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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.
Joyce L. Ross, MSN, CRNP, CLS, FNLA, FPCNA
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.
Lynn A. Kelso, RN, ACNP-BC, FCCM, FAANP
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.
Lynn A. Kelso, RN, ACNP-BC, FCCM, FAANP
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! 



The American Nurse Project

clock April 25, 2014 01:25 by author Lisa Bonsall, MSN, RN, CRNP

During a discussion with several nurses last night, we acknowledged the importance of nurses having a passion for the profession, and how this passion makes a difference in patient care. When I view the trailer for The American Nurse: Healing America, I feel the passion in the voices of those nurses featured. I can only imagine the impact that viewing this entire feature documentary will have. It premieres during National Nurses Week and I am really looking forward to seeing it! 

In 2012, Carolyn Jones, a photographer and filmmaker, traveled across the United States documenting the work of nurses. Her book, The American Nurse, was published that year and includes portraits, interviews, and biographies of nurses she encountered on her journey. An interview with Jones reveals her passion for this project, despite not being a nurse herself. She states, “Nursing is real. I'm fascinated by how a nurse can help all different people, even people that have committed terrible crimes, with the same compassion that they can treat a friend.” She learned a lot during her conversations with nurses and her journey is bringing our important work into the eyes of the public. For that, I am grateful. 

I will leave you with this powerful quote from the mission of The American Nurse Project: 

“At some point in our life each of us will encounter a nurse, whether it be as a patient or as a loved one. And that one encounter can mean the difference between suffering and peace; between chaos and order. Nurses matter.

I hope that many of you will get the opportunity to see this film. You can find a list of theaters here. I look forward to hearing what you think! 



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



Free CE for Perioperative Nurse Week!

clock November 11, 2013 00:34 by author Lisa Bonsall, MSN, RN, CRNP

Happy Perioperative Nurse Week! To celebrate your hard work and commitment to patient safety, the 2 continuing education articles in the November issue of OR Nurse 2013 are availabe at no charge! That's 4.8 contact hours for FREE! 

 Review of processes to reduce colorectal surgery site infections: An OR perspective
2.3 contact hours

 Tetralogy of Fallot: The evolution of congenital heart surgery
2.5 contact hours 

After reading the articles, just click 'Go to CE Details' to take the test and get your free CE. For even more savings, check out our CE collection on Surgical Site Infections.

Have a great week!



Standardizing nursing handoffs

clock March 29, 2013 02:54 by author Lisa Bonsall, MSN, RN, CRNP

Handoffs are a known “trouble spot” when it comes to patient safety. As nurses, we participate in handoffs any time we transfer care to another provider, whether at change of shift, transfer to another floor or unit, or transfer to another facility. Errors that occur during these times can result from a variety of barriers, many of which are human factors, ranging from understaffing and interruptions to fatigue and information or sensory overload. 

The Joint Commission requires a standardized approach to patient handoffs; it is one of the National Patient Safety Goals (2006 National Patient Safety Goal 2E). During her presentation “Effective Handoff Communication: A Key to Patient Safety” at Nursing2013 Symposium, JoAnne Phillips, MSN, RN, CCRN, CCNS, CPPS, shared several acronyms that can be used to help guide a well-organized transfer of information and minimize errors and omissions during patient handoffs. 

SBAR + 2 (See also The Art of Giving Report and The impact of SBAR.)
  Introduction
  Situation
  Background
  Assessment
  Recommendation
  Question & Answer

5 P’s Model
  Patient
  Plan
  Purpose
  Problems
  Precautions

PACE
  Patient/Problem
  Assessment/Actions
  Continuing/Changes
  Evaluation

I PASS the BATON
  Introduction
  Patient
  Assessment
  Situation
  Safety Concerns
  the
  Background
  Actions
  Timing
  Ownership
  Next

What is the standard for nursing handoffs where you work?

References:

Cairns, L., Dudjak, L., Hoffman, R., & Lorenz, H. (2013). Utilizing Bedside Shift Report to Improve the Effectiveness of Shift Handoff. Journal of Nursing Administration, 43(3). 

Riesenberg, L., Leisch, J., Cunningham, J. (2010). Nursing Handoffs: A Systematic Review of the Literature. American Journal of Nursing, 110(4). 

Schroeder, S. (2006). PATIENT SAFETY: Picking up the PACE: A new template for shift reportNursing2006, 36(10).  



Pause and listen

clock February 4, 2013 02:53 by author Lisa Bonsall, MSN, RN, CRNP

How many times has a patient said “I feel funny” or “I don’t feel right” and then proceeded to code shortly thereafter? That happened to me twice.

How many times have you felt pulled in different directions – between call lights, alarms ringing, medications to be administered, dressings to be changed, patient education to be provided, etc.? For me the answer is TMTC (too many to count!)

