Yeah Minnesota

 Courtesy of AANP.org

 Right after Connecticut Minnesota voted and now makes 19 States and the District of Columbia that have become full practice states for NPs. 

NP Independence expands again.

Eighteen States and the District of Columbia now allow NPs to practice independently. Connecticut being the most recent. As four decades of outcome research in primary care has shown, NPs provide safe, high-quality care. These are not straight out of school NPs practicing independently. Depending on the State it can only happen after gaining 2-4 years (approx 4200-8300 hours) of experience working in collaboration with a physician. Yes, there will be a few NPs able to become independent right away, but most will stay working in their current positions and with physicians.

The West seems to be more progressive in this matter, but the East will catch up. It's a tough fight with the National and State chapters of the AMA, a few think only doctors are qualified to diagnosis and treat patients. California tried to pass an NP bill last year, but the California Medical Association spent a lot of money and it failed. It usually takes a few tries to pass these types of things.

But what's happening in the South and not one State. I worked in Florida as an RN, and understand the good old boys club (FMA), with their large membership of retired and semi-retired doctors not wanting to give an inch to NP independence. But as for the rest of the south, this is the stroke belt and a recognized area of health problems, in addition to a shortage of primary care practitioners. NPs need to get together and organize because patients need you, but expect a smear campaign from your state medical association    

     

Time to Relax

Instead of stopping posts on this blog, it will now have to be my generic happy nurse practitioner blog.  This after finding it impossible to remain anonymous using Blogger which is a Google product. Because I also use and have accounts with other Google products like; Gmail, Picasa album, Google Docs, Google Drive, Google Maps, Android OS & apps, Google +, Chromecast, YouTube, Google Scholar and Google Music.  In addition, there is not much to complain about in life now that two big stresses have come to an end.

Nurse Practitioner Preceptors - Plan Ahead

I would not mind being a preceptor for an NP student sometime in the future, and when I feel comfortable with my own skills and time management, but that will be a year or two. These days I regularly see postings of students looking for nurse practitioner preceptors. I have even received emails via my LinkedIn profile asking me to be a preceptor. I was lucky in that my school matched us with preceptors, but here is the problem. Many schools and online degree programs do match you with a preceptor, and after you start do not give a damn that you cannot find a preceptor. They have your money and you are on your own to find preceptors. 

As a NP students you will need preceptors, and a minimum number of clinical hours to get board certified. National standards also require your preceptors to be certified, practicing and pass a screening process; this avoids fraud on the part of the school and by the student.

The thing is there are not enough preceptors for all the students out there.  Nurse practitioner I have talked to do not precept for many reasons and it has to do with the business of healthcare. Most companies give NPs a set block of time to see a set number of patients. In primary care that is usually 15-20 minutes to see the patient, diagnose, treat and chart, and the urgent care visits are as fast as possible. Your preceptor then needs to double check everything the student does, because it is their license in jeopardy every time the student sees one of their patients. I'm sure but probably some large and small companies also do not want the liability of a student.  

If you Google and look around at the comments about finding preceptors, I think the best thing you can do is to be proactive and line up your preceptors before starting a program, or go into one that matches you with preceptors. Pursue your dreams but plan ahead.

Concentra the fast food model of health care

I think I have found the perfect example of what happens when you combine a Fast Food business plan with healthcare, it is called Concentra. Concentra is owned by Humana, which as most people know is a for profit managed care and health insurance company. They are in the process of rapidly expanding nation wide, kind of like Subway with one in every strip mall. When I visited two of their clinics recently it was evident by the take a number, sit by the plastic plant, and one of our employees who all dress in the same uniform will help you shortly.  Healthcare has been going down this quicker, cheaper and dehumanizing path for a while.  





There are large companies that operate similar services like United Heath who do a good job of not turning  people into a commodity and hopefully there will be a rebellion against this type of plastic drive-thru model of care. What happened to the real family physician? 

Scam Cell Phone Calls

I remember when mobile phones were immune to solicitors and credit card service scams. Not any more now they are a regular thing. It is bad enough to have people in the states calling and scamming, but these area codes look like local US area codes but are not. The scam is they call and do not leave a message, and then when you call back you could be hit with a big one time charge. There are apps you can download or simply do not call them back. As for those local scam calls maybe an air horn into the phone.

242- Bahamas	441 – Bermuda	784 - St. Vincent & Grenadines
246 – Barbados	473 – Grenada, Carriacou and Petite Martinique	809, 829, 849 – Dominican Republic
264 – Anguilla	649 – Turks and Caicos	868 - Trinidad and Tobago
268 – Antigua	664 – Montserrat	876 - Jamaica
284 – British Virgin Islands	758 – St Lucia	869 - St. Kitts & Nevis
345 – Cayman Islands	767 – Dominica

ANCC or AANP NP Certification Exam

The American Nurses Credentialing Center (ANCC) and the American Association of Nurse Practitioners (AANP) are the two organizations that administer the tests to become board certified as a nurse practitioner. There are several tests depending on your educational qualifications. Tests areas include Family, AGNP, Peds, Midwifery and Psychiatric, and tests can then be Acute or Primary care, again depending on your degree. You only need to be certified by one, but I took the primary care test from both organizations. Why both, well I got cocky and failed the AANP the first time. That made me focus and get serious. I also said to hell with this and registered to take both the ANCC and AANP tests in the same week. Logic told me I can’t fail both, luckily I passed both and I am now 2 for 3.

