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’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?”

Think about it.

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.

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!

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.