One of the worse pet peeves I have is people who don't buckle up their children in car seats and seat belts. Too many times I see this while I'm driving through town and it just sets my teeth on edge! 

This is not a new concept! They are there for a reason. There is nothing worse than seeing children injured with permanent damage just because they were out of their safety restraints. 

Please buckle up your children and yourselves for goodness sake! Save a nurse practitioner's sanity if for nothing else.

It's National Nurse Practitioner Week. Make sure that you tell your favorite NP how much you appreciate them. 

I've seen several hypertensive men in my career as a nurse practitioner. Often on follow up visits, they present with uncontrolled blood pressures. I ask them if they are taking their medications. Most say no because they don't like the way the medication makes them feel.

When I ask in what way, they usually say that it makes them feel tired. This is a legitimate reason but usually not the real reason. Most actually finally tell me that it's not that they really feel badly, but that they have difficulty maintaining an erection. This is also a legitimate reason to feel bad because a person's sexuality is very important to their well being.

Unfortunately, being alive is also very important! I try to impress upon them that it may be more important to be alive long enough to have sexual relations than to have it as often as they would like. This sometimes convinces them to take their meds. I do try to find the least side effect causing medications as possible.

Please don't be afraid or embarrassed and discuss this with your health care provider. It's really a matter of life and death or at the very least a stroke that can incapacitate you.

Be well!

Pop over and check out my latest guest post over at Nurse Connect.com. Make sure that you sign up so you can leave me a comment. They have great nurse resources over there too.

I am currently trying to work on this template. This is a test post to see how it is working so far. Forgive the aggravation while I work on it. Thanks!

Below is an example of an ARNP Protocol that must be signed between you and your collaborating physician and filed with the Boards of Nursing and Medicine. I hope this helps you in your practice endeavors! Information retrieved from the Florida Board of Nursing.

ARNP Protocol - (format example)

(Should be no more than 2 to 5 pages)

1. Requiring Authority:

1. Nurse Practice Act, Florida Statutes, Chapter 464
2. Florida Administrative Code, Rules Chapter 64B9-4 Administrative Policies Pertaining to Advanced Registered Nurse Practitioners

II. Parties to Protocol:

(Should only list one ARNP & one Doctor here)

1.

Nancy R. Nurse, ARNP, RN 9999999

123 Main Street

Somewhere, FL 99999
2.

Ian M. Doctor, MD, MX 999999, DEA 999999

Practice Name

456 Center Street

Somewhere, FL 99999

III. Nature of Practice:

This collaborative agreement is to establish and maintain a practice model in which the nurse practitioner will provide health care services under the general supervision of Dr. Ian M. Doctor. This practice shall encompass family practice and shall focus on health screening and supervision, wellness and health education and counseling, and the treatment of common health problems. (Use appropriate description for your specialty and activities) Practice Location(s):

IV. Description of the duties and management areas for which the ARNP is responsible:

A. Duties of the ARNP:

The ARNP may interview clients, obtain and record health histories, perform physical and development assessments, order appropriate diagnostic tests, diagnose health problems, manage the health care of those clients for which she has been educated, provide health teaching and counseling, initiate referrals, and maintain health records. (Specific guidelines for patient care decision making may be referenced here. I.e., ARNP developed practice guidelines, professionally developed guidelines, text books, etc. Do not send these references to the Board of Nursing with protocol agreement.)

B. The conditions for which the ARNP may initiate treatment include, but are not limited to:

Otitis media and externa

Conjunctivitis

Upper respiratory tract infections

Sinusitis

C. Treatments that may be initiated by the ARNP, depending on the patient condition and judgment of the ARNP:

1. Suture of simple and complex lacerations not requiring ligament or tendon repair.
2. Incision and drainage of abscesses.
3. Removal of ingrown toenail.

D. Drug therapies that the ARNP may prescribe, initiate, monitor, alter, or order:

(ARNPs CANNOT PRESCRIBE CONTROLLED SUBSTANCES)

Any prescription medication which is not listed as a controlled substance and which is within the scope of training and knowledge base of the nurse practitioner.

-or –

Antibiotics

Antihypertensives

Etc.

V. Duties of the Physician:

The physician shall provide general supervision for routine health care and management of common health problems, and provide consultation and/or accept referrals for complex health problems. The physician shall be available by telephone or by other communication device when not physically available on the premises. If the physician is not available, his associate, John R. Doctor, MD, MX 999999 (or other description of designated doctor(s) or groups), will serve as backup for consultation, collaboration and/or referral purposes.

