Sunday, 28 May 2017

In terms of educational options related to the nursing profession, there are a plethora of programs available to students. It is important to understand all of the available alternatives and determine which program or advanced degree fits your career goals and lifestyle. According to the Henry J. Kaiser Family Foundation, there are currently 3.1 million active registered nurses and approximately 800,000 licensed practical nurses in the United States.

Nursing Degree US, Nursing Career, Nursing Practitioners, Nursing Roles,

LPN or LVN Degree

The quickest way to enter the nursing workforce is to become a licensed practical nurse (LPN) or licensed vocational nurse (LVN). These programs usually take a year to complete and can be done through local community colleges, vocational/technical schools, or hospital-based programs. This option is convenient for those who work or have families. Additionally, some courses can be taken online or during the summer, which gives students greater flexibility. These programs are faster paced than other nursing programs and only teach basic nursing skills vs. in-depth science and nursing classes.

While this may be the quickest avenue to enter the nursing profession, the use of LPNs is being phased out. In many facilities, LPNs are being replaced with Registered Nurses (RN) who hold Bachelors of Science in Nursing (BSN) degreesor those with Associates Degrees in nursing. Furthermore, LPNs have a smaller scope of practice than RNs. The scope of practice is determined by each state, and LPNs may or may not be able to:

■ Take verbal or phone orders from a doctor
■ Administer narcotics
■ Care for central intravenous lines
■ Administer medications that are given via intravenous push

According to the U.S. Bureau of Labor Statistics, LPNs can earn annual salaries as low as $33,300 in West Virginia, and up to $53,010 in Connecticut. LPNs average approximately $20 per hour. Fortunately, as LPNs are being phased out of hospital settings in some states, they are still able to find employment in nursing homes, rehabilitation centers, and home care.

Bachelor of Science in Nursing (BSN)

Obtaining a BSN requires a commitment to a four-year program through an accredited university. Some students enter these programs after completing high school. Nurse hiring committees often favor candidates with a BSN degree; nurses with their BSN will usually have better job opportunities and the potential to earn higher salaries.

BSN programs are a combination of lecture-based classes and clinical rotations completed at a local hospital or other medical facility. Nurses that plan on advancing their career and obtaining higher education degrees will need a BSN in order to enter those advanced programs. After completing a BSN program, students are able to sit for the National Council Licensure Examination (NCLEX) to become a registered nurse. A student needs to pass this exam before practicing as an RN.

Registered Nurse (RN)

A registered nurse is a nurse who has graduated from an accredited nursing program with a BSN, associate degree in nursing (ADN), or diploma from a hospital-based program in nursing. To obtain an RN license, an individual needs to pass the NCLEX in the state where they wish to obtain licensure. Students also need to check with their state of residence since some states have additional criteria for licensure. RNs are able to hold licenses in multiple states at the same time. A nurse is only required to pass the NCLEX once and then may apply for a license to practice in other states after the initial licensure.

Nurses are responsible for administering medication, monitoring patients' conditions, documenting nursing care, notifying medical staff about patient progress of the patient, and performing medical procedures that are within their scope of practice.

According to The U.S Bureau of Labor Statistics Occupational Outlook Handbook for 2016-17, the median expected annual salary for RNs is $66,640. California has the largest number of active registered nurses with an annual mean salary of $102,260. California, Alaska, Hawaii, Oregon, and Massachusetts have the highest mean salaries for nurses; however, they do vary within each state. West Virginia, Alabama, Mississippi, South Dakota, and Iowa have the lowest mean salaries for RNs.

Nurse Practitioner (NP)

Nurse Practitioners (NP) are advanced practice nurses (APRNs) who have taken masters-level classes and passed the American Academy of Nurse Practitioners Exam. Nurse Practitioners can specialize in adult, geriatric, pediatric, family, or women's health; within each of these specialties, a Nurse Practitioner can specialize even further. For example, a pediatric nurse practitioner (PNP) can specialize in cardiac care, intensive care, oncology, or become a general practitioner, to name a few. These subspecialties require additional classes and on-site training, and with more specialization comes potentially higher salary opportunities.

To become a nurse practitioner, one has to first be a current registered nurse. RNs interested in advancing their careers must apply to a graduate program that offers their specific program of interest. Applicants are required to submit resumes and letters of recommendation, as well as transcripts from their undergraduate education. Some programs require an applicant to take the GMAT (Graduate Management Admission Test) as well. NP programs generally require 2-3 years as a full-time student or 5 years if completed on a part-time basis.

