Anton Prado | Veer + Scrubs

A little over a year ago, I wrote a brief FYI blog post about the future goals of advanced practice nursing and the role of the DNP according to the consensus model by the AACN. Questions have come up that I’d like to address.

Will there be a set of uniform guidelines that each state follows in transitioning the requirements from an MSN to a DNP for a current practitioner?

As most nurses have discovered, state requirements are very different from national requirements. While all states share the same minimum requirement of following national certification guidelines, each state’s specific requirements for licensure and employment is at its own discretion.

In my opinion, this means each state will choose how you may transition. If the current state protocols are a reflection of things to come, be sure to do your homework and contact your local state agencies to get the details. I would not assume the guidelines for one state will mirror another, no matter how close their geographic locations are.

I’m in the last year of my ACNP program and we quickly are learning that there are many hoops to jump through and red tape to follow when applying for licensure.

What incentives does acquiring a DNP have other than just being a requirement?

Many nurses are questioning the motives behind the impending changes and what incentives exist to motivate a current nurse to pursue the DNP. More specifically, are there pay rate changes to the DNP as opposed to the MSN? I mean, we’re technically being required to get another 12-24 months of advanced education–are we being compensated? More education should equal more pay, right?

It’s not a simple answer.

The NP profession sort of shot themselves in the foot with this one. For years, NPs fought for independence. Independence in the practice, and then independence as a practitioner. Granted, this fight was more for the general practitioners (Family Nurse Practitioners), but since the NP profession has become more specialized, it affects all specializations.

Now in some states, an FNP can open a clinic or office with the assistance of an MD. And in some states, the FNP can practice without the actual physical presence of the MD (just a phone call away).

Not to minimize the concept, but Uncle Ben from the Spiderman comics said it best: “With great power comes great responsibility.” If we as a profession want to have the power to work independently and function with that kind of “power,” it is our responsibility to be prepared. More responsibility equals more education, period.

Oh, and let’s not minimize the ever-expanding complexity of health care, our patients and their health challenges. The truth of the matter is, our patients are living longer and have more health challenges that did not exist a decade ago thanks to advancements in treatment. We as the practitioners need to “up our game” to meet these challenges. Upping our game means attaining a higher level of education.

So the “motivation” for attaining your DNP is simple. Do it to improve the care of our patients.

If you’re worried about not being compensated for your additional education, we might want to take a step back and look at our economy as a whole. Our profession is one of the few that is not being affected by the current economic strain. There are MANY health care professionals out there who have no job opportunities at all.

I, for one, predict that depending on the area you choose to work, the pay rate will change, but not because you simply got your DNP–rather, because your role as a practitioner has expanded and will continue to expand in the years to come. Yes, an MSN prepared NP functions just as a DNP prepared NP does currently, but I foresee that changing very soon.

In the end, if the impending educational requirement from an MSN to the DNP is affecting your decision to advanced your degree or swaying you towards not advancing your degree all together, then maybe it’s just not for you.

Links of interest:

• http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx
• http://msntodnp.com/average-salary-msn-vs-dnp/
• http://community.advanceweb.com/blogs/np_7/archive/2010/05/04/will-employers-pay-for-a-dnp.aspx

Some additional articles:

• http://scrubsmag.com/5-perks-of-an-np-degree/
• http://scrubsmag.com/a-doctor-in-nursing-uniform/
• http://scrubsmag.com/doctoring-the-doctor-title/

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Does anyone else have problems getting to speak with a real live person anymore?

Today I called a doctors’ office to TRY to report an exacerbation of atrial fibrillation and resulting weakness in a 90-plus-year-old patient. What I got was a four-minute-long RECORDING on the medical assistant/nurses’ line AFTER getting past the three-minute initial voicemail system that answered the phone. And there was, according to the voicemail message, “no one to take your call” while the office was closed EVERY DAY from 12:30-1:30 PM for lunch.