Most of my classmates were taking the ANCC test and I started hearing people saying it was easy and not what they expected. First mistake, do not listen to people. I should have looked at the websites and noticed that about 80% pass both tests. That means next time you're in a lecture count off your classmates and realize that on average every 5^th person is going to fail. Like those awful group project, count off 1, 2, 3, 4. . (Shit it’s me).

Mistake number two is I studied wrong. You need to use more than one resource, and especially do not get stuck on practice test questions for your studying. Master your material from school and clinicals. Because although Fitzgerald and others books are decent, not one question from those books are on the tests. They may be similar enough to confuse you, but they are not the same.  

You will hear that it does not matter which test you take, which is true. The ANCC has been around longer than the AANP test, and there was a time when organizations like the Veterans Administration only recognized the ANCC. Today because they are both certifying boards, companies cannot discriminate against one or the other or they would probably be sued. 

The AANP is 150 timed questions and the ANCC is 175 timed questions. Some of the questions for both tests do not count, and you do not know which ones. They mix sample questions into the tests to see how people will answer them, and if they are viable test questions then they can be added in the future. This testing is also not like the NCLEX test, where the computer might turn off at 75 questions, or adjust based on how you are doing. You will answer all questions, and they are all random multiple choice. I did hear that they might be adding some pictures in the future, which would have been nice with those dermatology questions. For example reading erythematous scattered raised papules could be a couple things, give me a picture please.  

Truthfully, I really wanted to like the AANP test, because their organization seems geared towards Nurse Practitioners, and they have local and state chapters for NPs to network. The ANCC on the other hand is all over the place and seems to certify everything and anybody including the hospital itself. They are the ones behind the whole Magnet Hospital certification. Magnet status cost hospital a lot of money and research is showing Magnet status has not improved patient outcomes, but it does look good in the advertising and on the letterhead.

 Having now seen 475 of the board questions it is true, the AANP test is concentrated more on assessment, diagnostic and treatment based questions. While the AANC, while still having assessment, diagnostic and treatment questions, also includes therapeutic communication, research, policy, cultural issues, epidemiology, psychology and some regulatory questions mixed in. I liked this format, because as an NP only part of your business is assessing and treating patients. Also, look at your program it may be pushing you towards one or the other test. Besides the core curriculum our program had lots of research and cultural components.

It might be my background, but the ANCC seemed easy compared to the AANP. Since I took the AANP test twice their questions seemed redundant and they like to play word games. For example instead of checking your knowledge base, they would ask several questions on one topic like TSH, T3 and T4, or COPD and only change some words in the question or answer looking to trick you. 

Have to renew in 5-years, but for hundreds of dollars each it will not be with both organizations. We will see who does a better job of supporting and promoting NPs and probably renew with them.
 

85 vs 3,500,000,000

I found it shocking that the richest 85 people in the world, and many of them are in the pharmaceutical and various healthcare industries, now have the same wealthy as 3.5 billion or half the world's population. Will be hard not to think of that as I treat some of my patients who are struggling between the cost of food and housing, versus paying for healthcare services

http://business.time.com/2014/01/20/worlds-85-wealthiest-people-as-rich-as-3-5-billion-poorest/

http://www.nbcnews.com/business/worlds-85-richest-have-same-wealth-3-5-billion-poorest-2D11958883

In all parts of life, practice makes perfect.

Video of 20 day old Husky puppy learning to howl.

Probably won't be as cute when it is a 110 lbs.

What nursing shortage?

The hospital system where I pick up shifts as an RN recently went through a round of asking nurses and other staff to take ”voluntary severance packages”, or more accurately early retirement. They needed more than 200 people to accept this offer or they would need to start layoffs soon. This is not unusual as many hospitals including one of the largest systems in the country, Kaiser Permanente, has been recently been doing the same thing at their 37 hospitals and asking people to take severance packages and leave.

This is a good and a bad thing for nursing. Why is getting rid of RN’s a good thing? Because a lot of these retirement packages were aimed at nurses and staff who were hanging on, and needed encouragement to leave. I can’t blame them when in the bay area a nurse can easily make over six figures. But, healthcare is a business in this country and money will always be a factor in how decisions are made. It is hard to see some of them go because of the wealth of knowledge they had for newer nurses. However, maybe in a few years this will open up jobs again for new grads in this area.

The bad is if there was a nursing shortage do you think they would be getting rid of nurses, even expensive ones? You can Google nursing shortage myth or not, and get many reasons for the pros and cons of whether there is a nursing shortage now or in the future. All I know is around here new grads are not finding jobs. This may be different other parts of the country, but if you are going into nursing do some research. Because nursing schools will cry shortage, but they need students and their money. People need to make sure nursing is what you want to do and not because it is a job or you can’t think of anything else.