Archive for the ‘Nurse practitioners’ Category


The First 50 Years of NPs: An Illustrated Timeline Shows Triumphs, Continuing Practice Barriers

October 15, 2015

By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN.

This year marks the 50th anniversary of the nurse practitioner (NP) role. Themes of innovation and sustainability emerge as one examines an illustrated timeline of the history of NPs in AJN‘s October issue and reads the accompanying text. (The first section of the timeline is below. Click to enlarge.)

Screen Shot 2015-10-14 at 1.48.08 PM

How did this advanced practice nursing role come into being? As the timeline explains, “[d]uring the 1960s, health care was becoming increasingly specialized. Physicians were moving out of general practice and into more complex and lucrative specialties, creating a void in primary care and prevention services, and in care of the chronically ill.”

To fill this void, public health nurse Loretta Ford, working with Dr. Henry Silver at the University of Colorado in 1965, launched the first NP certificate program, a seminal moment in the history of this prevention-driven, primary-care-focused nursing role.

Ford wrote about the compelling need for NPs. Calling health care a capital investment, Ford said:

“We have failed to realize the full potential of professional nurses to improve the quality of life. This group has great unused potential for bringing about health care reforms. Properly prepared and effectively utilized, nurses could advance the nation’s health in preventing illness and helping people maintain their health states, both by educating the population in self-care and by increasing access to, quality of, and equity in health services.”

While the need for the types of care NPs are uniquely prepared to provide was great, the process of standardizing practice and academic requirements has not been an easy one. The timeline outlines some important steps in standardizing academic preparation, as well as the legal and practice barriers that the profession has faced and continues to face. Read the rest of this entry ?


AJN in October: Ablation for A-Fib, Holistic Nursing, 50 Years of NPs, Care Coordination, More

September 30, 2015

AJN1015 Cover OnlineThis month’s cover celebrates AJN’s 115th anniversary with a collage of archival photographs and past covers. The images are intended to reflect the varied roles and responsibilities of nurses past and present, as well as to commemorate AJN‘s chronicling of nursing through the decades.

In this issue, we also celebrate another nursing milestone, the 50th anniversary of the NP, with a timeline (to view, click the PDF link at the landing page) that illustrates and recaps the significant progress made by this type of advanced practice nurse.

To read more about what has changed—and what hasn’t—for AJN and its readers after more than a century in print, see this month’s editorial, “Still the One: 115 and Going Strong.”

Some other articles of note in the October issue:

CE feature: Integrative Care: The Evolving Landscape in American Hospitals.” As the use of complementary and alternative medicine has surged in popularity in the United States, many hospitals have begun integrating complementary services and therapies to augment conventional medical care. This first article in a five-part series on holistic nursing provides an overview of some of the integrative care initiatives being introduced in U.S. hospitals and reports on findings from a survey of nursing leaders at hospitals that have implemented such programs.

CE feature: Catheter Ablation of Atrial Fibrillation.” This treatment for the most common sustained cardiac arrhythmia is a complex procedure. Although complications are rare and their incidence is decreasing, early recognition and appropriate nursing care can prevent an adverse event from spiraling into a major complication. This article gives an overview of the procedure, its possible complications, and best practices for nursing care.

Special feature: Intergenerational Lessons and ‘Fabulous Stories.’” While directing the Future of Nursing: Campaign for Action, Sue Hassmiller, the Robert Wood Johnson Foundation’s senior adviser for nursing, realized the value that nursing history could bring to the campaign. With the help of two nurse historians, she decided to interview her mother, a 1947 graduate of the Bellevue Hospital School of Nursing, in order to understand the changes that had occurred in the nursing profession during the 20th century—and was also interviewed herself. This article shares five lessons that Hassmiller learned in the process. Read the rest of this entry ?


Planning Postdischarge Care with Cognitively Impaired Adults

October 15, 2014

A patient performs the CLOX 1, a clock-drawing task used to assess patients for cognitive impairment. Photo by Ed Eckstein.

By Shawn Kennedy, AJN editor-in-chief

The transition from hospital to home can be fraught with pitfalls, especially if the patient in question is an older adult with multiple conditions and a not-so-prepared caregiver. The transitional care model, in which NPs coordinate care and provide follow-up care after discharge, has been shown to be successful in reducing hospital readmissions in this group of patients.

With Medicare levying penalties on hospitals with higher-than-average readmissions rates, the stakes aren’t just high for patients and their families. Might similar models of care also work with cognitively impaired adults?

In “Studying Nursing Interventions in Acutely Ill, Cognitively Impaired Older Adults,” a feature article in AJN‘s October issue (free until the end of October), Kathleen McCauley and colleagues from the University of Pennsylvania seek to answer this question, among others.

In the article, McCauley and colleagues describe the methodology and protocols used in their study, summarize their findings, and discuss some of the challenges in conducting research in the clinical setting. Among their findings is the important lesson that research involving cognitively impaired older adults must actively engage clinicians, patients, and family caregivers, as well as the need for hospitals to make cognitive screening of older adults who are hospitalized for an acute condition “a standard of care.” Read the rest of this entry ?


A Physician Finally Gets Nursing

February 14, 2014

RelmanArticleCaptureBy Shawn Kennedy, editor-in-chief

Earlier this month, the New York Review of Books published an article by a patient who described his hospital stay following a life-threatening accident. This was no ordinary patient—the author, Arnold Relman, is a noted physician, emeritus professor of medicine at Harvard, a former editor of the New England Journal of Medicine, and along with his wife Marcia Angell, well known as a critic of the “medical–industrial complex.” His account is very detailed and gives a good example of how it can look when the system works (and when one has access to it).

