CRNAs: We'll Be Watching

Since I know I have a lot of friends who want to be CRNAs i have posted some information and a PSA announcement that might be useful.

Nurse anesthetists have been providing anesthesia care to patients in the United States for nearly 150 years. 
The credential CRNA (Certified Registered Nurse Anesthetist) came into existence in 1956. CRNAs are anesthesia professionals who safely administer approximately 32 million anesthetics to patients each year in the United States, according to the American Association of Nurse Anesthetists (AANA) 2009 Practice Profile Survey. 
CRNAs are the primary providers of anesthesia care in rural America, enabling healthcare facilities in these medically underserved areas to offer obstetrical, surgical, and trauma stabilization services. In some states, CRNAs are the sole providers in nearly 100 percent of the rural hospitals.
According to a 1999 report from the Institute of Medicine, anesthesia care is nearly 50 times safer than it was in the early 1980s. Numerous outcomes studies have demonstrated that there is no difference in the quality of care provided by CRNAs and their physician counterparts.* 
CRNAs provide anesthesia in collaboration with surgeons, anesthesiologists, dentists, podiatrists, and other qualified healthcare professionals. When anesthesia is administered by a nurse anesthetist, it is recognized as the practice of nursing; when administered by an anesthesiologist, it is recognized as the practice of medicine. Regardless of whether their educational background is in nursing or medicine, all anesthesia professionals give anesthesia the same way.
As advanced practice registered nurses, CRNAs practice with a high degree of autonomy and professional respect. They carry a heavy load of responsibility and are compensated accordingly.
CRNAs practice in every setting in which anesthesia is delivered: traditional hospital surgical suites and obstetrical delivery rooms; critical access hospitals; ambulatory surgical centers; the offices of dentists, podiatrists, ophthalmologists, plastic surgeons, and pain management specialists; and U.S. military, Public Health Services, and Department of Veterans Affairs healthcare facilities.
Nurse anesthetists have been the main providers of anesthesia care to U.S. military personnel on the front lines since WWI, including current conflicts in the Middle East. Nurses first provided anesthesia to wounded soldiers during the Civil War.
Managed care plans recognize CRNAs for providing high-quality anesthesia care with reduced expense to patients and insurance companies. The cost-efficiency of CRNAs helps control escalating healthcare costs.
In 2001, the Centers for Medicare & Medicaid Services (CMS) changed the federal physician supervision rule for nurse anesthetists to allow state governors to opt out of this facility reimbursement requirement (which applies to hospitals and ambulatory surgical centers) by meeting three criteria: 1) consult the state boards of medicine and nursing about issues related to access to and the quality of anesthesia services in the state, 2) determine that opting out is consistent with state law, and 3) determine that opting out is in the best interests of the state’s citizens. To date, 15 states have opted out of the federal supervision requirement, most recently California (July 2009). Additional states do not have supervision requirements in state law and are eligible to opt out should the governors elect to do so. 
Nationally, the average 2009 malpractice premium for self-employed CRNAs was 33 percent lower than in 1988 (62 percent lower when adjusted for inflation). 
Legislation passed by Congress in 1986 made nurse anesthetists the first nursing specialty to be accorded direct reimbursement rights under the Medicare program.
More than 40,000 of the nation’s 44,000 nurse anesthetists (including CRNAs and student nurse anesthetists) are members of the AANA (or, greater than 90 percent). Approximately 41 percent of nurse anesthetists are men, compared with less than 10 percent of nursing as a whole.  
Education and experience required to become a CRNA include:

• A Bachelor of Science in Nursing (BSN) or other appropriate baccalaureate degree.
• A current license as a registered nurse.
• At least one year of experience as a registered nurse in an acute care setting.
• Graduation with a minimum of a master’s degree from an accredited nurse anesthesia educational program. As of April 2010 there were 108 nurse anesthesia programs in the United States utilizing more than 1,700 approved clinical sites. These programs range from 24-36 months, depending upon university requirements. All programs include clinical training in university-based or large community hospitals.
• Pass the national certification examination following graduation.

