NursingCenter’s In the Round

A dialog by nurses, for nurses

The ‘Threat’ of NPs: An NCNP 2014 Wrap-Up

clock May 5, 2014 07:19 by author Lisa Bonsall, MSN, RN, CRNP

It’s been a little over a week since the National Conference for Nurse Practitioners in Chicago, and I am reviewing my notes and reminded of the learning and networking that took place during the conference. On my very first page, from the Welcome and Opening Remarks of Conference Chairperson, Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, SCP, FAAN, DCC, I had written the following: 

I remember this point vividly, as Dr. Fitzgerald had commented that years ago, when our numbers were much smaller, not too many people had an issue with nurse practitioners practicing to the full extent of our education and training. Now however, as there are over 180,000 nurse practitioners, the power of our numbers is threatening to many, even despite recent research demonstrating our value in patient outcomes and satisfaction. This point is incredibly evident in this recent Op Ed piece from The New York Times, Nurses are not Doctors, where the author cites a study from 1999 to support his opinion, which is clearly not the most up-to-date, best available evidence. Have you read it? I encourage you to do so when you are sitting down, because it did bring out a bit of my temper. Rest assured that some leaders in nursing did reply with some Letters to the Editor and you can read them here

And now back to some take-aways from NCNP…

*The states with the least restrictive NP regulations see twice as many patients as those in other states.
Carol L. Thompson, PhD, DNP, ACNP, FNP, FCCM, FAANP
Keynote Address: Awesome Practiced Daily

*Don’t use an ARB and ACE inhibitor concomitantly to treat hypertension.
JNC-Late: A Focus and Update on the Long-Awaited Hypertension Guidelines

*Not all infected patients are febrile and not all febrile patients are infected.
Acute: Fever of Unknown Origin in Adults

*If a patient has an inappropriate tachycardia related to his elevated temperature, consider pulmonary embolism as the cause.
Acute: Fever of Unknown Origin in Adults

*Sepsis doesn’t kill patients; multisystem organ failure resulting from sepsis does.
Sophia Chu Rodgers, ACNP, FNP, FAANP, FCCM
Acute: Understanding the Latest Sepsis Guidelines

*If a patient has kidney injury, used unfractionated heparin for DVT prophylaxis.
Sophia Chu Rodgers, ACNP, FNP, FAANP, FCCM
Acute: Understanding the Latest Sepsis Guidelines

*Our patients give us very important information, if we listen!
Christine Kessler, RN, MN, CNS, ANP, BC-ADM
Common Sense Assessment Tips Every NP Should Know

*If a patient has loss of the hair that makes up the outer eyebrows, think hypothyroidism. 
Christine Kessler, RN, MN, CNS, ANP, BC-ADM
Common Sense Assessment Tips Every NP Should Know

*The presence of pulsus paradoxus is a sign of cardiac tamponade, but can also be seen in severe asthma.
Christine Kessler, RN, MN, CNS, ANP, BC-ADM
Common Sense Assessment Tips Every NP Should Know

*To assess judgment in patients with traumatic brain injury, ask “What would you do if there was a fire in your kitchen?”
Tracey Andersen, MSN, CNRN, FNP-BC, ACNP-BC
Neuro Assessment and Diagnostic Work-up for Advanced Practitioners

Thanks for reading this wrap-up! Want to see photos from the event? Here’s our album – enjoy! 

Headlines from the ADA

clock July 8, 2011 01:39 by author Lisa Bonsall, MSN, RN, CRNP

The American Diabetes Association's 71st Scientific Sessions took place at the end of June and several headlines have come across our newsfeed .  Here are some highlights that you might be interested in:

Access more information from this meeting, including video highlights, webcasts of select presentations, and links to abstracts, at DiabetesPro: Professional Resources Online.

The Future of Nursing...can we steer through the bureaucracy and make it a reality

In 2008, the Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM) launched an initiative that looked at where the nursing profession was and where it needed to go. Their purpose was to make  recommendations for an "action-oriented" blueprint for the future of nursing. The group looked at the educational levels of nurses, the roles of nurses, and where nurses practice. This week, RWJF and the IOM released recommendations on how the nursing profession needs to transform to better meet the healthcare needs of people across the country.

The 4 key messages are:

1. Nurses should practice to the full extent of their education and training.

2. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.

3. Nurses should be full partners, with physicians and other health care professinals, in redesigning health care in the United States.

4. Effective workforce planning and policy making require better data collection and an improved information infrastructure.

As I read the report brief, it occurred to me that their recommendations seem like common sense. The evidence clearly shows all these things are true. It will be interesting to see if we are able to steer through the "politics of bureaucracy" and make these recommendations a reality. What do you think?

