see the benefit of providing a more holistic approach to providing medical care, we can all benefit greatly from the results. This should be required reading for all first-year medical students.

It should also be a must-read for nurses and nursing students to learn how we can all work together to improved the art of medicine and improve our patient outcomes. A video pitch by Dr. Kurapati is available on You Tube. 


Saturday, September 23, 2017

What is the OASIS in Home Health Care?

As many of you know, I have been in home health and hospice for over 35 years. I worked many years in the field seeing patients and writing plans of care. I've worked in middle management and mentored hundreds of nurses, therapists and social workers especially in documentation skills. Today I work in hospice as the QAPI nurse where I review documentation and the quality of care being provided by our fabulous staff.

Home health and hospice are growing fields for nurses and other healthcare professionals. Patients leave the acute setting much sicker than they ever have and skilled professionals are in demand to handle the growth.

But home health and hospice have LOTS of paperwork whether it be EHR or actually on paper. None the less it has always been a burden to the industry and not likely to change.

In home health there is also a major document known as the OASIS that paints a picture of the patient at various points during the episode(s) of care. In addition to all of the other necessary documentation, the OASIS is absolutely one of the most import documents.

I run a home health site called HomeHealth101.com and readers have been begging me for awhile to tell them how they can learn about the OASIS as they can't get a job in home health care unless they can show that they know something about it.

OASIS PODCAST
There are plenty of books about OASIS available, but you still need to have some understanding of what it is and why it's important.

So this week I have recorded 4 episodes to my new podcast channel specifically about the OASIS for those who have no idea about what it is. Don't judge me on the quality of the recordings please, I'm just beginning to dabble into this technology. I will improve. I just thought it important to get the content out there ASAP. You can find the links on HomeHealth101.com. 

OASIS eBook
Later this year, I will complete my eBook on OASIS for the beginner giving more examples and specific information. It will be available to purchase on HomeHealth101.com and I'll most likely post here about it as well.

If you're considering a transition to home health care you might want to check out my book, Exploring the Home Health Care Experience; Transition Your Career Path



Friday, September 15, 2017

Who Will Be Held Responsible for Nursing Home Deaths in Hurricane Irma?

I just have to rant. It sickens me to hear about nursing home residents suffering and dying in recent hurricanes. There's the haunting photo of people sitting in wheelchairs in water over their laps in the Houston area. But a later photo showed them all OK after being evacuated. At least no one died from that debacle.




Janice Connelly of Hollywood placed a memorial of balloons, 
flowers,
candles and signs for the eight people who died at the center.  
Credit Scott McIntyre for The New York Times
However, the 8 (so far) deaths in the Hollywood Fl rehab center are inexcusable. I hope the administrator and their owners are held responsible for these deaths.

Cooling measures are basic nursing care. And apparently the staff was doing their best to hydrate and cool patients. Obviously they needed more assistance and direction.

They also didn't ask for help when they needed to. Who was not there to ensure the disaster plan was being appropriately effected??? This is the responsibility of the administration and they FAILED their emergency planning and their residents miserably! This facility has been cited in the past for issues with generators and were well aware that they had issues with meeting codes for emergency planning. They corrected the issues, but FAILED to improve on the situation.

There were at least 3-5 days of accurate warnings about the severity of Hurricane Irma and potential disastrous effects including the challenges of power outages and downed trees. Hurricanes are not unusual happenings in Florida. They have a known "hurricane season" and there are evacuation signs up all over the state, so this isn't something new or unusual. Social media and television coverage for days were showing multitudes of preparation ideas for even basic things like how to bottle water and freeze bags of water for ice and drinking water.

Common sense tells you in a power outage scenario common to hurricanes, that generators need to be efficient enough to keep temperatures from becoming high enough to affect human life. Or you need to have a Plan B to sustain. And an emergency plan in place to say ask for help! In this case, a hospital was across the parking lot. Transfer your patients if you can't maintain cooling measures! The storm had passed by then.

CNN
Nurses and personnel working in long term care facilities are always the lowest paid and most overworked. No doubt. This is not on them. This is on the shoulders of the people in charge and the owners who did NOT ensure the comfort and safety of the residents. And in light of multiple failed routine checks by the governing agencies, this is pure criminal Abuse and Neglect at the highest level! These people who died were most likely bedridden and helpless. They relied on the staff to care for them and to protect them.

I am always one to say we have to look at both sides in a situation because there are always 2 sides. But this just wreaks. I cannot defend the owners and administrators in this one!

So let us all learn from this situation. Emergency and Disaster Preparedness planning is a pain to develop and to write policies!!!  But it's essential. And then we have to educate staff repeatedly and review when we know a potential disaster is coming. We can never assume that we can leave decision making to the low man on the totem pole. The buck stops at the top and that's who needs to be held responsible. These are the people who must be highly trained, present and active during disasters and emergencies.

