For yet (what is it, the third year in a row?) legislative session, the Kentucky senate figures our rural population can take their health problems and shove them in the coal mine. Enormous problems with obesity, smoking-related illness, and opiate abuse are prevalent all over the state, but hey, just think how much worse it would be if Nurse Practitioners were allowed to get involved by administering independent care to the full scope of their training and practice? Because after all, Nurse Practitioners are just a bunch of greedy harpies who were too dumb to get into medical school, have totally rigged the statistics showing cost-effective and equivalent outcomes in primary care, and are only in the healthcare business to divert narcotics, defraud the public, and take money out of the hands of the poor, selfless, hardworking medical doctors who work in cities.
This is why I can never run for office.
Here is the official press release from the AANP:
Access to Health Care
The American Association of Nurse Practitioners expresses disappointment
AUSTIN, TX (March 28, 2013)–
Angela Golden, President of the American Association of Nurse Practitioners (AANP), said today that the Kentucky legislature's failure to act on Senate Bill 43 will make it harder for state residents to obtain quality health care by barring access to direct and comprehensive services provided by nurse practitioners (NPs).
"The American Association of Nurse Practitioners is extremely disappointed that Kentucky continues to prevent patients from directly accessing high-quality health care services provided by NPs. Nowhere in the industry is it acceptable to limit patients the best that health care had to offer not two or even three, but four decades ago. However, that is exactly what states are doing when we keep these dated state practice laws in place.
"The health care services we provide – writing prescriptions, evaluating patients, making diagnoses, ordering and interpreting diagnostic tests, and managing acute and chronic health conditions – have been proven safe and effective for more than 40 years. There are more than 60 medically underserved counties across the state and every one would have benefited from the provisions in this bill.
"It is equally disappointing that the community of organized medicine in Kentucky went beyond simply opposing the bill by introducing counter legislation to increase state restrictions on NPs. This move flies in the face of recommendations by a growing number of independent entities (e.g., the National Academy of Sciences' Institute of Medicine) that call for modernizing state practice laws governing NPs. Such organizations understand that these changes are necessary in today's health care environment.
"The legislation that was before the Kentucky legislature did not expand NPs' scope of practice. It simply retired an outdated, bureaucratic piece of paper that prevents patients from having direct and full access to NP care. Removing this dated provision would have opened access points in rural and underserved counties, and streamlined care in all sites around the state.
"AANP and those who supported these measures remain committed to ensuring access and health delivery improvement. These pro-patient bills are planned to be reintroduced in 2014."
Lets get this fixed! For some real-world social networking, meet me in Las Vegas for the AANP national conference. For all of the details and registration, visit the AANP National Conference Page
And for more information on how to do Vegas your own fabulous way, check out my Pinterest Conference Board
Showing posts with label Reasons I Need a Vacation/Cocktail/Massage/Dancing Boys. Show all posts
Showing posts with label Reasons I Need a Vacation/Cocktail/Massage/Dancing Boys. Show all posts
Tuesday, April 2, 2013
Tuesday, November 20, 2012
Nurse Fight, Revisited.
At the 2010 APNA conference I was a newb to the plight of the Clinical Nurse Specialist phase-out. I listened, I empathized, and I agreed wholeheartedly that it was not fair. However, very little is fair in healthcare, and roles in all disciplines are continually merged, eliminated, grandfathered, or otherwise changed for the greater good of the consumer and the economy.
Two years later I am hearing the same arguments resentments and resistance to continuing education and not a single course of action beyond "someone should do something."
Yes, the CNS role in mental health was there before the NP. While I profess enduring gratitude to these pioneers, being first is not a relevant reason for continuance of a role that is being incorporated into the now-dominant nurse practitioner certification. The psychotherapy skills at the core of CNS education are now part of most NP programs and total more hours than were required in the first CNS programs. This is particularly true for those pursuing the DNP. Individual future-NPs may be drawn to one aspect of practice than another, and can choose programs that fit their emphasis area of interest, but the core requirements set forth from the ANCC must be met, whether you want to write scripts all day, facilitate therapy, or lead process improvement projects. If you are in healthcare, you should be dedicated to life-long learning whether it is to maintain or update certification. I am sure at some point, the American Board of Comprehensive Care exam - a ridiculously conceived and unvetted rip-off of the 3rd step of the USMLE - will be required for certification or recertification in Family/Adult NP practice, at which time I will have to suck it up and take it (but not one second sooner than mandated, and I will be protesting it up to that second).
Yes, the CNS has paved the way for expansion in scope of practice by consistently providing cost-effective, outcome-driven, patient-centered care. Again, we would not be where we are today without these leaders, however, maintaining the high level of respectability and competence that has been cultivated comes from didactic and clinical education at the graduate (soon doctoral) level, and finding mentors in the first years of practice - the roles are not mutually exclusive. PMH providers are already thought of as the "not-a-real" arm of our parent disciplines, do we really want to separate ourselves further by advocating for two of the same with a different name? Are taking any of the 3Ps and sending off for a transcript really that professionally insulting? Could it not be viewed as an expanded practice update, just as our yearly CEU requirements are mandated? I went to a PMHNP/DNP program that was attended by CNSs who wanted to keep current. They did not have to retake clinical hours or classes, and their educational plans were tailored to their experiences. The money and time spent to convert from a CNS to a NP (with a DNP if you want to keep REALLY current) would provide all the necessary CEUs for state licensing or national credentialing and, depending on the program, cost less than a couple of national conferences.
Yes, the CNS in PMH is different than the CNS role is in other nursing specialties because of the emphasis on direct patient care rather than nursing education, organization, and leadership. The current roles of the NP and CNS in mental health have become increasingly redundant because we let it get that way. It is too late to go back in time and decide not to start PMH NP programs and restrict advanced PMH practice to the CNS designation, or to ensure the PMH CNS role stay in line with the CNS role in other advanced nursing specialties. It is ridiculous enough that advanced practice nursing is divided into four roles with six population foci (instead of one APRN designation with specialization - a soapbox for another time), but having 2 roles with the same foci is just sloppy. This is why the consensus model supported the retirement of other CNS specialties that overlap with NP practice (adult health, adult psych, child/ado psych, gerontology) and retirement or amendment of NP specialties that were too specific or did not include lifespan.