In order to be recertified, CRNAs must obtain a minimum of 40 hours of approved continuing education every two years, document substantial anesthesia practice, maintain current state licensure, and certify that they have not developed any conditions that could adversely affect their ability to practice anesthesia.

Breastfeeding PSA

I choose this PSA because I feel that breastfeeding is the single best thing that a mother can do for their child. Plus its FREE!!!

Liver Cirrhosis

This week in class we are learning about liver cirrhosis. One of the number one causes of liver cirrhosis is alcohol abuse. After reading about it and watching the video below, I think I am going to stick to non-alcoholic drinks.

The liver weighs about 3 pounds and is the largest solid organ in the body. It performs many important functions, such as:

• Manufacturing blood proteins that aid in clotting, oxygen transport, and immune system function.
• Storing excess nutrients and returning some of the nutrients to the bloodstream.
• Manufacturing bile, a substance needed to help digest food.
• Helping the body store sugar (glucose) in the form of glycogen.
• Ridding the body of harmful substances in the bloodstream, including drugs and alcohol.
• Breaking down saturated fat and producing cholesterol.

Alcohol MySpace Comments & Myspace Comments

Cirrhosis is a slowly progressing disease in which healthy liver tissue is replaced with scar tissue, eventually preventing the liver from functioning properly. The scar tissue blocks the flow of blood through the liver and slows the processing of nutrients, hormones, drugs, and naturally produced toxins. It also slows the production of proteins and other substances made by the liver.

According to the National Institutes of Health, cirrhosis is the 12th leading cause of death by disease.

What Causes Cirrhosis of the Liver?

Hepatitis C, fatty liver, and alcohol abuse are the most common causes of cirrhosis of the liver in the U.S., but anything that damages the liver can cause cirrhosis, including:

• Fatty liver associated with obesity and diabetes.
• Chronic viral infections of the liver (hepatitis types B, C, and D; Hepatitis D is extremely rare).
• Blockage of the bile duct, which carries bile formed in the liver to the intestines where it helps in the digestion of fats. In babies, this can be caused by biliary atresia in which bile ducts are absent or damaged, causing bile to back up in the liver. In adults, bile ducts may become inflamed, blocked, or scarred, due to another liver disease called primary biliary cirrhosis.
• Repeated bouts of heart failure with fluid backing up into the liver.
• Certain inherited diseases such as:
  • Cystic fibrosis.
  • Glycogen storage diseases, in which the body is unable to process glycogen, a form of sugar that is converted to glucose and serves as a source of energy for the body.
  • Alpha 1 antitrypsin deficiency, an absence of a specific enzyme in the liver.
  • Diseases caused by abnormal liver function, such as hemochromatosis, a condition in which excessive iron is absorbed and deposited into the liver and other organs, and Wilson's disease, caused by the abnormal storage of copper in the liver.

Although less likely, other causes of cirrhosis include reactions to prescription drugs, prolonged exposure to environmental toxins, or parasitic infections.

Do People Who Drink A Lot of Alcohol Always Get Cirrhosis of the Liver?

Most people who drink large amounts of alcohol harm their livers in some way; but not all of these people get cirrhosis of the liver. Women who are heavy drinkers are at higher risk than men. People who have hepatitis B or hepatitis C are more likely to suffer liver damage from alcohol.

Emergency Nurses as Advocates

Nurses are the patient's advocate. But when a nurse disagrees with a doctor, how far should they go on behalf of their patient? Where do you draw the line? This is a recent article from the New York Times. 

A recent conversation with a physician at my hospital was laced with tension about the different roles of doctors and nurses.

“When you get down to it,” he told me, “Patients come to me for care, Theresa, not you.”

Both of us were called away before we could talk more, but his words have been ringing in my head ever since.

Jeff Swensen for The New York TimesTheresa Brown, R.N.