VI. Specific Conditions and Requirements for Direct Evaluation

With respect to specific conditions and procedures that require direct evaluation, collaboration, and/or consultation by the physician, the following will serve as a reference guide:

Clinical Guidelines in Family Practice, X Edition, by Constance R. Uphold, ARNP, PhD, and Mary Virginia Graham, ARNP, PhD (or other reference text or practitioner created reference guide)

OR

The physician will be consulted for the following conditions:

3rd degree lacerations

Severe hypertension determined by ____

Etc. (list appropriate conditions)

VII. All parties to this agreement share equally in the responsibility for reviewing treatment protocols as needed and no less than annually.

____________________________/ _______ License # RN9999999

Nancy R. Nurse, ARNP Date



____________________________/ ________ License #ME 999999

Ian M. Doctor, MD Date DEA # 999999

PLEASE NOTE:

Practicing ARNPs must file a protocol at the time of renewal or when there are changes with the Board of Nursing. Alterations or amendments should be signed by all parties and filed with the Board within 30 days.

The protocol and any amendments or changes are to mailed to the ARNP Department, Board of Nursing, 4052 Bald Cypress Way, Bin #C02, Tallahassee, FL 32399-3252. If there are no changes to the protocol, only a dated signature page is needed with a statement that there have been no amendments or changes since the last submission. A copy for each review period should be kept by each party for a period of four years. The supervising physician is responsible for submitting a notice to the Board of Medicine that they have entered into a supervisory relationship with an ARNP.

Once again, the legislative powers in Florida have chosen to drag behind the rest of the United States by not giving nurse practitioners prescriptive authority for controls.

Senate Bill 972 and companion House Bill 515 would have given NPs in rural areas the ability to write for controls such as sleep aids, anxiety medications, and various pain medications (Schedule II-V) under a collaborative agreement with their collaborating MD. Nurse Practitioners have been writing prescriptions since 1987. Florida is now one of the LAST TWO states that have continued to have a total block against NPs regarding these controlled medications.

One reason that Nurse Practitioners need the ability to write these medications is that many NPs practice independently in offices in which their collaborating MDs are not working. In the office that I currently work, I am the only provider for right now. They are recruiting a doctor but if I need to write a pain medication for an injury or abscessed tooth, for example, I have to contact my collaborating MD by calling him to pull him out of a room or leave him an email which slows down the processes at both offices. It also delays the care that my patients need at the time. In our office, we send chronic pain patients to pain management so we don't write a lot of controls anyway. It really frustrates me that I cannot write for a sleep aid for insomnia or testosterone for male menopause. 

It is also limiting my practice due to having my front office personnel screening any new patients by explaining that I can do everything that a MD can do (diagnose, treat, refer to specialists, and educate etc.) but cannot write for certain meds. My office is one of the few Tricare Prime, and Signa providers in my area and am having to turn them away causing them to drive additional mileage. This is causing a hardship due to gas prices and causing delays in care. All due to being in one of the last two states dragging their feet. 

How can we fix this? If you are a NP, become more vocal in your practice and have your patients who are being inconvenienced write letters to their State legislature and complain LOUDLY. Become a member of your local NP group and become active in local venues. Speak with physicians in your area and find out about their concerns and show them current studies showing how well nurse practitioners take care of their patients. 

It's time for Florida to get on the ball with patient care!

I work in a rural area where there are limited numbers of health care providers. I often eat at a local restaurant and have heard people refer to a nurse practitioner as "Dr. So and So." I have never seen this person correct anyone when they do that.

This is something that really burns my toast! I ALWAYS identify myself as a nurse practitioner and tell my patients to NEVER refer to me as Dr.

I do not have the MD degree and do not intend to pursue a doctorate in nursing any time soon. If I change my mind, I will let my patients call me Dr. but will remind them that I am still a nurse practitioner. There is much ado about the potential confusion with patients referencing us as Dr. in the medical side of the field. In my office, there is no confusion.

NPs should never pretend to be a MD. We are not and never will be unless we go back to medical school and obtain it. I have no intention of starting over and going through 8 years of college in order to do what I already can now as a FNP. I can diagnose, treat, and interpret tests just fine without it.

Please don't refer to NPs as Dr.

Thanks!