Yes, nursing changes the rules more than other health discipline. Why? From entry to master, there are more people who call themselves "nurse" than any other health profession. We have to change to keep current and to define, grow, and protect our scope of practice. This often-labled "betrayal" of our own may be more common, but it is not at all unique to nursing. If one were to ask bachelors-prepared physical therapists, masters-prepared psychologists, pharmacologists without an MD or other doctoral healthcare degree, a masters prepared pharmacist before 1994, or MDs who find their primary practice certifications compartmentalized into new ABMS categories, they would empathize to varying degrees with what is happening to the CNS certification. Doubtless there was and is outcry among our peer professional and some misunderstanding during the process, but I doubt most of them were calling shenanigans and recycling arguments years after the decision was made. I would like to think nurses, especially psych nurses, could figure out how to demonstrate resiliency and adaptation by finding ways to work the system to make the new system work for them.
For great background and perspective from someone involved in the development of the consensus model, check out the LACE Dialogue for CNS blog by Dr. Kelly Gourdreau, CNS.
Yes, the CNS role in mental health was there before the NP. While I profess enduring gratitude to these pioneers, being first is not a relevant reason for continuance of a role that is being incorporated into the now-dominant nurse practitioner certification. The psychotherapy skills at the core of CNS education are now part of most NP programs and total more hours than were required in the first CNS programs. This is particularly true for those pursuing the DNP. Individual future-NPs may be drawn to one aspect of practice than another, and can choose programs that fit their emphasis area of interest, but the core requirements set forth from the ANCC must be met, whether you want to write scripts all day, facilitate therapy, or lead process improvement projects. If you are in healthcare, you should be dedicated to life-long learning whether it is to maintain or update certification. I am sure at some point, the American Board of Comprehensive Care exam - a ridiculously conceived and unvetted rip-off of the 3rd step of the USMLE - will be required for certification or recertification in Family/Adult NP practice, at which time I will have to suck it up and take it (but not one second sooner than mandated, and I will be protesting it up to that second).
Yes, the CNS has paved the way for expansion in scope of practice by consistently providing cost-effective, outcome-driven, patient-centered care. Again, we would not be where we are today without these leaders, however, maintaining the high level of respectability and competence that has been cultivated comes from didactic and clinical education at the graduate (soon doctoral) level, and finding mentors in the first years of practice - the roles are not mutually exclusive. PMH providers are already thought of as the "not-a-real" arm of our parent disciplines, do we really want to separate ourselves further by advocating for two of the same with a different name? Are taking any of the 3Ps and sending off for a transcript really that professionally insulting? Could it not be viewed as an expanded practice update, just as our yearly CEU requirements are mandated? I went to a PMHNP/DNP program that was attended by CNSs who wanted to keep current. They did not have to retake clinical hours or classes, and their educational plans were tailored to their experiences. The money and time spent to convert from a CNS to a NP (with a DNP if you want to keep REALLY current) would provide all the necessary CEUs for state licensing or national credentialing and, depending on the program, cost less than a couple of national conferences.
Yes, the CNS in PMH is different than the CNS role is in other nursing specialties because of the emphasis on direct patient care rather than nursing education, organization, and leadership. The current roles of the NP and CNS in mental health have become increasingly redundant because we let it get that way. It is too late to go back in time and decide not to start PMH NP programs and restrict advanced PMH practice to the CNS designation, or to ensure the PMH CNS role stay in line with the CNS role in other advanced nursing specialties. It is ridiculous enough that advanced practice nursing is divided into four roles with six population foci (instead of one APRN designation with specialization - a soapbox for another time), but having 2 roles with the same foci is just sloppy. This is why the consensus model supported the retirement of other CNS specialties that overlap with NP practice (adult health, adult psych, child/ado psych, gerontology) and retirement or amendment of NP specialties that were too specific or did not include lifespan.
Yes, by supporting the APRN consensus model, the APNA did not advocate to keep the PMH CNS educational programs open throughout the country nor petition the ANCC to keep the certification exam active. I understand being upset at APNA for not advocating to keep the credential - every one of my mentors is now or started as a CNS - but the organization represents all psych nurses from vocational to doctoral degree. At any given time, some of the groups within the greater organization are going to feel their interests have been ignored. The APNA cannot dictate to profit-driven universities and certifying organizations how to conduct their business. The ANCC, who is responsible for administering, maintaining, and offering the certification, made the decision to discontinue the CNS designation, in part because universities have been phasing-out or incorporating CNS education into NP programs long before LACE. We can talk about how great CNS's are valued to patients, peers, and healthcare systems, but the hard truth here is the only argument that really matters is the economic argument. Frankly, I am shocked the AANP did not develop a limited-time bridge-exam for CNS-to-PMH just for the financial competition (tell me again why nursing has 2 certification bodies for advanced practice? Another soapbox for later). Universities and certification organizations are not making enough revenue to keep the PMH CNS viable. No money, no ticket.
Yes, nursing changes the rules more than other health discipline. Why? From entry to master, there are more people who call themselves "nurse" than any other health profession. We have to change to keep current and to define, grow, and protect our scope of practice. This often-labled "betrayal" of our own may be more common, but it is not at all unique to nursing. If one were to ask bachelors-prepared physical therapists, masters-prepared psychologists, pharmacologists without an MD or other doctoral healthcare degree, a masters prepared pharmacist before 1994, or MDs who find their primary practice certifications compartmentalized into new ABMS categories, they would empathize to varying degrees with what is happening to the CNS certification. Doubtless there was and is outcry among our peer professional and some misunderstanding during the process, but I doubt most of them were calling shenanigans and recycling arguments years after the decision was made. I would like to think nurses, especially psych nurses, could figure out how to demonstrate resiliency and adaptation by finding ways to work the system to make the new system work for them.
For great background and perspective from someone involved in the development of the consensus model, check out the LACE Dialogue for CNS blog by Dr. Kelly Gourdreau, CNS.
Saturday, July 21, 2012
The Study Plan
After listening through the Barkley review with a mix of triumph and dismay at my knowledge base, it is time to dig into the source material. My test date is looming and it is time to see if I know what I think I know. Sources are primarily the ANCC review book and a couple of the well-used texts from school, which I hope will result in a super-pass. Here is my life for the next few days:
Saturday: PMHNP role, scope, regulations, and theory
Sunday: Neuroanatomy, neurophysiology, behavior, and assessment of disease
Monday: Pharmacological principles and non-pharmacological treatment
Tuesday: Mood and anxiety disorders (apropos as I am getting a massage)
Wednesday: Psychotic and cognitive disorders
Thursday: Substance and personality disorders
Friday: Child/adolescent disorders and managing the dreaded yet interesting "other"
Weekend: Practice tests and reviewing the "know this cold" sections from Barkley review.