I couldn’t believe that this doctor, who had always worked well with the nurses on my floor, had just suggested, at least in my mind, that a nurse’s opinion on patient care matters less because patients don’t directly make appointments with us.

As I puzzled over our brief but heated exchange, I thought back to the events leading up to the conversation.

It all began after the doctor read a story I had written about a leukemia patient in his 70s. The doctor had not been involved in the case, but he was troubled by my role in it. Due to the patient’s existing health problems, I was concerned that giving him chemotherapy would cause more harm than good.

During the course of the treatment, the patient complained in agony, telling me “I can’t take it,” and I relayed his misgivings to the patient’s care team. A more aggressive lament from the patient — “What the hell are you doing to me?” — also got communicated to the team. I was the patient’s nurse and his advocate, and I worried that it was not ethical to subject him to more chemotherapy when he was clearly having a hard time with the treatment. The chemo we had given him before this latest round had already sent him into permanent renal failure and caused congestive heart failure.

Other members of the team shared these concerns, but the man’s doctor did not. He checked in with the patient to see if he wanted to continue treatment. After some gentle prodding by the doctor (“You want to keep going, right? Right?”), the patient agreed.

I recounted that story with great sadness, as it had been agonizing to watch my patient suffer through treatments that I believed he would not have chosen had he known the harm they could cause and the unlikeliness of being cured.

He eventually was admitted to hospice and died, but only after the chemo had left him with unstoppable and painful bleeding in his bladder, robbing him of a more peaceful and more comfortable end to his life.

The doctor colleague who cornered me at the nursing station was particularly unhappy with my aggressive objection to the patient’s care plan. This doctor felt strongly that for cancer patients, end-of-life decisions should ultimately be the responsibility of the physician in charge of his or her care. That physician, he argued, is in the best position to offer advice about care decisions because he knows the patient’s full history. Floor nurses, he said, usually only see a snapshot of the patient near the end of a long journey.

I understood his point, but I also felt he was too quickly dismissing the observations of oncology nurses, who intimately confront the suffering sometimes caused by well intentioned treatment.

And that’s when the conversation became tense.

Obviously, doctors and nurses have different roles in the hospital. Our training is different, and so are our responsibilities. It’s also true that patients choose their doctor and only end up with a particular nurse through the luck of the draw. But when a doctor and a nurse disagree over patient care, should the doctor always prevail?

Many of the nurses I know could share their own, dramatic stories of rescuing patients or catching frightening errors by other health care workers, including doctors. In fact, the same day the doctor cornered me at the nursing station, I had caught a potentially risky medication prescribing error by a doctor in training. I took my care question to a clinical pharmacist and the attending physician to insure that my patient was given the right treatment. Nurses don’t have the power to make certain types of care decisions, but they do have the power -– and the responsibility — to go up the ladder until they are satisfied that good decisions are being made.

Nursing care is also an important factor in a patient’s recovery. Several studies now show a strong association between nurse staffing levels and rates of patient complications like pneumonia or internal bleeding during a hospital stay. Patients in hospitals with high nurse staffing ratios get better sooner and have shorter hospital stays. Many doctors will tell you that it’s nursing care, not physician care, that makes the biggest impact on a patient’s recovery.

So is the doctor-patient relationship really more sacrosanct than the nurse-patient relationship? I don’t think so. Physicians have the ultimate responsibility for treatment decisions, but because nurses spend so much more time with hospital patients than doctors do, we have a unique view of how the patient is really doing. And at times, patients present very different faces to nurses and to doctors — complaining to a nurse in a way they never would to a doctor.

And while my physician colleague said that nurses only see a snapshot, that picture is often one the doctor does not see.

Later, I had another chance to talk to the doctor who raised this issue in the first place. I told him that I was planning to write about our discussion of the role of doctors and nurses. “Yes,’’ he said. “We never got to finish our conversation.”

So we finished it. He shared difficulties he’d had with nurses criticizing treatment decisions when they had only known the patient for a few hours. I nodded. Then I said that physicians can have blinders on, too, and he nodded as well.