His understanding of his condition and treatment, his knowledge of the system, and also his relative prominence as an individual, all undoubtedly helped him avoid some pitfalls and make a remarkable full recovery. However, as a number of others have pointed out recently, one comment in his account was surprising.

In reflecting on his hospitalization and recovery, he wrote, “I had never before understood how much good nursing care contributes to patients’ safety and comfort, especially when they are very sick or disabled. This is a lesson all physicians and hospital administrators should learn. When nursing is not optimal, patient care is never good.” After all his years in medicine, he only realized the value of nursing as a 90-year-old trauma patient.

This week, Lawrence Altman, another physician and author, wrote an excellent post for Well, the New York Times health care blog, examining why that might have happened. Altman, attributing a good part of physicians’ attitudes toward nurses (and other health care professionals) to how they have been educated, says that clinical medical education focuses on and values the interpretation of technology—the numbers as indicators of a patient’s progress, as in vital signs, monitor strips, ventilator settings, lab results, medication dosages. But personalized care is left to nurses, Altman argues, and physicians just don’t give it much attention.

Altman recognizes that nurses are sentinels, vigilant watchers who first note potential life-threatening problems, and he urges us to work toward a greater focus on interprofessional teamwork and education. I hope all who work in health care read his article, especially medical and hospital administrators.

While it’s always gratifying to hear that influential people support nursing’s value, the fact that Relman’s insight occurred so late in his life also makes me angry. How can a leading physician, an advocate for a better medical system, an educator of the next generation of physicians, go through most of his career and not realize nursing’s worth? One would hope that working alongside nurses during years of practice would have changed any misperceptions he might have had as a new physician. Read the rest of this entry ?


More Than a Headache: Migraines and Stroke Risk for Women

February 12, 2014
Photo by author. All rights reserved.

Photo by author. All rights reserved.

By Karen Roush, MS, RN, FNP, clinical managing editor

I used to think I was lucky. Most of the women in my family have migraines—awful, vomiting for three days, intense pain migraines. Not me. Oh, I have migraines. But no pain, no vomiting, just a visual aura—squiggly lines and loss of part of my visual field for about 45 minutes and then I’m good to go.

I was thankful that I just had the aura instead of the pain and vomiting. But now the evidence shows that migraine with aura, especially when there is no vomiting involved, is an independent risk factor for stroke, as much as if I were overweight, smoking cigarettes, and walking around with my blood pressure through the roof.

And it’s not just having migraines that places me at greater risk for a stroke. Read the rest of this entry ?


What Ever Happened to a Good History?

January 10, 2014
ky olsen/via Flickr

ky olsen/via Flickr

By Karen Roush, MS, RN, FNP, clinical managing editor

What ever happened to a good history? We were taught as NP students that the history portion of the exam was as important as the physical. In fact, in most cases it’s what you learn in the history—from asking the right questions and really listening to the patient’s answers—that gives you the information you need to figure out what is going on. The physical findings either support what you’re thinking or lead you to ask more specific questions.

A good history isn’t just listening to the patient’s answers to your questions; it’s listening to all the information they offer. Take for example, the middle-aged construction worker who takes his lunch hour to come in to the clinic complaining of a cold. He lists the usual symptoms, cough, fatigue, a little shortness of breath, and then as you’re starting the exam he casually mentions that he hasn’t been to a doctor in 15 years.

Someone who’s managed to stay out of a doctor’s office for 15 years and now shows up, on his lunch hour, because of a simple cold? So, you ask some more questions and learn about some chest pressure he attributes to the coughing he’s been doing and about his father’s death at 58 of a heart attack. And you realize it’s not a cough that has brought him in; it’s something more that doesn’t fit a neat checklist of symptoms. An ECG shows some nonspecific changes—nothing dramatic—but knowing what you do based on the history, you start an IV, give him an aspirin to chew, a little nitro, call an ambulance, and he’s off to the ED. Later you learn that he was immediately sent to a regional care center and into surgery for a triple bypass.

True story.

Any good NP can tell you their own version of this story. It was just something the patient said, or the way they said it, that heightened their alertness and led them to a diagnosis that could so easily have been missed.

But taking a good history is a skill that is in danger of getting lost in this age of computer checklist care. (That and eye contact, but we’ll save that for another blog post!) Two recent visits I made to clinics, one for primary care and one for urgent care, found me looking at the backs of nurses’ heads as they ran through standardized lists of questions, dutifully clicking them off a checklist on the computer. The provider at the urgent care center took a look at the answers and then proceeded, silently, with the exam. This may seem extreme, but unfortunately it or something very much like it is too often the norm. Read the rest of this entry ?


Bed Bath: The First Day of the Rest of Her Life

January 6, 2014

BedBathIllustration“Bed Bath,” the January Reflections column by pediatric nurse practitioner Kathleen Hughes, is a description of giving a first bed bath as a nurse after many years working in other professions. It’s not the first essay we’ve ever published about giving a bed bath, but it’s wise and meditative and well worth a read. Here’s a small section of this short essay, but please read the whole thing.—Jacob Molyneux, senior editor

An Ivy League degree and 15 years of teaching and writing did not prepare me any better than my mostly 20-something counterparts in the ways of giving a bed bath to a 72-year-old man I’d never met. What might be different for me is that I have known many kinds of professional challenges. What might also be different is that I have lived enough longer to have attended my father’s hospital-bound illness and death, and to have given birth to and cared for two young children. And so when I washed this man, I was washing my father, I was washing my children; I became one of those people who cared for us. Though giving a bed bath is not anything like lecturing to AP students on Faulkner, or writing a newspaper article on gun control or university library funding or modern exorcisms, I am not sure that either of those tasks made me hunker in a corner for five minutes, gathering myself before striding into the room. I’ve also never left a room feeling like I’ve had as simple and visceral an impact as I did that morning.

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