July 30th is the big day. Wish me success!
Friday, July 6, 2012
Authorizations and Dispositions
Getting Certified
I received my ANCC authorization to test. This is my last board exam ever, ever, ever. That is my official plan. I have less than a month to prepare and am using a combination of test preparation tools from both nursing and medicine. While the diagnostic and pharmacological facts remain consistent across disciplines, the differences in practice ideologies are immediatly evident just from the areas of focus and types of questions presented.
The psychiatric reviews by Kaplan and Saddock are heavy on etiology and pathology of the system with precision diagnostic differentials. The "why" of the diseases are given the greatest attention, as are the historical contexts of various disorders. Questions are posed first with rational presented later. Well care and prevention are not highlighted though they are addressed in some sections.
The nurse practitioner reviews by the ANCC focus on manifestations of disorders in the individual, the therapeutic alliance, and holistic factors of treatment adherence and compliance. The "how" of the diseases and interventions are given the greatest attention. Introduction to concepts are given first and questions later. Neural pathways and biochemical aspects of disease and treatment are given some attention, but are not in-depth.
What it boils down to is what it always seems to boil down to: Treat the disease with medicine. Treat the person with nursing.
Potato. Potato.
Getting Employed
Of the three positions I applied for, I received one disposition letter informing me they chose someone else, than a notification letter for the same position stating I was still in the running. I received another notification letter for a different position informing me that I was qualified, followed by a disposition letter stating they hired another candidate. No word yet on the third position, but I should hear something one way or the other next week once the announcement closes.
While the clock ticks, I am working on my marketing-for-employment-to-do list. This includes exciting such as renewing several licenses and certifications, updating all of my online profiles, getting published by a journal that that allows a high-word count with several tables and figures without charging a reviewer fee, investigating the postings from a number of locum companies that have me on their list, and rebranding my private practice identity for my new expansion of scope.
Getting Zen
My July mantra: I will be exactly where I need to be, doing what I am supposed to be doing.
I received my ANCC authorization to test. This is my last board exam ever, ever, ever. That is my official plan. I have less than a month to prepare and am using a combination of test preparation tools from both nursing and medicine. While the diagnostic and pharmacological facts remain consistent across disciplines, the differences in practice ideologies are immediatly evident just from the areas of focus and types of questions presented.
The psychiatric reviews by Kaplan and Saddock are heavy on etiology and pathology of the system with precision diagnostic differentials. The "why" of the diseases are given the greatest attention, as are the historical contexts of various disorders. Questions are posed first with rational presented later. Well care and prevention are not highlighted though they are addressed in some sections.
The nurse practitioner reviews by the ANCC focus on manifestations of disorders in the individual, the therapeutic alliance, and holistic factors of treatment adherence and compliance. The "how" of the diseases and interventions are given the greatest attention. Introduction to concepts are given first and questions later. Neural pathways and biochemical aspects of disease and treatment are given some attention, but are not in-depth.
What it boils down to is what it always seems to boil down to: Treat the disease with medicine. Treat the person with nursing.
Potato. Potato.
Getting Employed
Of the three positions I applied for, I received one disposition letter informing me they chose someone else, than a notification letter for the same position stating I was still in the running. I received another notification letter for a different position informing me that I was qualified, followed by a disposition letter stating they hired another candidate. No word yet on the third position, but I should hear something one way or the other next week once the announcement closes.
While the clock ticks, I am working on my marketing-for-employment-to-do list. This includes exciting such as renewing several licenses and certifications, updating all of my online profiles, getting published by a journal that that allows a high-word count with several tables and figures without charging a reviewer fee, investigating the postings from a number of locum companies that have me on their list, and rebranding my private practice identity for my new expansion of scope.
Getting Zen
My July mantra: I will be exactly where I need to be, doing what I am supposed to be doing.
Friday, June 8, 2012
What Now?
The post-graduation elation has given way to the reality that I now have to use the education I have taken a couple of decades to acquire. So, where does a DNP go from here?
For starters, I have to take the ANCC certification exam. Application was sent, the card was charged, and I am anxiously awaiting my approval to test. I will be provided a 90-day test window, and if all goes according to plan, I should be certified and licensed as an PMHNP in KY by August (and you know what I am going to do with that set of initials). As soon as I get this piece of paper, I will create my study plan.
Next, a job. I already have my private practice doing what I do, but if I want to truly put theory into practice, I need to create my own psych-mental health residency in the form of employment. Thus far, I have ruled out MSN or DNP university positions. I have had interviews and opportunities, but frankly, the teachers I admire most are the ones that can back it up with a few years of clinical practice. As someone who preaches to my BSN students to "be the nurse you would want as your nurse," I have an obligation to "be the teacher I would want as my teacher." I am most interested in the VA and had an interview for a few positions this week. I did my own reflective journal on this, but will wait to hear one way or another before I post my thoughts on the experience.
The capstone is completed, and I want it published. Since the topic involved interdisciplinary research, it is a bit more difficult to find a home than it would be for straight nursing. I have a few ideas that I plan to explore this coming week.
Next week, I am jumping out of a plane with the Golden Knights as part of the Army Medicine Experience Tour at the Brooke Army Medicine Center. The American Psychiatric Nurses Association was kind enough to ask me to represent the organization and I am especially looking forward to learning about all the work they are doing with Traumatic Brain Injury and PTSD at the Center for the Intrepid.
Speaking of APNA, this September I was invited to take part in a task force on local chapter operations. I and a colleague will also be presenting a pre-conference session on integrating Traditional Chinese Medicine in the psych/mental health setting at the 26th annual convention in Pittsburg.
Phew, school might be over, but the learning and leadership is just beginning!
For starters, I have to take the ANCC certification exam. Application was sent, the card was charged, and I am anxiously awaiting my approval to test. I will be provided a 90-day test window, and if all goes according to plan, I should be certified and licensed as an PMHNP in KY by August (and you know what I am going to do with that set of initials). As soon as I get this piece of paper, I will create my study plan.
