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The Rise of the Nurse Practitioner

clock April 3, 2014 16:36 by author Lisa Bonsall, MSN, RN, CRNP

This infographic was shared with us by Maryville University’s Nursing Program

 



Nursing2014 Symposium

clock March 31, 2014 08:08 by author Lisa Bonsall, MSN, RN, CRNP

I’m on my flight home after another successful LWW nursing conference! Nursing2014 Symposium was held from March 26 to March 29, and between the preconference workshops, sessions, exhibit hall, and city of Las Vegas, these days were overflowing with learning from national experts, networking with colleagues, and fun!

I was lucky enough to assist with the preconference workshop, Let’s Get Messy: Hands-On Anatomy, Resuscitation, and Emergency Skills Lab, presented by Scott DeBoer, RN, MSN, CEN, CPEN, CCRN, CFRN, EMP-P. During this one-of-a-kind course, we reviewed anatomy and practiced procedures such as intraosseous device placement, airway management techniques, and more. We even practiced skills on actual pig airways, hearts, and lungs. Here are some pictures!  

A recurring theme throughout the sessions I attended had to be changing clinical practice based on the evidence. In the opening session, Nurse’s Habits: “But That’s the Way We’ve Always Done It!, Julie Miller, RN, BSN, CCRN, reviewed many of the practices that we perform just because we’ve always done them. From the use of Trendelenburg for hypotension to methods used for verifying placement of feeding tubes, it is clear that we’ve got a long way to go to change practice based on the evidence. (FYI – unless contraindicated, position hypotensive patients flat with the legs elevated; get an x-ray to confirm feeding tube placement.) 

Here are some more tips & takeaways from this conference: 

*The guiding principles of patient and family-centered care are information sharing, participation, dignity and respect, and collaboration. 
Tiffany Christensen
Partnering with Patients – A Bed’s-Eye View of Patient and Family-Centered Care

*If you don’t know how to do something, don’t ask someone else who doesn’t know! 
JoAnne Phillips, MSN, RN, CCRN, CCNS, CPPS
Medication Safety: Going Far Beyond the Five Rights

*It costs between $45,000 and $55,000 to treat central line bloodstream infection (CLBSI). 
Sophia Chu Rodgers, ACNP, FNP, FAANP, FCCM
Best Practices for PICCs and CVCs

*The only thing you can pre-chart is a plan. Anything else, document as you do it or after it’s done. 
Edie Brous, RN, MS, BSN, MPH, Esq.
Documentation and Liability: How What You Write Can Show Up in Court

*HgbA1C levels are not accurate in sickle cell carriers or anemic patients. 
Christine Kessler, RN, MN, CNS, ANP, BC-ADM
ADVANCED TRACK: Sweet Success – Making Sense of the Dizzying Deluge of Diabetes Drugs

*Test for alpha-1 antitrypsin deficiency in Caucasian patients younger than 45 with COPD. 
Mary Knudtson, DNSc, NP, FAAN
Acute Exacerbation of COPD

*Make sure the ‘tank is full’ before using vasopressors. 
Michael Ackerman, DNS, RN, ACNP-BC, FCCM, FNAP, FAANP
ADVANCED TRACK: Hemodynamic Stability

These are just the highlights of the many notes I took during the conference. I hope that those of you who attended had a great time learning and networking too! Don’t forget that you can access the slides from many of the presentations online at Lippincott's eConference Center. Also, be sure to complete your evaluations and obtain your CE credit!

I am now looking ahead and getting excited for the National Conference for Nurse Practitioners April 23-26, 2014 in Chicago, Illinois. What conferences have you attended or do you plan to attend this year?



Shampoo-rinse-repeat

clock March 14, 2014 04:55 by author Lisa Bonsall, MSN, RN, CRNP

I was a new graduate working in the Medical ICU, a few weeks off orientation, when I cared for Jenny*. She was 18 years old, the youngest patient on our unit. It was not the norm for such a young person to be a patient on our unit. In fact, it was odd. 

She was a college student who had gone to Student Health Services with an upper respiratory infection. She was given antibiotics and sent on her way. Why did she develop acute respiratory failure? I’m not sure anyone ever knew that answer. It was just one of those things…

Jenny spent a long time in our unit – months – battling the gamut of ICU complications we were used to seeing, just not in someone so young. ARDS, renal failure, GI bleed…just to name a few. She had her share of time spent on vasopressors, paralytics, and sedatives; endured arterial lines, SWAN placement, and dialysis; received multiple blood transfusions and courses of antibiotics; and was on and off isolation precautions for various resistant organisms. A tracheostomy and g-tube were placed when she became more stable and ready to wean from the ventilator. 

I was usually the nurse that wanted the sickest patients. I didn’t mind getting an unstable new admission or going on a road trip with a patient to a diagnostic study or procedure. One of my best days, however, was a slow one in the unit. Jenny was fairly stable, and she was my only patient that day. Her mom was there and was always eager to help with Jenny’s care. 