But we MUST also ensure the tools are working, up to code and available. And that the disaster/emergency plan is being worked as it was designed to do. Drills are not just annoying time wasters! They help us to move into a crisis mode quickly and make correct decisions. They help us to learn where the strengths and weaknesses are and to improve our planning.

Owning and running long term care facilities is not just about making money and sitting back and letting the workerbees work their asses off with very little resources to try to make 99,000 residents in FL alone safe and comfortable. This is a HUGE responsibility to care for our rehabilitating and aging loved ones with the utmost respect, honor and care. This is a deplorable situation and one that should spark changes!!!

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Thursday, September 7, 2017

How Does an Electrocardiogram Work?

By Dsealy - Own work, CC BY-SA 4.0, Link

I hope this post is useful especially to student nurses and to those who need to educate patients about ECG/EKGs.😊



Doctors use a test known as an electrocardiogram, also referred to as an ECG or EKG, to measure the heart’s electrical activity and detect any anomalies in one of the most important organs of the body. An ECG makes a recording of the timing and strength of electrical impulses as they flow through the heart. Coming out in a moving strip of paper from the ECG device, the recording is then
read and interpreted by the doctor to see if the heart is working normally.
While it may seem simple to understand, how the test actually works is truly a mind-boggler, especially if one does not know how the heart works in the first place.

The electrical system of the heart
The heart is composed of specialized tissues that are capable of creating electrical signals that cause the cardiac muscles to contract. In every contraction, the heart works by pumping blood out to the lungs in order to absorb oxygen and to deliver it to the cells all over the body.

Particularly, the sinus node, also referred to as sinoatrial node, is the tissue that’s responsible for generating electrical activity throughout the heart. Located in the atrium or the upper right chamber of the heart, the sinus node sends out an electrical impulse in every fraction of a second, traveling through the atrial muscles, which causes them to contract. The impulse then travels through the atrioventricular node in order for it to reach the ventricles of the heart.
As the electrical impulse flows through the organ, the heart normally contracts, or beats, about 60 to 100 times in a minute at rest in most adults.

Understanding the ECG reading

Every activity of the heart can be seen through the electrocardiogram reading, which appears like a line graph with valleys and peaks. These peaks and fluctuations actually represent the “waves” of signals flowing through the heart. The P wave represents the electrical signal sent through the heart’s upper chambers. Meanwhile, the QRS wave indicates the electrical activity in the lower chambers. Lastly, T wave records the heart’s activity as it returns to rest.

By MoodyGroove at the English language Wikipedia, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=2581061
Reflected on the ECG print, the size and shape of the waves and the interval between each wave reflect the rate and regularity of the heart activity, which is valuable information for your doctor as it will help diagnose your condition. Aside from shedding light to the heart’s rhythm, the ECG can also determine possible heart muscle damage as well as detect abnormal levels of blood electrolytes, including calcium and potassium.

How it is performed
An electrocardiogram is a painless procedure that often takes only a few minutes. It may be done at the doctor’s office or as a laboratory procedure at the hospital. Since ECG equipment is portable, the test can be carried out almost anywhere. For patients admitted to the hospital, your heart patterns may be constantly monitored by an ECG system.

During the test, the patient may initially be required to shave the chest, arms, and legs to provide a smooth surface to attach the electrodes in the ECG cables. Once the area is cleaned, the patient is then asked to lie on a bed, where several ECG cables and leads are attached to the skin on the chest and on each arm and leg. These cables are connected to the machine that records the patient’s heart activity into print.

The three main types of ECG
An electrocardiogram is required by the doctor depending on three different purposes. The resting ECG is when the doctor wants to know how your heart works while you are at rest. The second type, exercise ECG, is requested if the doctor wants to determine the heart’s reaction to activity. This test may be done while the patient is walking or running on a treadmill. There is also what we call the 24-hour ECG, which monitors the patient’s heartbeat the entire day.

The ECG is an essential test that can detect any damage to the heart so you and your healthcare team can prevent it from getting worse. With the convenience of the test results and your doctor’s intervention, the least you can do is to make changes in your lifestyle and to be more proactive in dealing with your own health.


Friday, September 1, 2017

Arrest of Utah ER Nurse is Deplorable Act!

There is a firestorm on social media about this atrocious act against a Utah ER nurse for advocating for an unconscious patient's rights. We all have a lot to learn from this issue and to take actions to prevent the same situation from happening in our own backyard! THANK YOU Alex Hubbels! 

Please share.




Friday, August 18, 2017

Role of Substance Abuse Nursing in the Opioid Addiction Crisis

As you know, I don't often include infographics, but opioid addiction and substance abuse is such an urgent issue and this document captures how it affects the nursing profession...

"Drug abuse is a crisis for people in the United States. According to the CDC, in 2015-- alone-- more than 15,000 people died from opioid overdose. Drugabuse.gov reports that 80% of those addicted to opioids first took an opioid as a prescription. Nurses play a vital role in diminishing this crisis. To learn more about how important nurses are in helping people with substance abuse, check out this educational graphic from Duquesne University."