Most home health clients are elderly. These people grew up with party lines and ONE telephone, black with a white dial, in the house. They are often hard of hearing and have difficulty with voicemail systems. I honestly do not know how they can even make an appointment with a practice that uses an answering system lasting longer than a commercial break on TV.

Nurses who work out “in the field” carry cell phones into areas which have little to no service. Sending a text message to a doctors’ office is not an option because no one can receive it on the other end. Dropped calls are the norm more than the exception (and we have to pay for them, even when we are waiting for a voicemail to finish so that we can “leave a message!”).

I once worked for an agency whose management decided to save money by going with a voicemail answering system after business hours instead of the answering service our clients were used to–a person answering the phone and taking messages for the on-call nurse. It lasted less than a month before customer satisfaction fell to zero and we got the “real person answering service” back. And that was back in the 1980s.

Patient care still requires a human interface in order to be effective.

So, in order to assure with the highest probability that a licensed nurse or physician will actually see your message, I recommend this: Write up a clinical note and FAX it to the office! Because FAX machines do not use cyberspace, the Twilight Zone of critical information, they are more secure and are HIPPA compliant. Also, the clinical note becomes a legal part of the medical record, therefore fulfilling the CYA requirement as well.

We are in the 21^st century and have the most sophisticated means of communication that has ever existed on this planet, but we still can’t get someone on the phone!

What we have here…is a Failure to Communicate! -The Captain, Cool Hand Luke

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Blogging is a fairly recent form of social/political/professional communication. By “recent,” I mean since computers and smart phones became an indispensable part of daily life.

Why do nurses blog, anyway?

Most modern nurses use a computer at some point every day, whether at home, work or school. If you follow Scrubs Magazine or any other nursing site, you are aware of the wide scope of issues which nurses face. Online is where nurses can share their many opinions with each other to hopefully improve the profession and also lift their spirits in connecting with their community.

The great peril in speaking up

On any site where comments are invited, including Scrubs, you may notice a login name is required along with perhaps a bit of voluntary information. Know that what you create and share is up to you.

Be warned! You are in a sense putting yourself in great peril by speaking up: to your job, reputation and even your license, because employers, schools, families and law enforcement also look at these sites.

Many nurses choose to keep their true identity anonymous when they choose their usernames. This way you can feel a certain level of safety. You can get things off your chest with fellow nurses without giving away your real identity, as long as you are careful not to be too specific with people and places.

The benefits of staying connected

Nurses blog and join nursing sites because no one else understands better than another nurse!

Most of us gave up trying to share about our workdays with our families and significant others (unless, of course, they ALSO happen to work in healthcare!). They simply will never understand HOW or WHY we keep doing what we love to do!

How many times have we all heard someone else say: “I could NEVER be a nurse!” or, “How CAN you stand to do and see all of this every day?”

Kind of discouraging, isn’t it?

And yet, in spite of everything, there are those among us who DO keep going and doing what we love and feel that we are called to do every day. We need to support each other in this – at work and in our communities whether online or off – because it’s not easy sometimes making this choice.

When you’ve had a rough day, it can make a huge difference when no one around you seems to get it – until the person on the other end of a comment thread does!

Your profession is not simply what brings home your paycheck, your profession is what you were put on earth to do. With such passion and such intensity that it becomes spiritual in calling (Vincent van Gogh).

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The recent advancement in medical technology is astounding, if you think about it.

We can view the inside of the human body to such a fine detail that the human eye has a difficult time deciphering the pieces. We can monitor physiological processes remotely. We can view and document just about anything related to patient care remotely.

I think every piece of new technology that’s come across the healthcare spectrum in the past two decades is one of those inventions you hate when it’s first introduced. In fact, you hate it so much you might be offended by the audacity that someone thought this invention would even work, let alone benefit healthcare.