Next, a job. I already have my private practice doing what I do, but if I want to truly put theory into practice, I need to create my own psych-mental health residency in the form of employment. Thus far, I have ruled out MSN or DNP university positions. I have had interviews and opportunities, but frankly, the teachers I admire most are the ones that can back it up with a few years of clinical practice. As someone who preaches to my BSN students to "be the nurse you would want as your nurse," I have an obligation to "be the teacher I would want as my teacher." I am most interested in the VA and had an interview for a few positions this week. I did my own reflective journal on this, but will wait to hear one way or another before I post my thoughts on the experience.
The capstone is completed, and I want it published. Since the topic involved interdisciplinary research, it is a bit more difficult to find a home than it would be for straight nursing. I have a few ideas that I plan to explore this coming week.
Next week, I am jumping out of a plane with the Golden Knights as part of the Army Medicine Experience Tour at the Brooke Army Medicine Center. The American Psychiatric Nurses Association was kind enough to ask me to represent the organization and I am especially looking forward to learning about all the work they are doing with Traumatic Brain Injury and PTSD at the Center for the Intrepid.
Speaking of APNA, this September I was invited to take part in a task force on local chapter operations. I and a colleague will also be presenting a pre-conference session on integrating Traditional Chinese Medicine in the psych/mental health setting at the 26th annual convention in Pittsburg.
Phew, school might be over, but the learning and leadership is just beginning!
Tuesday, August 2, 2011
"We Take Care of It"
It's that time of year again. Time for me to curse Delta, humidity, and numb-butt. On campus for our third semester means 10 months until graduation . . . 10 months + 1 day until student loans go back into repayment. It also means I get to explore a bit more of downtown and contemplate how exacly to formulate a group session on alcohol therapeutics.
Compared to last year, it is almost like we are barely on campus. Monday was for the newbie and the only thing on the official agenda for Tuesday was Evaluation of Practice. I proudly waltzed in an hour late along with several other slackers (all of which I believe were from the Psych option) and spent most of my time looking up old evidenced-based practice lectures from my MSN to refresh myself on what a PICO question was. I would love to report I have any idea what the class was about, but a revised syllabus, 2 detailed assignment lists, and a lesson in literature search later and all I know is everything must be submitted electronically and the professors are willing to fire our group partners for us if they are not pulling their weight. You fire our problem? I don't think so. In psych, if we have a problem, we take care of it. No need to resort to tattling (I think that is a king to rook four on the lateral violence chess board, but I need to look it up to be certain). I think this class is going to be the Epidemiology of year two.
Did I mention 10 months until graduation?
Compared to last year, it is almost like we are barely on campus. Monday was for the newbie and the only thing on the official agenda for Tuesday was Evaluation of Practice. I proudly waltzed in an hour late along with several other slackers (all of which I believe were from the Psych option) and spent most of my time looking up old evidenced-based practice lectures from my MSN to refresh myself on what a PICO question was. I would love to report I have any idea what the class was about, but a revised syllabus, 2 detailed assignment lists, and a lesson in literature search later and all I know is everything must be submitted electronically and the professors are willing to fire our group partners for us if they are not pulling their weight. You fire our problem? I don't think so. In psych, if we have a problem, we take care of it. No need to resort to tattling (I think that is a king to rook four on the lateral violence chess board, but I need to look it up to be certain). I think this class is going to be the Epidemiology of year two.
Did I mention 10 months until graduation?
Saturday, May 14, 2011
On the Road Again
For once, it is me this time and not the husband. Being alone all of the time kind of sucks mental health wise - social media tools just don't have that interpersonal touch that makes you believe no man is an island. The good part is that I get to realistically try out some self-CBT before recommending a particular exercise to a client. I even managed for the first time in my post-secondary, oh hell, post-first grade education turn a paper in a whole 30ish hours before it was due. I am still debating if taking on a an teaching gig was helpful or harmful to my overall development. On one hand, it was a psych class and the 20 hours a week I spent on prep provided forced study time I may have otherwise neglected. On the other hand, I would not have flaked out on a few Blackboard discussions, could have delved deeper into the material, and, at least theoretically, concluded my clinical hours without having to take an incomplete.
I love hindsight.
In these last few hours before I leave for Memphis, I have a final in assessment strategies, 2 SOAP notes, 1 Reflective Journal, and 1 process recording to do. When I get back, I also have roughly 90 hours of clinical time I need to log before August. Thankfully, my second clinical site came through so I should just get done before I have to start over again.
If I am not mistaken, the new deadline for the end of the world comes while I am in school. At least I get to go out listening to Elvis with a belly full of barbecue and a blueberry sidecar.
Until the road gets rolling . . .
I love hindsight.
In these last few hours before I leave for Memphis, I have a final in assessment strategies, 2 SOAP notes, 1 Reflective Journal, and 1 process recording to do. When I get back, I also have roughly 90 hours of clinical time I need to log before August. Thankfully, my second clinical site came through so I should just get done before I have to start over again.
If I am not mistaken, the new deadline for the end of the world comes while I am in school. At least I get to go out listening to Elvis with a belly full of barbecue and a blueberry sidecar.
Until the road gets rolling . . .
Tuesday, February 15, 2011
Updated DNP Explanation Link List
Say that 3 times fast!
After sending survey monkey out to my soon-to-be students for psych/mental health, I nearly pulled my hair out after reading some of the results to the question "If you plan to attend graduate school, what field of graduate study?" A number of people said "DNP" without naming an area and others answered things like "either CRNA or DNP" as though they had nothing to do with one another.
I had a talk with some of my current students in my clinical group for leadership, and received the same uncertainty when I asked them what the DNP was. My on-going explanation has been something like this:
The DNP is a clinical doctorate much like the MD, PharmD, DPT, DDS, etc - nursing is just the last one to the party. Instead of having a masters degree as the entry to advanced practice nursing, they are expanding the education and clinical experience to a doctoral level to be on par with our peers in other healthcare disciplines. Much as the MD signifies a type and level of education, it is useless without residency in specialization. Likewise, the DNP does not stand alone, but rather uses a core curriculum integrated with one of the four APRN foci: CNS, CNP, CNS, and/or CRNA. We are currently in transition as universities phase out the advanced practice MSN, states start creating grandfather clauses, and certification bodies start amending their requirements, but the goal is to have this streamlined and uniform by 2015.