In the end he said, “The point is, it needs to be a conversation.” And we both agreed on that.

But when in doubt, I will err on the side of aggressive advocacy for my patients. Nurses have a professional obligation to make sure that patients receive the best care possible and to insure that all care given in hospitals is safe. For better or for worse, patients who come into our hospital are the responsibility of the nurses, even if the patient has been admitted by a doctor of her own choosing. A good nurse will share his or her opinions with the medical staff — sometimes loudly — because that’s part of our job, even if we ruffle a few feathers in the process.

Bone Marrow Drive

My Capstone group and I are in the process of organizing a bone marrow drive on Bloomfield College in the Spring. In the mean time here is some information about a local bone marrow drive at Jersey City University, in Jersey City, New Jersey. I will be there, hope to see you there.

Since tissue types are inherited, patients in need of a bone marrow transplant are most likely to match with someone from the same ethnic background. Currently, minority groups are underrepresented in the donor registry. As a result, is it is much harder for anyone from a minority background with leukemia or other blood disease to find a donor match. "It's sad that African-Americans are severely under-represented, comprising only 7% of the national registry's of 6 million donors.

Get Swabbed, New Jersey City University!

Date: 

Tue Nov 2, 2010

- Jersey City, NJ

Every year, more than 10,000 men, women, and children could benefit from a bone marrow transplant. Sadly, 6 out of 10 patients will not find a matching donor that could save their lives. The students at New Jersey City University want to beat these odds.
Get Swabbed, New Jersey City University!
Tuesday, November 2nd
11:00am - 5:00pm
Multipurpose Room A, Gilligan Student Union
40% of DKMS Americas donors were registered between the ages of 18-22. That’s why it is so important to get as many college students registered as possible. The more students who register as bone marrow donors, the better the chances for patients in need!!

Email kelly@dkmsamericas.org for more information.

Stroke Awarness

I know Stroke Awareness Month is not until May but I found this pretty cool video that I think will be helpful to anyone who has no idea what to do when they suspect someone is having a stroke.

Nursing Quote of the week

Haha, I think this is soooo true!


Be nice to your kids. They'll choose your nursing home.
Anonymous

How to become a Pediatric Nurse?

I think that Pediatric nursing is a difficult field to work in. Children have a way to tug on people's heartstrings. I am certain that I will not make a good pediatric nurse. Pediatric nurses must be very patient and be able to see things from a perspective of a child at the same being able to educate and reassure already nervous parents. I hope that when my son gets sick that I will receive care from a nurse that truly loves her job. I posted this article I found on www.degreefinder.com. Check it out!!

Pediatrics is an important field of medicine that deals with providing medical care to infants, children, and adolescents. Pediatric nurses are specially trained registered nurses that provide preventative and acute care to pediatric patients in a variety of healthcare settings.

What does a pediatric nurse do?

Pediatric nurses specialize in providing care to a variety of pediatric patients ranging in ages from birth to 18 years old. They provide primary care such as routine examinations and developmental screenings, treatment of childhood illnesses, administration of immunizations, school physicals, and guidance regarding common health concerns. They also provide acute and specialty care including caring for children who are critically or chronically ill, ordering medications, performing therapeutic treatments, interpreting test results, and performing thorough physical examinations. Pediatric nurses also develop treatment plans and discuss options with family members and caregivers. They provide education and support to families and document the progress of their patients.

What kind of training does a pediatric nurse need?

Pediatric nurses must complete an approved registered nursing program and a specialization in pediatrics. Nursing programs provide extensive classroom instruction and supervised clinical experience. Pediatric nursing courses usually include human growth and development, family centered care, health promotion and maintenance, childhood disorders and diseases, physiology of children and adolescents, and psychosocial and behavioral health of children.
All states require pediatric nurses to be licensed. Licensing requirements include graduating from an approved nursing program and passing a national licensing examination called the NCLEX-RN. Many pediatric nurses also take the examination to become a Certified Pediatric Nurse (CPN) administered by the Pediatric Nursing Certification Board (PNCB). Continuing education is required to maintain licensure and pediatric nurses frequently complete continuing education courses and attend conferences, workshops, and seminars.

