Working the System to Make the System Work for Me!

One of our big projects this semester is an economic analysis of a healthcare issue or technology.  Between my APNA presentation and Capstone project, I am a little spent (ha, I made a pun) on social media and wanted to tackle something a bit more juicy: Collaborative practice agreements.

After about 10 hours reading a lot of stuff I already knew:

• The Institute of Medicine's position that APRNs should be full partners and allowed to practice their full scope of practice
• In states without collaborative practice agreements APRNs rank as high or better than MDs when it comes to outcomes 
• State medical boards have banned together to push the idea that nursing is actually medicine and must be regulated by state medical boards
• MDs are still bitching to each other on Sermo and publishing their opinions that so-called mid-level providers are only competent so long as they hand 5-15% of their revenue over in exchange for an on-paper collaborative agreement

I learned some interesting things I did not know regarding the Federal Trade Comission citing that the collaborative practive agreement could be considered monopolistic and a restraint of trade.

Then I decided, I like my blood pressure where it is, and scrapped it. I decided to analyze workforce management solutions for healthcare systems, specifically when it comes to mobile technology. Why? Because there is a Kronos conference in Orlando this November that I have been invited to that will allow me to get first, the latest data, second, the ability to network as part of the research, and third, to write off the entire trip.

Now thats some health economics!

The New & Improved ANA Social Networking Principles!

While I am not narcissistic enough to believe my contributions during the "open to public comment" period had anything to do with the excellent edits, I like to think the synergy of many like-minded nurses worked to improve the specificity and decrease the Ratched. The ANA was also nice enough to provide a Tweet and Learn #anachat for 0.5 CEU credits. Now we own it!

Benefits

• Networking and nurturing relationships 
• Exchange of knowledge and forum for collegial interchange 
• Dissemination and discussion of nursing and health related education, research, best practices 
• Educating the public on nursing and health related matters 

Risks 

• Information can take on a life of its own where inaccuracies become “fact” 
• Patient privacy can be breached 
• The public’s trust of nurses can be compromised 
• Individual nursing careers can be undermined

 ANA’s Principles for Social Networking 

• Nurses must not transmit or place online individually identifiable patient information.
• Nurses must observe ethically prescribed professional patient — nurse boundaries.
• Nurses should understand that patients, colleagues, institutions, and employers may view postings.
• Nurses should take advantage of privacy settings and seek to separate personal and professional information online.
• Nurses should bring content that could harm a patient’s privacy, rights, or welfare to the attention of appropriate authorities.
• Nurses should participate in developing institutional policies governing online conduct.

6 Tips to Avoid Problems

• Remember that standards of professionalism are the same online as in any other circumstance.
• Do not share or post information or photos gained through the nurse-patient relationship.
• Maintain professional boundaries in the use of electronic media. Online contact with patients blurs this boundary. 
• Do not make disparaging remarks about patients, employers or co-workers, even if they are not identified.
• Do not take photos or videos of patients on personal devices, including cell phones.
• Promptly report a breach of confidentiality or privacy.

Research for Capstone Research

I am currently developing a survey for my DNP capstone project to examine usage trends and perspectives on social media within a number of psychiatric healthcare disciplines.  I am looking into a number of online survey sites to determine which one provides the most feature with the lowest (free?) cost.  It seems there is not one company that dominates the Doctorate student market, but if anyone has a great experience with a particular company, I would love to hear about it! Here are the links:

QuestionPro

SurveyShare

FluidSurveys

SurveyMonkey

SocialSci

SurveyGizmo

PsychData

LimeSurvey

I hope to have the survey up and distributed via a number of social media platforms and professional organizations by the APNA conference in October.  Check back soon!

¡Viva, Terminado y Voladores!

It is off to Spain in a few hours . . . well, off to a 6 hour layover in Atlanta and THEN Spain. I get to play journalist for a week by gorging on cured meats and stomping through vineyards. But the biger point is:

• Group Meta-Analysis Project: Done and Sent to Project Leader
• Health Economics Paper: Done and Submitted
• PMH Pediatrics Quiz: Done with 100%
• PMH DB Posts for This/Next Week: Done
• APNA Slide Presentation: Done and Uploaded
• APNA Post Test Questions: Done and Submitted

Which means the only thing I ran out of time to do was pre-write my Health Economics DB posts for next week. Unless I want to stay up another 3 hours and pull an all nighter . . . which I don't. But I probably will anyway. 


I think I have put on 5 years in the last 12 months.

First Week Down

I have been spoiled by summer break and have now retreated into my isolative, distractible state. On-Campus week was a blast and I will get around to posting the highlights from Dr. Carter's talk on the future of primary care, but in the meantime, this is what I am looking at for a schedule:

Evaluation of Practice:
Formulate a PICO question to post to discussion board and respond to those who post on mine while also posting advice to others, complete 4 CITI modules, take the 7 IHI Open School courses, work on my part of the clinical phenomena group project on care transitions (testing), work on my portion of the group meta-analysis project, and read. A bunch.

Healthcare Economics:
Answer the assigned questions by posting on Blackboard and responding multiple times within the group to show I read all of the assigned readings and have some independent thought and understanding of the topics, format my first essay paper and decide what topic I want to write about, watch some powerpoint presentations of economic theories and applications in healthcare, and read a few chapters in the Health Economics texts (and these guys must know what they are talking about since the cover price for the book is $236 - I bought the international edition for $50 brand-new on eBay. How's that for economics?!).