As the shift went on, and it looked like things were going to stay quiet on the unit (not that we EVER said that our loud), I asked Jenny if she’d like me to wash her hair. Her eyes got real big and she looked at me questioningly. She nodded.

Like many tasks, it took longer to gather supplies than to actually perform it. I finally found real shampoo (and conditioner!), used a water pitcher for wetting her hair and rinsing, set up a trash bag to catch the excess water, and piles and piles of towels. 

Jenny’s mom and I worked together washing her hair. We joked about opening our own salon and Jenny was smiling looking up at us. We made a mess and all got pretty wet, but it was worth it. We had gotten those weeks of knots and dried blood and betadine from her hair, combed it neatly, and it smelled so nice! 

When we finished, Jenny asked for a paper and pen. She wrote “Think you could shave my legs?”

Her mom and I looked at each other. “Sure.”

*Not her real name.



Take a look inside our collection of stroke resources

clock March 6, 2014 03:43 by author Lisa Bonsall, MSN, RN, CRNP

Caring for patients with stroke can be challenging; when a stroke is occurring, it is imperative to distinguish the symptoms from other diagnoses. Determining the type and location of stroke is yet another difficulty. Further challenges are met with treatment and rehabilitation. 

To help you manage these complex issues, we’ve created a Focus On: Stroke collection, which is comprised of journal content, as well as the following special features:

Each item in this collection is only $1.99, or you can purchase the entire collection together with the Powerpoint slides, podcasts, and the Take5 for only $19.99 (doesn’t include CE).  

To further your learning and help you meet your continuing education requirements, we've bundled the three CE articles below at a reduced rate. Earn 7 contact hours for only $19.99 – that's a savings of more than $50 if purchased individually!

Aneurysmal subarachnoid hemorrhage: Follow the guidelines
Nursing2013
3 contact hours

Ischemic Stroke: The first 24 hours
The Nurse Practitioner
2 contact hours

Recognizing and Preventing Acute Stroke in Women
Nursing2012
2 contact hours

I hope you’ll take some time to explore this collection! Have a question or comment? Please feel free to connect with me here on the blog by leaving a comment or you can email me at clinicaleditor@nursingcenter.com.  



3 days left!

clock February 25, 2014 05:03 by author Lisa Bonsall, MSN, RN, CRNP

Two of our most popular CE collections will be expiring on Friday, February 28, 2014. If you haven’t already taken advantage of these specially-priced collections, you should check them out ASAP!

Anticoagulant Medications
7.3 contact hours - $19.99
Expiration Date:  2/28/2014
When patients are on anticoagulant medications, significant safety concerns exist, especially the risk of excessive anticoagulation and hemorrhage. It is important to understand these risks yourself, as a healthcare provider, and to educate the patients in your care on how to minimize their risk and be alert for complications. 

NP: Pharmocology Hours
10.4 contact hours/10.4 advanced pharmacology hours - $44.95
Expiration Date:  2/28/2014
Depending on the state where you work as a nurse practitioner or your area of practice, it may be necessary for you to maintain a certain number of advanced pharmacology hours for your license or certification. 

Need more CE? See our complete list of topical CE collections and our special collections on ‘never events.’ Please be aware that the CE tests for each article must be taken before they expire.



AACN Choosing Wisely®

clock February 8, 2014 00:19 by author Lisa Bonsall, MSN, RN, CRNP

The Choosing Wisely® campaign was launched in 2012 by the American Board of Internal Medicine as a way to spark conversations to improve care and minimize unnecessary testing. The goals of the campaign are to ensure that care is supported by evidence; not duplicative of other tests or procedures already received; free from harm; and truly necessary (ABIM Foundation, 2014). Many organizations have released recommendations in support of the campaign – a full list is available here.

Last week, the American Association of Critical-Care Nurses (AACN) became the first nursing organization to get involved in the campaign. Its Choosing Wisely® list includes the following five evidence-based recommendations (American Association of Critical Care Nurses, 2014) :

  • Don't order diagnostic tests at regular intervals (such as every day), but rather in response to specific clinical questions.
  • Don't transfuse red blood cells in hemodynamically stable, non-bleeding critically ill patients with a hemoglobin concentration greater than 7 mg/dL.
  • Don't use parenteral nutrition in adequately nourished critically ill patients within the first seven days of a stay in an intensive care unit.
  • Don't deeply sedate mechanically ventilated patients without a specific indication and without daily attempts to lighten sedation.
  • Don't continue life support for patients at high risk for death or severely impaired functional recovery without offering patients and their families the alternative of care focused entirely on comfort.

As a nursing professional, I am proud to see AACN collaborate on this important initiative. I encourage you all to remain cognizant of these recommendations, share them with your peers, and stay up-to-date on the latest evidence.

For further reading, the articles below are available for free to logged in members of Lippincott’s NursingCenter.com.  Not a member?  Join now!