Sounds good in my head, but I am not sure I am communicating the message. Thankfully, there are a host of people specialized in this sort of explanation and interpretive dance.
Understanding the Doctor of Nursing Practice (DNP): Evolution, Perceived Benefits and Challenges
From the National Association of Neonatal Nurses - an excellent review of the why, what, where, and when of the DNP.
AACN Fact Sheet
Updated March 2010, this provides the current state of affairs on the profession. There is also a powerpoint presentation with greater detail.
APRN Consensus Model FAQ Sheet
This may be a bit off the point, but for folks who are trying to get into an MSN program and graduate before the 2015 deadline, the language used in here should give you pause. We here at OneDNP to take exception to item 5 on the grounds that multiple sets of initials makes one appear like they are trying to compensate for something
Sincerely,
Jaclyn Engelsher APRN, CPN, FNP-BC, PMHNP-BC, DNP (my anticipated 2012 credentials minus BSN, RN-BC, MSOM, CAc, DOM . . . hard to take that seriously, isn't it?)
After sending survey monkey out to my soon-to-be students for psych/mental health, I nearly pulled my hair out after reading some of the results to the question "If you plan to attend graduate school, what field of graduate study?" A number of people said "DNP" without naming an area and others answered things like "either CRNA or DNP" as though they had nothing to do with one another.
I had a talk with some of my current students in my clinical group for leadership, and received the same uncertainty when I asked them what the DNP was. My on-going explanation has been something like this:
The DNP is a clinical doctorate much like the MD, PharmD, DPT, DDS, etc - nursing is just the last one to the party. Instead of having a masters degree as the entry to advanced practice nursing, they are expanding the education and clinical experience to a doctoral level to be on par with our peers in other healthcare disciplines. Much as the MD signifies a type and level of education, it is useless without residency in specialization. Likewise, the DNP does not stand alone, but rather uses a core curriculum integrated with one of the four APRN foci: CNS, CNP, CNS, and/or CRNA. We are currently in transition as universities phase out the advanced practice MSN, states start creating grandfather clauses, and certification bodies start amending their requirements, but the goal is to have this streamlined and uniform by 2015.
Sounds good in my head, but I am not sure I am communicating the message. Thankfully, there are a host of people specialized in this sort of explanation and interpretive dance.
Understanding the Doctor of Nursing Practice (DNP): Evolution, Perceived Benefits and Challenges
From the National Association of Neonatal Nurses - an excellent review of the why, what, where, and when of the DNP.
AACN Fact Sheet
Updated March 2010, this provides the current state of affairs on the profession. There is also a powerpoint presentation with greater detail.
APRN Consensus Model FAQ Sheet
This may be a bit off the point, but for folks who are trying to get into an MSN program and graduate before the 2015 deadline, the language used in here should give you pause. We here at OneDNP to take exception to item 5 on the grounds that multiple sets of initials makes one appear like they are trying to compensate for something
Sincerely,
Jaclyn Engelsher APRN, CPN, FNP-BC, PMHNP-BC, DNP (my anticipated 2012 credentials minus BSN, RN-BC, MSOM, CAc, DOM . . . hard to take that seriously, isn't it?)
Sunday, January 16, 2011
Settling into Semester Two
Well, maybe if you define settling as a crazed and disorganized irritability.
First, the good stuff - I did not start any fights on Blackboard in either Leadership & Health Policy or Psychiatric Assessment. I got a head-start on my facilitator duties for the first week of February in Concept & Theory Analysis and completed all of my reading for Leadership & Health Policy through the end of this week, including taking the emotional intelligence and leadership analysis quizzes which revealed I am rather perfect.
The bad stuff - I have made only a tiny dent in the reading assignments for Psychiatric Assessment which is arguable the most important class of the semester. My clinical sites for Therapy, which I though were a stone cold lock, are now up in the air and I am going to have to go begging this week. Also, according to the Riso-Hudson personality test I took for Leadership & Health Policy, I am a contradictory jerk.
The plan - I am putting all of my weekly assignments into Google calender every Sunday so I can get the organization train moving by scheduling appointments with myself to sit and get it done. Ditto for my workouts which slacked way off since the semester started. I feel much smarter when the endorphins get flowing.
First, the good stuff - I did not start any fights on Blackboard in either Leadership & Health Policy or Psychiatric Assessment. I got a head-start on my facilitator duties for the first week of February in Concept & Theory Analysis and completed all of my reading for Leadership & Health Policy through the end of this week, including taking the emotional intelligence and leadership analysis quizzes which revealed I am rather perfect.
The bad stuff - I have made only a tiny dent in the reading assignments for Psychiatric Assessment which is arguable the most important class of the semester. My clinical sites for Therapy, which I though were a stone cold lock, are now up in the air and I am going to have to go begging this week. Also, according to the Riso-Hudson personality test I took for Leadership & Health Policy, I am a contradictory jerk.
The plan - I am putting all of my weekly assignments into Google calender every Sunday so I can get the organization train moving by scheduling appointments with myself to sit and get it done. Ditto for my workouts which slacked way off since the semester started. I feel much smarter when the endorphins get flowing.
Friday, January 7, 2011
Because Life Happens
As I was grumbling to myself about fitting in a blackboard post, I received this message in my email. I did not know Kim personally, but as a fellow traveler on the doctoral road I felt it was important to chronicle this tragedy. Positive thoughts and prayers to her family, friends and classmates. WIth hope, someone will be inspired to continue her work.
Sad news….
Marie Gill and Michelle Collins inform me this morning that Kim Stewart, a 2nd year student in the PhD in Nursing program, died earlier this week at her home in Nashville after falling and hitting her head the preceding day. A subdural hematoma is the suspected cause of death.
Kim worked as a nurse practitioner at the Matthew Walker clinic in Nashville and was passionate about improving the health of African-American women. With her mentor, Dr. Mona Wicks, Kim planned to conduct research on depression in African-American female caregivers seen in primary care settings. Prior to entering the PhD program, Kim also taught at TSU, sharing her expertise with nursing students.
Kim leaves behind her son, Jimmie, (a senior in high school) and husband, Buddy, and her extended family. Kim often mentioned how supportive her family was of her decision to pursue doctoral education and their pride in her accomplishments.