How many times has a patient deteriorated quickly or coded without any warning signs? I’d say several.

I wonder if during any of those times a patient was trying to reach out to me to say “I feel funny” or “I don’t feel right” and the opportunity to intervene passed without my knowledge because I was busy with other tasks.

Just thinking…

I wish that we had enough time during our day to just pause and listen. Wouldn’t that be nice?

 



Nurses call to action

clock December 21, 2012 09:27 by author Lisa Bonsall, MSN, RN, CRNP

I have been trying to limit my watching of the Newtown, Connecticut events on television. I feel guilty about it, as those directly affected by the horrible massacre that occurred December 14th must face the tragedy every minute of every day. Like you, I am experiencing all sorts of feelings of sadness and anxiety and my thoughts and prayers are with the victims, their families, and the first responders.

I have not limited my reading though. I feel that by reading the stories shared by family members, I am getting to know the victims and in some small way, I am honoring them. I am reading the stories shared by the survivors and feeling that in some small way, by doing so I am helping them process the events by “listening.” I am reading the thoughts and feelings of how others are processing what happened, hoping to contribute to the discussion and let our voices be heard so that changes can be made to make our nation a stronger and safer place for ourselves and our children. 

Now I turn to the feelings of “How can I help?” and “What can I do?” I encourage you to see posts from our colleagues at AJN’s Off The Charts and Nursetopia for lists of resources and ways to help. Also, the American Nurses Association has assembled a list of more than 30 nursing organizations joining forces to call for change. 

“The nation’s nurses call on President Obama, Congress, and policymakers at the state and local level to take swift action to address factors that together will help prevent more senseless acts of violence. We call on policymakers to: 

• Restore access to mental health services for individuals and families 

• Increase students’ access to nurses and mental health professionals from the elementary school level through college 

• Ban assault weapons and enact other meaningful gun control reforms to protect society”

Nurses – we are the largest single group of health care professionals. We see the devastation caused by weapons and violence. We care for patients with mental illness and know there is need for improved services and access to treatment. It is time to take action.



To Those Affected By Hurricane Sandy...

clock November 2, 2012 08:29 by author Lisa Bonsall, MSN, RN, CRNP

What to say here? I am still in shock by the devastation caused by this hurricane. 

I grew up on Long Island. My parents, my brother and his family, and many childhood friends still live there. Yes, they experienced loss of ‘things’ and remain without power, but they are all safe. As the stories emerge of lives lost, I know how lucky we are. 

The accounts of hospitals closing and patients being evacuated are amazing. I am in awe of those who’ve worked so hard and continue to work so hard to keep patients safe and provide care to those in the hospital as well as out in the community. The evacuation and transfer of patients, especially of NICU babies from NYU Langone Medical Center, is incredible to me. As a mom of 2 NICU graduates, I remember well the challenges of repositioning a sick premature baby in his isolette; I can’t imagine moving across New York City during a hurricane. What more can I say but THANK YOU to our nurse colleagues and the other healthcare professionals who managed this incredible feat. 

To those dealing with loss, I imagine you will never see this post. If, by chance, you do come across this writing someday, know that at this moment, my thoughts and prayers continue for you. I hope that you have rebuilt your home, whether in the same location or somewhere new, and you’ve been comforted and supported in your grief. 

American Journal of Nursing has created a list of helpful resources (open access) to help us cope now and be ready for future emergencies. 

Wishing everyone safety and good health during recovery efforts. 



Resources for Alcohol Awareness

clock April 13, 2012 04:55 by author Lisa Bonsall, MSN, RN, CRNP

I was taken aback when I read that “one in five patients admitted to a hospital suffers from alcohol use disorder” in Managing alcohol withdrawal in hospitalized patients in the April issue of Nursing2012 (here’s the pdf for the best view). With numbers like this, it really is critical that we are aware and able to assess all patients for signs and symptoms of alcohol withdrawal. I’d like to bring this article to your attention because there are some great resources included to help assess patients and also care for those experiencing alcohol withdrawal. There is a table on timing of symptoms – when they might occur in relation to the last drink – and also a copy of the Clinical Institute Withdrawal Assessment for Alchohol Scale, Revised (CIWA-Ar), which is the gold standard for assessing for withdrawal. The CIWA-Ar is not copyrighted – so go ahead and print it out, share it, and use it (in accordance with your facility policy, of course.)

April is Alcohol Awareness Month. While those of us in the hospital setting may come in contact with patients at risk for or experiencing alcohol withdrawal, we all know that a critical component of alcohol awareness is prevention. This year’s theme is “Healthy Choices, Healthy Communities: Prevent Underage Drinking."  Won’t you read more about this and help spread the word?



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