In the News: Rethinking Routine Blood Work in Patients with MI
American Journal of Nursing
 
Blood Management: Best-Practice Transfusion Strategies
Nursing2013
 
Parenteral Nutrition Risks, Complications, and Management
Journal of Infusion Nursing
 
Sedation Vacation: Worth the Trip
Nursing2013 Critical Care
 
Ethics in Critical Care: Twenty Years Since Cruzan and the Patient Self-Determination Act: Opportunities for Improving Care at the End of Life in Critical Care Settings
AACN Advanced Critical Care
 
Hoping for the Best, Preparing for the Worst: Strategies to Promote Honesty and Prevent Medical Futility at End-of-Life
Dimensions in Critical Care Nursing

References:

ABIM Foundation. (2014). About. Retrieved from Choosing Wisely: http://www.choosingwisely.org/

American Association of Critical Care Nurses. (2014, January 28). News: Critical Care Groups Issue 'Choosing Wisely' List. Retrieved from American Association of Critical Care Nurses: http://www.aacn.org/wd/publishing/content/pressroom/pressreleases/2014/jan/choosing-wisely-aacn-ccsc.pcms?menu=aboutus



Well done, CVS!

clock February 6, 2014 08:14 by author Lisa Bonsall, MSN, RN, CRNP

My very first job was at a CVS store. I worked as a cashier there in high school and for 2 summers during college. As a cashier, I was responsible for restocking the cigarettes behind the counter…not a part of the job that I enjoyed, but it passed the time when we were slow. The area behind the counter was pretty narrow, and I would often have to step over and around cases of cigarettes while working. They sold quickly back then and my hands would smell of cigarettes after an evening of work.

I was impressed when I read the announcement yesterday that CVS stores would no longer be selling cigarettes. What an example this organization is setting, and I am hopeful that this will start a trend among other pharmacies and retailers. 

"Ending the sale of cigarettes and tobacco products at CVS/pharmacy is the right thing for us to do for our customers and our company to help people on their path to better health," Larry J. Merlo, president and CEO of CVS Caremark, said in a statement. "Put simply, the sale of tobacco products is inconsistent with our purpose."

Along with this news, the company has announced the launch of a smoking cessation plan this spring. 

Well done, CVS! 

According to the 2014 Surgeon General's Report: The Health Consequences of Smoking—50 Years of Progress, there are 12 cancers and 20 chronic diseases linked causally to smoking. It is encouraging that the prevalence of cigarette smoking has declined from 42% in 1962 to 18% in 2012  (U.S. Department of Health and Human Services, 2014), however, it is even more encouraging that smoking cessation programs are continuing to be developed. There is more work to be done to educate the public and help people to not start smoking and to quit if they already do smoke.

More Resources:

Reference:
U.S. Department of Health and Human Services. (2014, January). 50 Years of Progress: A Report of the Surgeon General, 2014. Retrieved from SurgeonGeneral.Gov: http://www.surgeongeneral.gov/library/reports/50-years-of-progress/50-years-of-progress-by-section.html



World Cancer Day

clock February 4, 2014 02:24 by author Lisa Bonsall, MSN, RN, CRNP

Today is World Cancer Day and it is inspiring to see the large number of tweets with the hashtag #WorldCancerDay on our twitter news feed! To add to your reading and education, listed below are some of the latest articles published in our journals. All are free to read online and are available for CE credit.

Non-small cell lung cancer: Recent advances 
Nursing2014, February 2014 

 Cancer Pain Strategies and Interventions for Brain Metastases
Oncology Times, January 2014

 Supporting Cancer Survivors
Oncology Times, December 2013

You can find more continuing education articles related to oncology on NursingCenter’s CEConnection.



Go ahead and share!

clock January 21, 2014 14:34 by author Lisa Bonsall, MSN, RN, CRNP

 

You may have noticed these new ‘share’ options on each of our article pages. Since we can't all read everything (although I do try!), if there is something that really interests you or that you think will benefit your friends, followers, email contacts, people in your circles, or the like, please feel free to pass it along! I hope this new feature makes it easier to share the content from our journals. 

Any problems or suggestions, you can comment here or email me at clinicaleditor@nursingcenter.com. Thanks!



Celebrate Nursing 2014: Part 1

clock January 18, 2014 03:12 by author Lisa Bonsall, MSN, RN, CRNP

As we move into 2014, let’s not forget to celebrate our hard work and that of our colleagues! Here’s the list of nursing recognition days and months for the first part of 2014*. Please let me know if you know of others.

*I will add/update links as they become available.

National Nurse Anesthetists Week
January 19-25, 2014

National IV Nurse Day
January 25, 2014

PeriAnesthesia Nurse Awareness Week
February 3-9, 2014

Critical Care Transport Nurses Day
February 18, 2014

GI Nurses and Associates Week
March 24-28, 2014

Certified Nurses Day
March 19, 2014

Radiologic & Imaging Nurses Day
April 12, 2014

April 16, 2014

May 2014

May 2014

May 6-12, 2014 (National Nurses Day is May 6)

May 7, 2014

May 7, 2014

May 12, 2014

May 11-17, 2014

May 11-17, 2014


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