Funeral services will take place in Jennings, Louisiana, her home town, on Saturday, January 8 at Our Lady of Perpetual Help Catholic Church. Visitation will be from 9:00 a.m. to 11:00 a.m. and the Funeral Mass will begin at 11:00 a.m. The arrangements were made through Kings Funeral Home in Lake Charles, Louisiana.
Kim’s classmates are devastated over this tragic loss, and sending an arrangement for the services tomorrow. The PhD program will also be sending flowers.
We will gather on Monday, Jan. 10th from 12:40pm-1pm, in room 601 LA, to hold a brief memorial service in honor of Kim.
Sometimes we need someone who is associated with our loss or situation to talk to. University Health and the Student Assistance Program are available if you would like that outside support.
We consider you to be this University’s most important asset. The health and well being of every student is of primary importance to us. Today’s society is increasingly complex and we know that you may face a variety of difficult personal situations as your education continues, such as the recent loss of one of your colleagues. If you would like to schedule an appointment for counseling, there are providers available through University Health Services.
Sunday, October 10, 2010
Life in the Midst of Midterms
And finals.
Saturday
We found out we were pregnant in August after 8 positive home pregnancy tests. Since I had a miscarriage in June, I wanted to get serial HCGs and breathed a sigh of relief when it doubled in 48 hours and my progesterone was where it needed to be. Went for the ultrasound on Sept 22nd with hubs laden with camera gear. We should have been about 9 weeks along but the fetal pole measured 6 weeks 4 days. I can read ultrasounds and I saw there was no heartbeat. Doc told me to come back in a week to make sure because I could have been off on the due date.
Surprisingly, this was not the longest week of my life because by the time we walked out of the office, I came to grips with the fact he (I always felt the baby was a boy) was dead.
Sure, there was a chance, but somehow I knew we would not be in the lucky percent. I had a dream a couple of weeks ago that I gave birth to a belly full of water. I also had stabbing pains in He-Gu, an acupuncture point that is contraindicated in pregnancy because it can dilate the cervix. Around week 7 I also developed a total aversion to all the prenatal books and videos I had been so gung-ho about and had stopped browsing Amazon day and night. None of this was meaningful at the time, but as I sit here and think, they all kind of work together.
I am a little irritated that the first pregnancy symptom to go away was the great complexion I had developed.
I spotted very lightly through the week, so I had prepared myself for the inevitable. On the return trip to the OB, the fetal pole measured 6 weeks and 1 day but the gestational sac had grown. Great. Before he could finish the "D&C" talk, I asked how he felt about 800mg of Cytotec i-vag instead. He was somewhat surprised (hell, if you told me a few years ago I would rather pass a dead baby then get it all over with at once with a D&C I would have called you crazy) but he did a quick consult with one of his partners and fixed me up with 2 prescriptions and his cell phone number.
A part of me was hoping I would not need it, but by Friday night I was still spotting only slightly heavier so I decided to take the plunge around 8:30. I also popped 5 mg of valium hoping to sleep through the cramps. I didn't, but I also don't remember them that well. Even knowing there is no life to be had, it was still difficult to do this. Had I though there was even a slight chance I would have waited another week, but unfortunately clinical reality squashed optimistic hope.
Within a few hours, I had mild but escalating cramping. I spend a good part of the wee hours of the morning writhing around and deep breathing. I guess the "Bellydance for Labor" video paid off since the more I moved my hips, the less it hurt. And it hurt.
24-hours later I am not gushing as some others have described, and while I have clots I have not passed the sac. I don't think this is going to be real for me until I do.
I had a deeper attachment to the baby this time than I did the first time, yet somehow this miscarriage is easier. I guess it is a combination of saying good-bye, not having told as many people, and navigating (unfortunately) familiar territory. The good news is, we are fertile and, with hope, will remain so and actually conceive and carry next time.
I have to admit I harbor some bitterness over the situation since, as a nurse practitioner and psych nurse, I have seen so many women do everything wrong and have one baby after another without a problem. On the other hand, I have several clients who have due dates close to when I should have been due for both my first and current miscarriage and I feel so happy for them and proud of the role I played in helping them conceive.
As for trying again, I do not think I am going to be ready for quite some time. I am not sure I can ever have a positive pregnancy test again and feel excited about it. It sounds morbid, but I feel as though "hey, we made it over halfway through the first trimester this time, maybe we will get all the way to the second trimester before we kill the next one." Maybe I need to take up smoking or a crack habit - it seems to work well for a lot of my former patient population.
Hmmmm, that was not a subtle defense mechanism, was it?
As the guilt wheels start turning, I wonder if I did too much baby acknowledgement and prenatal madness. Too much reading, too much talking to the baby, too many prenatal workouts. But then again, I do not want to second guess my actions since all of the research left me armed with a plan for the future - doulas, hospital, postpartum care, etc - so it was worthwhile for next time. Or maybe someone else's next time.Tuesday
At one day past the Cytotec dosage, I was toeing the line between heavy spotting and light period with discomfort, but not pain exactly. I planned on giving myself until Monday evening to start the second dose if things had not progressed.
Monday morning I want into the office around 9 for my first patient and the cramps, well, I think I should call them contractions since it felt like a vampire squeezing my uterus, began. I popped some IBU and arnica which did little to help anything. By 10:30 I had passed 3 baseball-sized blood clots that were, thankfully, bright red. Not really knowing what the sac was supposed to look like, I collected one of the clots thinking there might be tissue in there.
I clinically detached first because, aside from the entire thing being tragic, it is an amazing process. The sensations are unique because they are cramps, but they are much different than your basic menstrual variety, and the passage of the endometrium is morbidly fascinating in an "did that just seriously come out of me" way. Second, I needed to dissociate for my own emotional stability.
About halfway through my next patient I was doubled over in pain in the office bathroom and begging for 5 minutes of peace so I could finish up and cancel out for the rest of the day. I have never had malaria, but I must of looked like I did with the cold sweat that kept dripping off my forehead. The "Bellydance for Labor" video was worth it's weight in gold because it really did help move through the contractions and decrease the pain.