 

I was reading a blogpost regarding the Doctor of Nursing Practice and wondered if it was truly worth the time and cost of going back to school for three more years. I don't feel the need to add another three years worth of classes to my already burgeoning loan debt after 7 years of school at 83,000 dollars (you read right!).  I would have more schooling than a general MD with 8 years of schooling (DrNP title after 10 years), but will it bring me more money in my current position? I highly doubt it. Will it bring me more respect? I think that the way that I treat my patients and my treatment outcomes already speak for themselves. WIll the new title of Dr. NP cause my patients role confusion? Not in my practice. I already continuously remind them that I am not a MD and don't pretend to be one. Pretty darn close though! There are others in our profession that do not correct patients when they refer to us as Dr. So and So. This is a real pet peeve of mine!

I also have to disagree about the DNP being a new hybrid. Nurse Practitioners with Master's Degrees already work by blending the nursing and medical models together. That's the only way to practice as a NP because we are diagnosing and treating medical conditions. We don't just go by nursing theory contrary to beliefs, or at least I don't.

I have to admit that I was gungho about the new concept and planned to pursue the "end degree" but think that I will reserve judgment until I see the true benefits. I can already teach RN students with a Master's degree so unless I decide to teach BSN or Master's then I would go back. But then, the practice Doctorate isn't really about teaching. It's about furthering our knowledge base and practice experience. I can also do that by going to conferences, doing CMEs and reading the most current practice research. All mostly for free!

Any DrNPs out there who can tell me if it is worth the time and effort currently. Why do you think so or not? Leave me a comment on the comment blog or the guestbook. 

I was checking out my sitemeter and usually research what brings people to my site. One of the most common entries is "Are you happy being a NP?"
Well...let me think about it for a minute...Sure am!! I love my job! I can't say enough about it. It is one of the greatest things that has EVER happened to me. Here's some of the top reasons why I love being a Family Nurse Practitioner.

1. I can actually make patients better! I have the ability to interview patients and get to the root of their health problems and show them ways to  gain some control over their lives.
2. Patients trust me with their lives. What an awesome and humbling responsibility.
3. I get to take care of entire families as a Family Nurse Practitioner. It's fun to take care of the kids as well as the parents. It makes for an interesting visit sometimes.
4. Of course, I make really good money. While it's not my main reason for being a NP, it does help to pay off my student loans and keeps a decent roof over my family's head.
5. I help teach other nursing students when I can. I often have students stop by my office and ask for advice and help with homework. I only wish I could do it more often. I plan to teach one day when I can afford to.
I can't think of any others right now because I'm a little tired. You can tell me some of your reasons for being a health care professional by leaving me a comment on the guestbook or on the contact me page where you will find links to do so. Till next time! Be healthy and help others.

All Florida-licensed RN's and LPNs are now in a 24-month renewal cycle and must complete 24 hours of appropriate continuing education during each renewal period. One (1) contact hour is required for each calendar month of the licensure cycle, including two (2) hours on Prevention of Medical Errors. HIV/AIDS is now a one-time, 1-hour CE requirement to be completed prior to the first renewal. Domestic Violence CE is now a 2-hour requirement every third renewal. For example, if you renew your license on January 31, 2007, you are required to complete the Domestic Violence CE before the January 31, 2011 renewal.

A registered nurse who also holds a current Advanced Registered Nurse Practitioner certificate may satisfy the continuing education requirements for both licenses by completing appropriate courses for a registered nurse, or may satisfy up to 50% of the requirement by completing continuing medical education coursework.

Appropriate subject matter for continuing education are those which meet the professional education needs of the licensee in order to meet the health care needs of his or her patients and consist of content from one or more of the following:

1. Nursing practice areas and special health care problems.

2. Biological, physical, behavioral, and social sciences.

3. Legal aspects of health care.

4. Management/administration of health care personnel and patient care.

5. Teaching/learning process of health care personnel and patients.

6. Subjects at an accredited education institution that are taken and are advanced beyond that completed for original licensure.

7. Personal development subject matter must include application of content as it relates to improved patient care.

I have finally decided to start a new site after my husband commented that he thought that it was time to spread my wings a bit and get a dot com. I hope that you enjoy it as much as you do my other site "The Nurse Practitioner's Place" on blogspot. I am still working out the kinks and look forward to your input regarding this new endeavor. Please leave a comment on my guest book due to the inability to comment directly to blog posts.

The picture of the flowers on the background are ones in my back yard that I took a few weeks ago. I am partial to the color purple so I thought it was appropriate. I will occasionally update the background image based on my moods. 

Enjoy!