I have been asked several times over the last few weeks about the “Shingles” vaccine. In the hospital setting as a floor nurse, I remember a particularly bad case of shingles that was causing my patient an excruciating amount of pain. He actually begged me to kill him because he couldn’t stand the suffering any longer.
Shingles is caused by the Herpes Zoster virus, which also causes chicken pox. It is usually more common in patients who are 60 and older but can happen sooner based on a lowered immune system or increased stress.
Symptoms sometimes include fever, malaise, and a burning, stinging sensation followed by a usually linear rash that is vesicular. The viral fluid in the vesicles are contagious to those who have never had the chickenpox. Once the vesicles dry out and scab over, they are no longer contagious.
One of the secondary problems with shingles is the potential for continued nerve pain. This can last for several years post outbreak. In order to help prevent it, patients can be vaccinated against Herpes Zoster.
Patients need to check with their insurance companies to see if it’s considered a covered vaccine and ask their health care provider about whether it’s a good idea.
I have been busy seeing patients at the new office and am finding rural health very challenging. Some of my patients are reporting chest pain and are in the population with the highest risk of heart attack. We offer sliding scale fee for those who don’t have insurance. This helps get people into the office but what happens after they report the chest pain? I tell them that they need to be evaluated with a stress test.
Here’s how it usually goes….
I’ll have to wait and see what happens or go to the Emergency Room if I have chest pain that won’t go away.
“You need to understand the risk of sudden death if you don’t evaluate the reason for the chest pain, right?”
Sure… but you know how it is. I have to put food on the table and pay the bills. I can’t afford to have a stress test.
“What will happen to your family if you pass away or become permanently disabled with a stroke? What about burial expenses?”
“Can you afford to die?”
“Can your throw your life away over being stubborn?”
While I was a NP student, I read an article by Gail Guterl. She is a consulting editor for Advance for Nurses magazine. She questioned the need for public disclosure of hospital acquired infections. There are 6 six states, Pennsylvania, Florida, Illinois, Missouri, Nevada and Virginia who require this information be public. The author wondered if this was viewed as a public shaming in order to force hospitals to lower the rates of infection.
This could also bring a higher incidence of lawsuits as well. Her question to the readers of the article was “Do we have a solution?”
After a bit of thought, I still thought that public disclosure was a good idea and I still do. If you try to hide information that could be potentially important to patients, it could be perceived as suspicious. I would like to have as much information about a facility before I am admitted in order to make a more informed choice. If I know that there is a higher rate of post-surgical infection, you can better believe I won’t be having surgery there. This information should not be used to punish facilities, but to help them to investigate why the increased infection rates are occurring.
Another thought on the subject of “hospital acquired infections”?? How many times have you instructed family members when a patient is on contact isolation with MRSA, VRE and C-diff about the importance of using the proper precautions? Multiple times I have explained this and find families respond with “I live with so and so. If I was going to be infected, I would already have it.” These people pick up the infection and pass them to others. If a person wants to infect themselves and take a serious health risk, whatever.. But don’t expose your children who are too young to understand the risks.
The solution? Put the visitation restrictions back in place regarding 12 and younger children. No babies allowed in the hospitals. Period. You don’t follow precautions before entering a patient’s room, you don’t get to enter. Period. Watch the number of infections drop. Enough said…
I’m not usually easily offended since I understand that there has always been conflict between nurses and doctors since time memorial. Paramedics have fought for years for the rights to practice their skills in the field. They were told to go to medical school if they wanted to practice medicine and “be doctors”. Through years of experience, look at how many lives they have saved in the field. Nurses have fought for the rights to take care of their patients for years as well. Years ago, we weren’t even allowed to take a temperature with a thermometer for goodness sake.
NPs are fighting for the rights to practice in their full capacities as well. What about the MD vs DO competition? DOs weren’t considered “real doctors” either.
For those who ask “if you want to act like a doctor, why don’t you go to medical school?”, I don’t feel like doing four years of Chemistry plus Physics or Calculus. I’ve already done 5 years of classes with extensive A&P, pharm, etc. Why would I go back to school for another 8 years just to take the same classes again along with a class in bedside manners when I already know how to take care of my patients? I’m happy with the opportunity to diagnose, treat, and educate my patients as a NP until I finish my Doctorate of Nursing Practice. I will then be at the pinnacle of the nursing profession and proud to have gotten that far. I understand my limitations and will consult a doctor when I need to.
I am lucky enough to work with progressive doctors who aren’t threatened by me as a primary provider.
I try not to include entire posts while commenting on stories, but I felt it needed to be read in it’s entirety to understand my angst. Please look for my responses mixed into the article in bold.
Council for the Advancement of Comprehensive Care and National Board of Medical Examiners Announce New Certification Examination for Doctors of Nursing Practice
NEW YORK–(BUSINESS WIRE)–The Council for the Advancement of Comprehensive Care (CACC) and the National Board of Medical Examiners (NBME) today announced that they have reached an agreement to develop and administer a Certification Examination for Doctors of Nursing Practice (DNP). This competency-based examination, which will be administered to DNP graduates for the first time in November 2008, will assess the knowledge and skills necessary to support advanced clinical practice. It will be comparable in content, similar in format and will measure the same set of competencies and apply similar performance standards as Step 3 of the United States Medical Licensing Examination (USMLE), which is administered to physicians as one component of qualifying for licensure.
At first, I was very excited upon hearing about a DNP in order to help us advance to the next level but:
The Doctor of Nursing Practice degree was developed in 1999 to respond to a national need for increased access to comprehensive patient care. More than 200 schools have or plan to establish a DNP program. This degree builds on nursing licensure as an advanced practice nurse by adding expanded knowledge and skill in nursing and medical aspects of care for complex illness. The growing burden of chronic illness in the United States will require an even greater focus on collaborative and team-based care.