At noon (about 5 minutes after my patient left), the pain reached epic proportions and shortly after, baby and all came out. There is no mistaking the difference. The sac looks like a little wrinkled balloon attached to the dark tissue of the placenta. After delivering (I guess you call it that), there were no clots and the pain backed off considerably, but did not totally abate. I have worked-out nearly every muscle in my body before, but this was defiantly new territory for DOMS.
Fred has been a rock, but when I handed him the bag to put in the fridge before going to the OB, he broke a little. After the pain settle down a little, we went over to the OB and he told us it looked like I had passed everything. I wanted to open the sac and see the baby, but I knew they wanted to run tests on it so I left well enough alone. I did take a couple of pictures though. He expects I will continue to have a light period for a week or so, and then have a normal cycle in 6-8 weeks. After that, he is going to run a bunch of tests to make sure all of this is not the result of a clotting disorder.
I cannot say Cytotec was the reason for this occurring Monday or at all, but what I do know is I do not require a D&C, which was my goal. I did not have the massive bleeding others have described, but there was still quite a bit. I hope I never have to go through this again, but if there is a next time, I am going to be sure to ask for some hydrocodone and take a few days off.
Today the clinical observation persona has given way to wistful-mommy-not-to-be grief. I am grateful I have a support system to rely on and that I now have an idea of what labor will be like (to a very small extent) when I finally do have a term pregnancy. There has been a lot of outside drama the past couple of days which I feel is a great distractor, but I am going to have to process this soon if I want to move on.
I made an over-ambitious workout plan for this week, that I quickly realized needed adjustment. I gained back 7 pounds of what I had lost so I am ready to get back on the weight-loss plan next week. In the meantime, I am trying not to "feed the soul hole" with comfort foods, and getting 30 minutes of cardio or weights in every day.
I posted most of the following on another blog, but feel it is important to include since this led to asking for extensions on all of my tests and assignments this past week. I have never done this before, but I realized there are some things you can't just suck up and perform. At least if you want to stay sane. Since I am specializing in mental health, I decided to practice what I preach and ask for help. Thankfully, all of my professors gave me an extension without asking for an explanation. And here it is.
Saturday
We found out we were pregnant in August after 8 positive home pregnancy tests. Since I had a miscarriage in June, I wanted to get serial HCGs and breathed a sigh of relief when it doubled in 48 hours and my progesterone was where it needed to be. Went for the ultrasound on Sept 22nd with hubs laden with camera gear. We should have been about 9 weeks along but the fetal pole measured 6 weeks 4 days. I can read ultrasounds and I saw there was no heartbeat. Doc told me to come back in a week to make sure because I could have been off on the due date.
Surprisingly, this was not the longest week of my life because by the time we walked out of the office, I came to grips with the fact he (I always felt the baby was a boy) was dead.
Sure, there was a chance, but somehow I knew we would not be in the lucky percent. I had a dream a couple of weeks ago that I gave birth to a belly full of water. I also had stabbing pains in He-Gu, an acupuncture point that is contraindicated in pregnancy because it can dilate the cervix. Around week 7 I also developed a total aversion to all the prenatal books and videos I had been so gung-ho about and had stopped browsing Amazon day and night. None of this was meaningful at the time, but as I sit here and think, they all kind of work together.
I am a little irritated that the first pregnancy symptom to go away was the great complexion I had developed.
I spotted very lightly through the week, so I had prepared myself for the inevitable. On the return trip to the OB, the fetal pole measured 6 weeks and 1 day but the gestational sac had grown. Great. Before he could finish the "D&C" talk, I asked how he felt about 800mg of Cytotec i-vag instead. He was somewhat surprised (hell, if you told me a few years ago I would rather pass a dead baby then get it all over with at once with a D&C I would have called you crazy) but he did a quick consult with one of his partners and fixed me up with 2 prescriptions and his cell phone number.
A part of me was hoping I would not need it, but by Friday night I was still spotting only slightly heavier so I decided to take the plunge around 8:30. I also popped 5 mg of valium hoping to sleep through the cramps. I didn't, but I also don't remember them that well. Even knowing there is no life to be had, it was still difficult to do this. Had I though there was even a slight chance I would have waited another week, but unfortunately clinical reality squashed optimistic hope.
Within a few hours, I had mild but escalating cramping. I spend a good part of the wee hours of the morning writhing around and deep breathing. I guess the "Bellydance for Labor" video paid off since the more I moved my hips, the less it hurt. And it hurt.
24-hours later I am not gushing as some others have described, and while I have clots I have not passed the sac. I don't think this is going to be real for me until I do.
I had a deeper attachment to the baby this time than I did the first time, yet somehow this miscarriage is easier. I guess it is a combination of saying good-bye, not having told as many people, and navigating (unfortunately) familiar territory. The good news is, we are fertile and, with hope, will remain so and actually conceive and carry next time.
I have to admit I harbor some bitterness over the situation since, as a nurse practitioner and psych nurse, I have seen so many women do everything wrong and have one baby after another without a problem. On the other hand, I have several clients who have due dates close to when I should have been due for both my first and current miscarriage and I feel so happy for them and proud of the role I played in helping them conceive.
As for trying again, I do not think I am going to be ready for quite some time. I am not sure I can ever have a positive pregnancy test again and feel excited about it. It sounds morbid, but I feel as though "hey, we made it over halfway through the first trimester this time, maybe we will get all the way to the second trimester before we kill the next one." Maybe I need to take up smoking or a crack habit - it seems to work well for a lot of my former patient population.
Hmmmm, that was not a subtle defense mechanism, was it?
As the guilt wheels start turning, I wonder if I did too much baby acknowledgement and prenatal madness. Too much reading, too much talking to the baby, too many prenatal workouts. But then again, I do not want to second guess my actions since all of the research left me armed with a plan for the future - doulas, hospital, postpartum care, etc - so it was worthwhile for next time. Or maybe someone else's next time.Tuesday
There is plenty of info on the feelings and emotions related to miscarriage, and I have been through all of them. Since I had a difficult time finding personal stories, I wanted to speak to the physical aspects of what happened to me on the end of my Cytotec journey.
At one day past the Cytotec dosage, I was toeing the line between heavy spotting and light period with discomfort, but not pain exactly. I planned on giving myself until Monday evening to start the second dose if things had not progressed.