Management of Mental Health and Psychiatric Disorders:
Attend a conference call . . . while inputting all of my clinical notes into Medatrax, spend 2 days at my clinical sites, decide which consultation project to tackle and hopefully get a couple of others to join in, and read a couple hundred pages from textbooks and secondary sources.

For this next week - see above. I also need to get my butt in gear for the APNA. I have most of the powerpoint complete but I find the balmy 85 degree temperatures much more tempting than my laptop.

What's in a Set of Initials?

During on-campus time this week (more on that later) some of us were looking through the UTHSC yearbook and realized every other health discipline with the exception of nursing only listed their highest academic/licensed achievement. For those that were strictly degreed and certified in one discipline (i.e. only a medical doctor or a pharmacist rather than a physical therapist with a philosophy doctorate), their formal listings looked something like this:

John Doe, MD
Neurology

Jane Doe, DDS

Will Brown, PhD

Sara Brown, DPT

Steve Norris, AuD

Nancy Norris, Pharm.D

 . . . and then there was the nursing department:

Ann Smith, PhD, DNSc, MSN, APRN, FNP/GNP-BC, BSN, RN-BC

(Really? Yes, really.)


On a few of my professional LinkedIn groups, a number of threads have been started questioning the need for alphabet soup credentials and in what order to put them in. One of the participants posted an informative article from ANCC called Playing the Credentials Game (and quite appropriately, the author had an absurd number of credentials listed after her name) which reccommends listing degrees highest to lowest, state license, ANCC certifications, fellowships, and other awards. So I guess my high school GED comes before my RN-BC which comes before the Walden Theatre Unicorn Award I won for being a team player, but after my Golden Key Honor Society membership.

What it comes down to is that without a national scope of practice represented by one designation, as most of our healthcare colleagues have, we are likely doomed to feel listing degree, licensure, state designation, and national certification essential. I suppose either bravado or compensation makes us feel it necessary to list awards and certifications. As for myself, I will stick with my original response to the question of how to present one's name:

I am passionate about the over-listing of credentials that nurses have adopted in comparison to other healthcare professionals that pick their highest degree/license. I list my highest licensing credential (APRN) and that is it because it encompasses my RN and graduate level education (which you cannot have without some level of undergraduate, and for that matter high school education). After reading the article Francis posted (thank you), I am more compelled with my plan to list my DNP only, since it is the terminal degree for advanced practice, just like the MDs, PsychDs, DPTs, and PharmDs do:

Jaclyn Engelsher, DNP
Family, Psychiatry

"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?

A Final Word on Epidemiology

This time last year I was in knots of excitement over starting the DNP program and had no idea I was in store for one of the most challenging and frustrating courses since Mr. Wilhelmi's 7th grade science class (I contend his leaf identification test is still the most difficult exam of all time). So in honor of Epi memories of yore, and since I am stuck with the textbook which couldn't even pass "acceptable" status on Amazon buyback, I would like to share the following quotes:

"People commonly use statistics like a drunk uses a lamppost: for support rather than for illumination."—Mark Twain

"Epidemiology is nothing to hang your hat on. Correlations may indicate something about populations, but if you, yourself, find you exercise better at a particular time of day, they are almost useless." - Mark Sisson

"To every complex question there is a simple answer … and it is wrong."—H.L. Mencken

"Of course we don't know what we're doing, that's why it's called research."—Albert Einstein

"The greatest public health threat for many American women is the men they live with" - Anna Quindien

"Being approximately right most of the time is better than being precisely right occasionally."—Anonymous

"Prejudice is a great time saver. You can form opinions without having to get the facts."—E.B. White

"Chance favors the prepared mind."—Louis Pasteur

"That's all very well in practice, but will it work in theory?" - Anonymous

"I'm Going to Disneyland!"

I am officially registered for the APNA conference . . . a good thing since I am presenting!

3011: Social Networking for Psychiatric and Mental Health Nurses
Jaclyn Engelsher, RN-BC, APRN, FNP-BC, DOM; Tanitha Moncier, FNP

Abstract
Social networking, a relatively new communication phenomenon, has the ability to provide education, foster advocacy, promote the profession, and influence mental health policy. It also has the potential to violate boundaries, infringe on privacy, create liability, and damage professional credibility. A review of the literature revealed limited research has been conducted concerning the impact and use of social networking sites in nursing practice and other healthcare disciplines. In 2010 the ANA issued an informal resolution regarding use of social media in keeping with the Code of Ethics and called for additional study.

In Psychiatric/Mental Health Nursing, communication is the foundation of the therapeutic alliance. Because social networking communications have the potential to positively and negatively affect this alliance, it is imperative to develop guidelines for prudent and resourceful usage of social networking media that complies with practice acts, promotes professionalism, and maintains work-life balance for the psychiatric mental health nurse. This session will provide an overview of different types of social media outlets, review published position statements from other healthcare disciplines, and consider best practices for Psychiatric/Mental health nursing.

After looking at the schedule, I wish I was multi-planer because there are a lot of interesting topics going on at the same time including a military specific track, integration of mental and physical healthcare practice, and use of complementary modalities from music making to use of heavy quilts as a comfort measure for depression. I must admit, I am hope the LACE discussions are as lively as they were last year. I love a good nurse fight (getting it out is far better mentally and much more entertaining then letting angst fester into lateral violence later on!).

Networking Nurse Notice

Just "LinkedIn" with author and fellow FNP Stephen Ferrara from NYC. Check out his awesome blog about the nursing world: A Nurse Practitioner's View