DNP certification is a three-part process. Candidates must attain licensure as advanced practice nurses, graduate from a DNP program, and successfully complete the CACC Doctor of Nursing Practice Certification Examination. In addition to completion of the DNP educational program, a passing score on the DNP Examination is intended to provide further evidence to the public that DNP certificants are qualified to provide comprehensive patient care. CACC will also focus its efforts on working within the nursing communities to define standards of care as well as develop and implement policies and procedures for monitoring the performance of individuals certified as DNPs, including their patients’ outcomes.
The Council for the Advancement of Comprehensive Care (CACC) was established in 2000 to further the development of standard clinical competencies for graduates of Doctor of Nursing Practice (DNP) programs. The Council determined that a national certification process would provide the public with a reliable way to identify advanced nurse clinicians with the DNP degree who can provide comprehensive care. Council membership is comprised of nurses, physicians, health care organization representatives and health and public policy experts.
The NBME is an independent, not-for-profit organization that provides high-quality examinations for the health professions. Protection of the health of the public through state of the art assessment of health professionals is the mission of the NBME, along with a major commitment to research and development in evaluation and measurement. The NBME was founded in 1915 because of the need for a voluntary, nationwide examination that medical licensing authorities could accept as the standard by which to judge candidates for medical licensure. Since that time, it has continued without interruption to provide high-quality examinations for this purpose and has become a model and a resource of international stature in testing methodologies and evaluation in health professions.
Rubenstein Communications, Inc.
Adam Pockriss, 212-843-8286
apockriss@rubenstein.com
This is implying that Master’s level NPs are not capable of giving comprehensive care to our patients? I am offended by this statement. I don’t feel the need to continue my education in a college setting in order to do what I already do on a daily basis very well. My patients receive comprehensive, family practice primary care without feeding the University machine. I don’t think taking a medical doctor type of exam is going to give us any more credence that an exam written specifically for NPs. Until I see a real need to go further, with real proof that we benefit from doing the DNP, I will watch and wait.
Come into office. Check phone and desk for messages. Check the labs that came across from the day before, and write out instructions on lab letters to be sent back to the patients. Draw labs on patients that my nurse can’t “hit”.
New pt visit 30-45 minutes: Complete history, including medical, surgical, and family history. Head to toe review of systems. Head to toe physical exam. Address any new symptoms or chronic symptoms. Refill or write any prescriptions needed. Educate about all disease processes and about what each prescription is for. Review if any preventative care has been completed such as mammogram, Pap, colonoscopy, bone density, etc. Request record release so that I can obtain prior records to review. Ask is there is anything else that they wanted to ask me. Explain our “open access scheduling (same day) to set up follow up. Off they go!
Next visit (established 15 minutes)- Medication review, ask if any changes in ROS since last visit. Address new problem or review established problems. Review any test results since last visit. Reinforce education about disease processes.
This process happens throughout the morning until 12:00 when we break for lunch. I usually eat in 30 minutes (left over from the hospital days- eat fast whatever is available). Use the rest of the lunch break to do any of the never ending paperwork.. I REALLY HATE THIS PART!
See patients throughout day varying from pediatrics to geriatrics. I also see minor emergencies such as I&D, suturing, stapling etc. Refer to Emergency Department any cases needing such expertise (You’re up all you emergency room nurses! Keep my patients safe and healthy!) We often get cases as a walk in basis that are serious because patients wait too long before being seen. That’s a story for the next edition..
04:15-05:00- Email or call my collaborating MD to discuss any difficult cases dealt with during the day. Return other physician phone calls if arise. Read through consultation notes received. Discuss the cases encountered during day with my nurse to encourage her to expand her knowledge base as well as pick her brain when needed.
That’s pretty much a day in the life of a Family Nurse Practitioner. I love my job and really enjoy building relationships with my patients and watching them respond to the treatments I recommend. I am taking care of entire families now and that’s what it’s all about!
I had a question at my other blog site that I thought would be a great post for this one.
If an individual is a Respiratory Therapist (RT) with an associates degree (with the possibility of doing an online completion program to make it a bachelors degree) is it possible to become a Nurse Practitioner without having to completely start from scratch in a nursing program? Like, go directly into the NP masters program? I do understand it is required to be an RN before going to NP school…but there must be SOME route around having to start all over…
Joe, You do have to become an RN before advancing into the Master’s level as a nurse practitioner. The good thing is that it is fast tracked in a much shorter program in many such as the one below that I found online. If you Google the subject, you will find many programs available.
One such program states, “Recognizing the urgent need to build the nation’s pool of qualified nurses, the MGH Institute of Health Professions implemented a new baccalaureate degree program in May 2008 designed to quickly move graduates into the nursing workforce.
The 14-month Accelerated Bachelor of Science in Nursing (BSN) provides you with the knowledge and skill preparation that employers increasingly prefer for entry-level nurses. Designed for applicants who already possess a bachelor’s degree in another field, no prior nursing education or experience is required to apply to the Accelerated BSN.
As the first educational institution in Massachusetts, and one of the first in the nation, to develop a Master of Science in Nursing curriculum for individuals holding a bachelors degree in a field other than nursing, the MGH Institute has more than 20 years of experience in preparing students with no nursing background to become advanced practice nurses.
The direct-entry Master of Science in Nursing (MS) program consists of a three-year, graduate-level curriculum that commences with three semesters of generalist-level (pre-RN) courses, followed by three semesters of advanced-practice-level specialty coursework.
I hope this little bit of information helped. You can probably find many more programs on the web.
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