Monday morning I want into the office around 9 for my first patient and the cramps, well, I think I should call them contractions since it felt like a vampire squeezing my uterus, began. I popped some IBU and arnica which did little to help anything. By 10:30 I had passed 3 baseball-sized blood clots that were, thankfully, bright red. Not really knowing what the sac was supposed to look like, I collected one of the clots thinking there might be tissue in there.
I clinically detached first because, aside from the entire thing being tragic, it is an amazing process. The sensations are unique because they are cramps, but they are much different than your basic menstrual variety, and the passage of the endometrium is morbidly fascinating in an "did that just seriously come out of me" way. Second, I needed to dissociate for my own emotional stability.
About halfway through my next patient I was doubled over in pain in the office bathroom and begging for 5 minutes of peace so I could finish up and cancel out for the rest of the day. I have never had malaria, but I must of looked like I did with the cold sweat that kept dripping off my forehead. The "Bellydance for Labor" video was worth it's weight in gold because it really did help move through the contractions and decrease the pain.
At noon (about 5 minutes after my patient left), the pain reached epic proportions and shortly after, baby and all came out. There is no mistaking the difference. The sac looks like a little wrinkled balloon attached to the dark tissue of the placenta. After delivering (I guess you call it that), there were no clots and the pain backed off considerably, but did not totally abate. I have worked-out nearly every muscle in my body before, but this was defiantly new territory for DOMS.
Fred has been a rock, but when I handed him the bag to put in the fridge before going to the OB, he broke a little. After the pain settle down a little, we went over to the OB and he told us it looked like I had passed everything. I wanted to open the sac and see the baby, but I knew they wanted to run tests on it so I left well enough alone. I did take a couple of pictures though. He expects I will continue to have a light period for a week or so, and then have a normal cycle in 6-8 weeks. After that, he is going to run a bunch of tests to make sure all of this is not the result of a clotting disorder.
I cannot say Cytotec was the reason for this occurring Monday or at all, but what I do know is I do not require a D&C, which was my goal. I did not have the massive bleeding others have described, but there was still quite a bit. I hope I never have to go through this again, but if there is a next time, I am going to be sure to ask for some hydrocodone and take a few days off.
Today the clinical observation persona has given way to wistful-mommy-not-to-be grief. I am grateful I have a support system to rely on and that I now have an idea of what labor will be like (to a very small extent) when I finally do have a term pregnancy. There has been a lot of outside drama the past couple of days which I feel is a great distractor, but I am going to have to process this soon if I want to move on.
I made an over-ambitious workout plan for this week, that I quickly realized needed adjustment. I gained back 7 pounds of what I had lost so I am ready to get back on the weight-loss plan next week. In the meantime, I am trying not to "feed the soul hole" with comfort foods, and getting 30 minutes of cardio or weights in every day.
Sunday
Okay, the grief-bravado lasted a day and the mourning hit hard and fast. All of the pregnancy symptoms disappeared and I was left with continual cramping and aches until last night. Thursday night I realized I was going to fail the Epidemiology final and Stats midterm if I did not ask for an extension, and there was no way I was going to have an effective empathy recording for Interviewing and Counseling because I had none. I am granted an extension until Wednesday and decide to take the weekend to really process and take all of the support my husband had to give.
We had a wedding to go to this weekend and mingled with a lot of folks we had not seen in over a year. I was hoping I could be bride-centric, but naturally we were asked about our plans for children. Fred and I are terrible social liars, especially with friends, so we wound up telling a few people what happened. We received an amazing amount of support and hope. I have found even unhelpful comments usually are a result of wanting to say something and are meant to show concern, so I appreciate them.
I am thinking about re-labeling my prenatal vitamins "pre-conception" so it does not feel so depressing. I am taking a postnatal herbal formula that has also helped with the emotional ebb and flow as well as the dizziness and aches. I packed up all of the books, DVDs, and other accouterments I acquired to celebrate the pregnancy. Fred finally looked at the pictures I took and it made me feel so much better emotionally and physically to share that. He has been amazing through this entire experience and has postponed his own processing to be strong for me. I hope to be as strong for him when he finally lets himself grieve.
Right now the nights are the worst. It is when I feel the intensity of the loss. That was my baby meditation time and when I felt the most excited and pregnant.
There was discussion in class about the benefits of therapy as a healthcare provider and I thought at the time a mental health check-up was a great idea for everyone. we are looking into a few options to help get through this time, but I imagine I will need some sort of support for the next pregnancy as well.
Friday, August 27, 2010
The Motherload
This was the first week where all of the classes had readings and a post, test, or quiz due. Yaoza! Here is a rundown of the assignments so those reading can get an idea of what 14-credit-hours in a DNP program wants from your brain:Epidemiology:
Chapters five, six, and eighteen - about 70 pages
Additional readings (ACS and CDC reports - another 30 pages)
About 30 homework questions
Blackboard discussion
Quiz (4-hour time limit)
Biological Treatments of Psychiatric Disorders
Stahl chapters one through four - 122 pages
Pliska chapter seven - 20 pages
Discussion board posts on chapter reading
BioStatistics
2 chapters - 60 pages
Webcasts (a little over an hour)
Submit a test question that covers descriptive statistics
Complete review questions
Test 1
Interviewing and Counseling
Chapter three - 20 pages
Descriptive Log
Philosophy of Science
Read "A Briefer History of Time"
Chapter 1
Essay quiz submission
And this week was my first, and hopefully only, official goof. In his mercy. my bioethics teacher let me turn in my question a day late because I neglected to see Friday, not Sunday was the due date. I was not the only culprit and he sent our an email that sufficiently chastised me to the point where I already have the assignment for next week completed. The great news is, I got 100 on my test - doing the review questions does pay off . . .
. . . unlike in epidemiology where I bombed the quiz and lowered my grade to a B. Lovely. Next week is the midterm and there is supposed to be 10 points extra credit. I imagine the credit will be as impossible to get as her normal test questions. I would not mind doing so badly if I could understand the rational for asking some of the questions (seriously, 20% of it came from the book and a bunch had unnecessary word-play that had nothing to do with understanding the material . . . and having taken MSN board exams, those questions do test you understanding, not your test-taking ability!) and get an explanation of the answers. Alas, it is sink or swim. If I ever needed validation I am not cut out for public health, it was this week.
And yes, I am behind on the reading. This week has been nuts in many ways and I have come to the realization I have to budget in more study time and take less patients. Thankfully I have all Labor Day to labor away and catch up!
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