Friday, July 28, 2017

Nursing Community Comes Together for One of Our Own

The nursing community is huge, but it's also a very small world. I've been off tending to some family business, so I'm a little slow to get this posted, but it's an important matter and I want to be sure to spread the word. We need to come together to help our own.

One of our own, Keith Carlson BSN, RN, NC-BC, who you may recognize from RN FM Radio, Digital Doorway, and Nurse Keith Coaching, was severely injured in a gym accident recently. He details his ordeal brilliantly in his recent post, "When the Nurse Becomes the Patient." This is a must read for ALL nurses. We MUST prevent this type of horrible care! There is simply NO EXCUSE!!

At some point in our lives, we or a loved one have already, or will become the patient and we need to be prepared to advocate from the start of care through discharge and beyond. Keith certainly had to do this for himself, and thankfully he was alert enough to do so because it was essential to his well-being and recovery!

I hope you will all also be inclined to follow the Meal Train established to help Keith in his recovery process. Imagine if you will, yourself in his position. Meals and assistance from your local community would be invaluable and essential even if you are not inclined to ask for any help. For those of us who aren't local to Keith and Santa Fe, the Meal Train allows for us to donate so that meals, assistance and other needs can be met.  You can read more about this at Beth Boynton's Confident Voices post. 

photo borrowed from Nurse Keith's Digital Doorway  



Thursday, July 6, 2017

New Grad Programs Grow But Not For Everyone

I've been hearing a lot lately about new grad nursing programs. I'm pleased to know there are more of them cropping up. It will hopefully help us to keep new nurses in the profession. We continue to lose far too many in the first 3 years because nursing isn't what they expected it to be. Combined with increasing workloads, nurse bullying and physician bullying as a continuing issue, we are losing too many nurses period.

New nurse grad programs are an essential part of the future of nursing and curtailing the nursing shortage,
but they're not necessarily there for the top graduates. These programs are also highly sought after and have far more applicants than the programs can take on at any given time. The competition is stiff and top nurse grads are primed to compete.

Top Grads May Not Be Accepted

However, if you graduated at the top of your class and/or have some nursing experience already, it becomes nearly impossible to get into a new nurse grad program. This can be emotionally devastating and frustrating. In reality these nurses should feel honored to be turned down even though they value the opportunity to learn even more.

Many new grad programs are designed to boost the confidence and skills level of new nurse grads who perhaps didn't have the best opportunities, or didn't avail themselves of them. If you're shy and stand to the back of the crowd in nursing school you're not going to get the clinical opportunities unless your instructors are vigilant in making sure each student demonstrates proficiency. That isn't always possible given the populations of patients at any given time.

Even if you had all the best opportunities, but you struggled in certain areas and/or were in the middle to lower end of your class, a new grad program can offer extended education and supervision opportunities to make you a great nurse.

New Grad Programs Help Reduce Bullying

This creates another scenario for not accepting the top of the class grads; boredom and the possibility of encouraging nurse bullying of the grad who takes a little longer to catch on. These programs help these new nurses need a little extra time and preceptoring them with nurses dedicated to help them helps to reduce the nurse bullying by not throwing them into the water and expecting them to sink or swim in a pool of experienced nurses who don't have time or desire to help them.

New grad programs are also designed to build the workforce in that particular hospital. This is why they are often called residency programs.  They are looking for nurses who will be dedicated to staying on for at least 3-5 years and possibly working in certain areas of high turnover. Nurses at the top of the class are quite often energized and looking towards higher education in the near future. These nurses frequently want to be nurse educators, nurse practitioners, and clinical nurse specialists. This may not be a need for the hospital offering a new nurse grad program. And investing their time and money on nurses who will quickly move along is just not economically feasible.

This is NOT to say you shouldn't apply. Look for every possible opportunity to continue your education while working and soak up every ounce of knowledge to make you the best nurse ever! But if you get turned down, keep looking for other opportunities.  Even new nurses who really need a little extra help should do well in the right place. Be honest and willing to learn. DO some homework so you're ready to learn a new skill. You Tube, for instance, has a multitude of instructional videos. Sites such as NucleusHealth.com offer many forms of media for learning about conditions and treatment modalities and they have a You Tube site as well. Be willing to help a co-worker with tasks in exchange for preceptoring.

Nursing is a lifelong journey of learning, but it's not a one-size fits all situation. Nurses of all levels need to continue to be sponges and absorb all the information they can. Health care is constantly changing and nurses are expected to be the backbone. More and more responsibilities become part of the nurses everyday world. We all have to be prepared and willing to learn and to teach. Explore your opportunities and never feel stuck in something that isn't right for you.



Image from Bing images 

Sunday, July 2, 2017

Budweiser | A Dream Delivered | Folds of Honor


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