No more "P" in CPR

When I was a nursing student, my boyfriend's grandmother suffered a cardiac and respiratory arrest in front of me. After a second or two of shock and saying to myself I can't believe this is happening to me, I told my boyfriend to call 9-1-1 and then I moved her from the bed to the floor and started CPR. After a few series of chest compressions and rescue breathing, she vomited into my mouth. They certainly didn't teach me that could happen in the CPR class I had! Once the paramedics arrived, they defibrillated her, got a rhythm and pulse back and they transferred her to the hospital.  When I told several people what had happened, they told me they could never have done CPR on someone because they could never get the ratio of compressions to ventilations right, and they feared catching something from the victim or having the victim vomit in their mouth.  As we now know, lay people are often hesitant to do CPR for just these reasons.

Today The New England Journal of Medicine published an article that will hopefully change laypersons perceptions of doing CPR. The multicenter, randomized trial looked at 1,941 patients who were randomly assigned to one of two groups, to receive chest compresions alone or to receive  chest compressions plus rescue breathing. According to the study, the results support a strategy for CPR performed by laypersons that emphasizes chest compressions and minimizes the role of rescue breathing.

What does this mean for layperson CPR?  Chest compressions are the priority, press hard, press fast, and don't stop until the person wakes up, the rescuer gets too tired to continue, or help arrives. It will be interesting to see if more bystanders will be willing to jump in and perform chest compressions on people who cardiac arrest outside the healthcare setting.  Giving a victim a little "push" may be just the thing to improve their future.



Do I really need to take that NSAID?

How many of us take an ibuprofen or a naproxen when we have aches or pains or even a headache without thinking twice about it. If you're like most people, I'm sure that's exactly what you do.  Research published in the journal Circulation: Cardiovascular Quality and Outcomes recently may have many of us thinking differently.  The article, "Cause-specific cardiovascular risk associated with nonsteroidal anti-inflammatory drugs (NSAIDs) among healthy individuals", looked at a sample size of 1,028,437 Danish individuals over the age of 10. Use of the nonselective NSAIDs, diclofenac, and the cyclooxygenase-2 inhibitor, rofecoxib, were associated with a dose dependent increased risk of cardiovascular death.  In addition, ibuprofen, was associated with an increased risk of fatal or nonfatal stroke. Naproxen was not associated with an increased cardiovascular risk in this study.

While this is not the first study to highlight the cardiovascular risks associated with NSAIDs, it gives us a chance to consider the thought that all drugs in a certain pharmaceutical class, don't have the same risk profile. NSAIDs are an integral part of the arsenal of medications we use everyday to alleviate our patients' pain as well as our own.  We need to keep in mind  that  one drug maybe more appropriate for a patient than another.

Here's my challenge for you. Before you take your next dose of one of these drugs, ask yourself this question? Do I really need this medication, or is there something else I could do to feel better? 

The "D"s have it

What type of personality did the last cardiac patient you took care of have?  When I think about my last cardiac patient, a Type "A" personality automatically comes to mind.  But, an article in the American Journal of Cardiology may change our perception about who is having a heart attack.  The article I am referring to looked at patients who either had a myocardial infarction or died of it. People with a Type "D" personality had triple the risk of having an MI or dying of an MI.  What does a Type "D" personality look like you ask? It's someone who is angry or suppresses their anger. 

This makes a lot of sense when you think about it.  Someone who is always angry or suppresses their anger, does sound like quite a few of the cardiac patients I've taken care of recently.  Do we tell patients to let loose with their anger?  Of course not.  We need to help educate these patients in anger management techniques and connect them with a counselor who can teach them to handle their emotions in a more constructive way.  

So next time  you take care of a patient experiencing a cardiac event, don't be so quick to give them an "A".  They may be a "D" after all.

A pill a day won't keep heart disease away...on its own

"An apple a day keeps the doctor away." "Take an aspirin and call me in the morning." We're all familar with these sayings and it appears there will be another added shortly.  If you had the opportunity to take a medication to help prevent heart disease would you take it?

 Recently the FDA approved  the added indication of heart disease prevention to a popular statin drug. There are 6.5 million people without cholesterol issues or heart problems that will be eligible for this preventative therapy.  Some healthcare providers are questioning whether putting patients on this  type of preventative therapy is worth it.  Will patients be compliant with the laboratory tests that are necessary while they are on the medication?  Will patients stick to a low fat, low cholesterol, heart healthy diet or will they see this as an opportunity to eat anything and everything they want?  Will patients take the initiative to get off the sofa and exercise on a regular basis?  What about the potential drug side effects? And the final question, can the patient afford this medication? 

Regardless of where you stand on this issue one thing is clear, every patient must be evaluated for this type of preventative therapy on an individual basis. As healthcare providers we  must make sure patients understand they need to follow through with other lifestyle changes needed to prevent this disease in addition to taking the medication.  A pill a day won't keep heart disease away...on its own. 

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Views expressed on this blog are solely those of the authors or persons quoted. They do not necessarily reflect Lippincott's's views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.

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