The American Academy of Nurse Practitioners (AANP) released a statement, revised in 2015, outlining the scope of practice for an NP. "Nurse practitioners assess, diagnose, treat, and manage acute, episodic and chronic illnesses. NPs are experts in health promotion and disease prevention. They order, conduct, supervise, and interpret diagnostic and laboratory tests, prescribe pharmacological agents and non-pharmacologic therapies, as well as teach and counsel patients, among other services." The AANP acknowledges that these practices will vary among individual states and institutions.

As of May 2015, the U.S Bureau of Labor Statistics reported the median salary for NPs was $98,190. California registered the highest median salary for NPs at $120,930. Currently, California, Hawaii, Alaska, Massachusetts, and Oregon have the highest median salaries for NPs. Pennsylvania, Kansas, South Carolina, Missouri, and Illinois have the lowest median salary for nurse practitioners.
Question Of The Day, Gastrointestinal Disorders
Q. A client with gastroenteritis is admitted to an acute care facility and presents with severe dehydration and electrolyte imbalances. Diagnostic tests reveal the Norwalk virus as the cause of gastroenteritis. Based on this information, the nurse knows that:

A. the client requires an antiviral agent.
B. enteric precautions must be continued.
C. enteric precautions can be discontinued.
D. the client's infection may be caused by droplet transmission.

Correct Answer: B
Explanation: The nurse must continue enteric precautions for a client with gastroenteritis caused by the Norwalk virus because this virus is transmitted by the fecal-oral route. No safe and effective antiviral agent is available specifically for treating viral gastroenteritis. The Norwalk virus isn't transmitted by droplets.

Friday, 26 May 2017

Question Of The Day, The Neonate
Q. Just after delivery, a nurse measures a neonate's axillary temperature at 94.1° F (34.5° C). What should the nurse do?

A. Rewarm the neonate gradually.
B. Rewarm the neonate rapidly.
C. Observe the neonate hourly.
D. Notify the physician when the neonate's temperature is normal.

Correct Answer: A
Explanation: A neonate with a temperature of 94.1° F is experiencing cold stress. To correct cold stress while avoiding hyperthermia and its complications, the nurse should rewarm the neonate gradually, observing closely and checking vital signs every 15 to 30 minutes. Rapid rewarming may cause hyperthermia. Hourly observation isn't frequent enough because cold stress increases oxygen, calorie, and fat expenditure, putting the neonate at risk for anabolic metabolism and possibly metabolic acidosis. A neonate with cold stress requires intervention; the nurse should notify the physician of the problem as soon as it's identified.

Nursing is a call to leadership

By its very nature, the professional nurse role is one of leadership. Across the healthcare continuum, regardless of our role or practice setting, we are looked to as leaders. As nursing students, we are taught we will lead colleagues from other ancillary groups, oversee care teams and be accountable for patient care outcomes. Some nurses spend years leading in an informal leadership capacity, while others take on formal management and leadership roles. However, all management and leadership roles are not the same, and although the titles often are used interchangeably, they are not synonymous.

Nurse manager, Nurse Career, Nursing

The nurse manager role up close

Whether managing a unit, division or service line, at its core the nurse manager role is to ensure everything functions like a well-oiled machine. The nurse manager is involved in myriad daily tasks and details related to patient care planning, quality improvement, goal setting and budgeting. But that’s not all. Nurse managers also oversee staff schedules and assignments, performance, professional growth and the ongoing provision of educational and career enhancement opportunities. The manager is responsible for ensuring the staff carries out all assignments and is held accountable if they’re not.

And staff members — nurses, CNAs, techs, etc. — have certain expectations for their nurse managers. They look to their managers for clear communication, direction and support in fulfilling their roles and responsibilities. They also want their managers to be available, open and honest. Nurse managers are their source for information, advice and guidance, but they also want — and deserve — encouragement, clear expectations and directions, and some teaching and coaching. Most of all, they want to be included in decision-making, recognized for their contributions and considered important to the team.

“Nurse managers are their source for information, advice and guidance, but they also want — and deserve — encouragement, clear expectations and directions, and some teaching and coaching.”

The nurse leader role up close

Upper level nurse leaders, in most instances, are less task-oriented than nurse managers. They are less hands-on and more focus on setting standards, spearheading transformation and inspiring and influencing their teams. They are charged with fulfilling the organization’s mission, vision and strategic long-range plans.