The invention picks up steam and eventually is adopted as the “standard.” You go from hating it and refusing to use it to sluggishly accepting it. We all become Eeyore from Winnie the Pooh: “Hooo-hummm. I guess I’ll go ahead and use this.”

Eventually, life seems to improve due to the use of said invention, and you bashfully admit it’s worthwhile. But then something crazy happens: You actually start to like the invention.

You like it so much you become proficient at using it. Your job gets–dare I say–easier because of this technology.

The switch has been flipped. You love it.

Then something happens. The new technology–you know, the one you thought was the best thing since sliced bread–turns out to be fallible.

Not only is it fallible, it’s downright breakable. Breakable and useless, I tell ya!

Now that it’s out of order, you have no idea what to do. You have to pull from the depths of your memory what the heck you did before your new toy, err, technology.

Does this sound familiar to anyone? A few weeks ago, our electronic health record system went down. I can’t even begin to tell you how crazy it was trying to function without that “crutch.” We were writing physicians’ orders on real paper! We were faxing orders to pharmacies with a real fax machine! And we were charting on real paper! (Madness, I tell ya!)

It was as if the sky was falling and I was Chicken Little.

Thankfully, the sky only fell on us that morning, and by the afternoon we had our crutch back.

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We’ve talked about social media at length here at Scrubs.

With so many gray areas that accompany the proliferation of social media for nurses, there’s great potential to connect with fellow nurses and patients like never before.

There are also great risks of instantaneously committing the biggest professional blunder of your life.

Did you know:

• Nursing schools can view your Facebook profile without your permission
• Yes, nurses have been fired for Facebooking inappropriately
• The ANA has published a set of social media principles

Recently, the National Council of State Boards of Nursing (NCSBN) has released a Nurse’se Guide to Use Social Media  – available here.

You can download this PDF and get the lowdown on the appropriate uses of social media, the pitfalls and risks as well as debunked myths and misconceptions.

According to Market Watch, NCSBN is:

…a not-for-profit organization whose members include the boards of nursing in the 50 states, the District of Columbia and four U.S. territories — American Samoa, Guam, Northern Mariana Islands and the Virgin Islands. There are also nine associate members. Mission: NCSBN provides education, service and research through collaborative leadership to promote evidence-based regulatory excellence for patient safety and public protection.

The NCSBN has also released a video to dramatize the potential pitfalls of social media for nurses:

Have you seen a fellow nurse violate a patient’s trust and privacy by using social media? How big is this issue?

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by Tania Khadder

Technology is a beautiful thing. Most of us can’t imagine doing our jobs without it.

But sometimes, overindulging in email, texts, and social networking might actually hinder your performance as a nurse.

We’ve identified five ways your iPhone, BlackBerry, Facebook and that endless information superhighway are actually making you worse at your job.

1. Instant messaging is twisting your words

2. You’re afraid of the phone

3. You never unplug

4. You’ve forgotten how to fax

5. Social media is distracting you

IM is making you lazy –>

Hemera | Thinkstock + Scrubs

That’s the newest concept in the world of health care these days. Telemedicine, telehealth and of course telenursing. They all seem to fall under the same umbrella definition of delivering care from a remote distance.

We nurses are no strangers to this type of care. There are nurses out there who used to deliver their care to their patients over the phone (and some still do). What has changed over the years is the avenue by which this care is delivered…for example, via this lil invention called the internet (have you heard of it?). The ‘net brought enormous technological advancements in health care delivery and health care monitoring.

Everything from Holter monitors to 24-hour pharmacies to the Electronic Medical Health Record has catapulted the way in which we provide care to patients.

We’ve leapfrogged from downloading patient data ‘after-the-fact, to real-time monitoring of an event as it happens. This real-time monitoring has now been taken to the ‘next level’.

Traditionally, patients who are being monitored by ‘telemetry’ (bare-minimum continuous ECG ) are monitored by nursing staff (as well as physicians) who are with the patient on the same unit, the same floor, heck – the same building!