What are the prospects for a career as a pediatric nurse?

Employment of all registered nurses is expected to grow much faster than average for all professions, increasing 23% from 2006 to 2016 (1). Technological advances and the increase in pediatric patients will drive job growth.
Job prospects are expected to be excellent especially for pediatric nurses with at least a bachelor degree and extensive experience. Many job openings will also arise from the need to replace pediatric nurses that retire, transfer, or leave the field for other reasons.

How much do pediatric nurses make?

As of October 2009, pediatric nurses with less than 1 year experience earn average annual salaries between $42,253 and $51,395. Those with 1 to 4 years experience earn average annual salaries between $38,322 and $63,918 (2).
A career as a pediatric nurse is an excellent choice for individuals interested in providing nursing care to infants, children, and adolescents. Pediatric nurses must be compassionate, sympathetic, caring, detail-oriented, and open-minded. They must have excellent communication and interpersonal skills and be able to carefully explain conditions in ways the patient and the family can understand. Good stress management, emotional stability, and ability to comfort patients and families are also essential.

Now what? The next step is easy!

Take the first step today and request free information from our selected top online nursing and healthcare schools, or simply use the form below to find the program that is right for you!

Here is a video I found on youtube.com on how to perform a physical assessment on a school age child. Hope it helps anyone.

How to become an ICU Nurse....

Ok, so this week I did my intensive care rotation at the MICU at St. Josephs Hospital in Paterson. Words cannot describe my experience. All I can say was that it was AWESOME!! So, I found the following article on eHow.com. I hope you find it useful.

Complete the degree requirements for a RN or BSN at an accredited academic institution. If you are thinking about an online degree or distance-learning program, it is critical that you verify the program's accreditation status before you start your classes.

Pass the licensing exam in your state after you've finished the required coursework. Contact your state board of nursing for any additional requirements.

Listen attentively during rounds. The ICU nurse will have extensive interaction with doctors as they perform daily rounds and will be inundated with patient care information. When in doubt, ask a resident for help in clarifying a doctor's orders 

Get used to dealing with uncertainty. When a new patient arrives in the ICU, her condition is often bad and getting worse. Even if one problem is obvious, there may be several more hidden complications making the condition even worse. Never expect that you have all the information you need at hand.

Haha, pretty cute T-shirt

Study prescription drugs. Because patients in ICU are often in excruciating pain and are susceptible to infections of various kinds, they may be given several different drugs at once. You need to know how each medication works and be aware of any potentially dangerous interactions.

Learn the workings of ICU machines. A nurse working in the ICU must be familiar with some of the most advanced medical technology available today, including EKG machines, defibrillators and ventilators.

Apply for a full-time ICU nurse position with the hospital at which you made your rounds. Many times, a hospital is more likely to promote a recent graduate who has worked on the grounds before.

Stay up-to-date on the latest developments in ICU technology by joining the Society of Trauma Nurses (see Resources below).

Past Nursing Quotes of the Week

Week 1
Nursing would be a dream job if there were no doctors.~ Gerhard Kocher

Nursing Quote of the Week

Wow, I found the following quote to be true in so many ways. One of my new favorites. I now want to know the name of the Hispanic janitor that always in the library cleaning.


During my second year of nursing school our professor gave us a quiz.  I breezed through the questions until I read the last one:  "What is the first name of the woman who cleans the school?"  Surely this was a joke.  I had seen the cleaning woman several times, but how would I know her name?  I handed in my paper, leaving the last question blank.  Before the class ended, one student asked if the last question would count toward our grade.  "Absolutely," the professor said.  "In your careers, you will meet many people.  All are significant.  They deserve your attention and care, even if all you do is smile and say hello."  I've never forgotten that lesson.  I also learned her name was Dorothy.  ~Joann C. Jones