Their role involves policy setting and overseeing quality measures; dealing with regulatory compliance, certainly taking on fiscal responsibilities and more. They have responsibility and accountability for the overall quality of patient care delivery, patient and staff satisfaction, and organizational outcomes.

Both staff and management look to them for their knowledge, experience and vision. Their role is an expansive one that touches the entire organization.

Managers and leaders complement each other

Managers function best in the company of good leaders, but both roles should be filled by individuals who earn the respect and admiration of their staff, are passionate about their work and instill that passion in their staff. Both managers and leaders:

Must be motivators who positively influence their staff and set positive examples.
Must have excellent decision-making skills — able to coordinate teams and delegate duties.
Must be committed to the organization and those they lead.

Title aside, all nurses are called to leadership

The call to leadership moves all of us to a higher plane of responsibility and accountability, with or without a management title; it is inherent in all nursing positions from staff nurse to CEO. We all have similar goals and responsibilities for patient care.

“The call to leadership moves all of us to a higher plane of responsibility and accountability, with or without a management title; it is inherent in all nursing positions from staff nurse to CEO.”

With all the changes currently underway in our healthcare delivery system and the nursing profession, all nurses must strive to emulate the hallmarks of good management and leadership and never stop working on our professional growth. We all need to stay informed and be politically saavy; we need to know what our professional journals and nursing organizations are saying and advance our education.

In the end, all nurses must be visionaries, critical thinkers, skilled communicators and teachers. And the good news is you do not need a formal manager or leader title required to do any of these things.

Thursday, 25 May 2017

Question Of The Day, Postpartum Period
Q. A client is experiencing an early postpartum hemorrhage. Which item in the client's care plan requires revision?

A. Inserting an indwelling urinary catheter
B. Fundal massage
C. Administration of oxytocics
D. Pad count

Correct Answer: D Explanation: By the time the client is hemorrhaging, a pad count is no longer appropriate. Inserting an indwelling urinary catheter eliminates the possibility that a full bladder may be contributing to the hemorrhage. Fundal massage is appropriate to ensure that the uterus is well contracted, and oxytocics may be ordered to promote sustained uterine contraction.

Saturday, 20 May 2017

Question Of The Day, School-age Child
Q. On initial assessment of a 7-year-old child with rheumatic fever, which of the following would require contacting the primary care provider immediately?

A. Heart rate of 150 beats/minute.
B. Swollen and painful knee joints.
C. Twitching in the extremities.
D. Red rash on the trunk.

Correct Answer: A

Explanation: A heart rate of 150 beats/minute is very high for a 7-year-old child and may indicate carditis. For this age group, the normal heart rate while awake is 70 to 110 beats/minute. Swollen and painful joints such as the knee are characteristic findings in the child with rheumatic fever and do not require immediate physician notification. Twitching in the extremities, known as chorea, is a characteristic finding in a child with rheumatic fever and does not require immediate physician notification. A red rash on the trunk typically indicates rheumatic fever and does not require immediate physician notification.

Thursday, 18 May 2017

Q. The nurse is assessing the development of a 7-month-old. The child should be able to:  

A. Play pat-a-cake.
B. Sit without support.
C. Say two words.
D. Wave bye-bye. 

Correct Answer: B

Explanation: The majority of infants (90%) can sit without support by 7 months of age. Approximately 75% of infants at 10 months of age are able to play pat-a-cake. The ability to say two words occurs in 90% of children by age 16 months. A child typically can wave bye-bye at about 14 months of age.

Tuesday, 16 May 2017

Question Of The Day, Medication and I.V. Administration
Q. Total parenteral nutrition (TPN) is prescribed for a client who has recently had a significant small and large bowel resection and is currently not taking anything by mouth. The nurse should:

A. Administer TPN through a nasogastric or gastrostomy tube.
B. Handle TPN using strict aseptic technique.
C. Auscultate for bowel sounds prior to administering TPN.
D. Designate a peripheral intravenous (IV) site for TPN administration.

Correct Answer: B
Explanation: TPN is hypertonic, high-calorie, high-protein, intravenous (IV) fluid that should be provided to clients without functional gastrointestinal tract motility, to better meet their metabolic needs and to support optimal nutrition and healing. TPN is ordered once daily, based on the client's current electrolyte and fluid balance, and must be handled with strict aseptic technique (because of its high glucose content, it is a perfect medium for bacterial growth). Also, because of the high tonicity, TPN must be administered through a central venous access, not a peripheral IV line. There is no specific need to auscultate for bowel sounds to determine whether TPN can safely be administered.




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