Well, not anymore.

The amazing advancements in our technology have opened new doors (literally). Patients are being ‘monitored’ remotely. The nurse (or physician) is now monitoring patients and their dynamic vital signs from a distance. That distance can be as close as the next floor or as far as the next building. I read somewhere that monitoring was performed across state lines and even across coast lines! The distance threshold seems to hold no boundaries lately.

As a critical care nurse this equally excites and scares the bejeezus outta me. How awesome that would be to have the ability to possibly stop an emergent event from happening from a distance?! But, on the other hand, how horrifically scary would it be to make an error in judgment!

The possibilities are endless if you think about it. There are of course numerous adjustments and accommodations that would have to be made for every instance. Patient safety would be the priority.

I’m not sure how comfortable I would be performing those duties? As a critical care nurse we are always, always, always taught to never trust a monitor and to always, always, always (did I emphasize always enough?) check the patient first. No matter how great the technology may be, I just don’t think anything can replace your 5 senses.

This got me thinking about what would be appropriate for a person to post about their work.

Obviously, never, EVER post any patient information.  This could get you in tons of trouble and possibly cause you to lose your job, and even legal issues.  I know we want to post funny things that happen at work, but do not use patient names, describe them or give any information that could identify them to others.  If for some reason I post something like that, I even try to change the sex of the patient.

When it comes to your boss or job, you may want to get online and complain when you think your boss did something unfair, or when you have a bad day at work.  But try not using their name, your hospital and/or unit name.  This will make your boss, unit and organization look bad to others.  Maybe it is just a personal thing between the two of you and your boss will get along great with somebody else.  It can also give patients an inappropriate view of the type of care they will receive or had received there at one time.

What I would suggest…..keep work at work.  The best way to keep yourself from possibly getting in trouble is to just not talk about it in a public forum.

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Nurses are busy enough taking care of patients, calming families, and keeping doctors updated on cases. Don’t let a silly email mistake ruin your shift! In this age of BlackBerry-toting professionals connected by email around the globe, it’s crucial to abide by the written (and unwritten) rules of email communication. You don’t want to embarrass yourself, do you?

Don’t send another message without this checklist in mind:

Fit for Email or Text?

Email’s speed and effectiveness is perfect for sending important message about a new swine flu outbreak or some other hospital emergency. But is it the best way to deliver every message? Are you sending an email about your vacation plans? Or are you responding to a message riddled with patient questions and clarification requests? Picking up the phone or chatting face-to-face with fellow nurses could cut down on time-wasting (and highly unproductive) back-and-forth prattle, which saves everyone time and energy. Remember, one size doesn’t fit all, so make sure an email is the correct mode of communication.

Who’s your target audience? –>

These words, published in a 2010 study by the online research journal Perspectives in Health Information Management, depict a hard-to-miss reality of how smartphones are becoming an integral element in today’s ever-evolving healthcare industry. The study went on to state the reasoning behind the power that smartphones hold over our industry: “They merge and integrate multiple and varied technological functions into a single device that is both versatile and portable.”

For many nurses, the findings of this study are nothing new. Introduced in 2000, smartphones are increasing in popularity every year and nurses are finding new ways to put them to use—for work and for play.

We’ve profiled our favorite mobile apps and smartphones in the past couple years, but new apps emerge all the time. Here’s a look at some of the apps that nurses are loving right now.

1. Johns Hopkins Guides

ABX Guide
Diabetes Guide
HIV Guide

Johns Hopkins Medicine publishes three mobile apps that are the authoritative guides on antibiotics, diabetes and HIV. Each guide includes up-to-date, comprehensive information about its subject, as well as links to further reference sources. Additionally, the guides include detailed drug and treatment information. Though the three guides can be purchased separately, you can save by purchasing all three at the bundled rate.

Price: $24.95 each; $49.95 bundled

NEXT: Kaplan Math for Nurses