An NP’s Plea: Hold That Specialist

By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

Recently someone I know woke up in the middle of the night with severe foot pain. In the morning he headed to the ED, where he was diagnosed with a fracture of one of the sesamoid bones in his foot and sent to an orthopedist. Over the three days between the ED visit and the orthopedist appointment, the pain began to ease. At the orthopedist it was determined that the problem wasn’t that little sesamoid bone, but gout.

And then they sent him to a rheumatologist.

Why? The condition was already improving and he had no comorbidities. So, why the need for a specialist visit at a cost of $500 just to walk through the door as a first-time patient? A primary care provider should be competent to manage a straightforward case of gout—order and review bloodwork, prescribe medications, educate the patient about their diet, and follow up on their progress. Then if the patient doesn’t respond to treatment or anything unusual develops, call in the specialist.

This happens all the time. When I was first diagnosed with hypothyroid I was sent off to an endocrinologist (under protest). There was nothing unusual in my presentation and I had no comorbidities or history […]

2018-03-28T10:35:59-04:00August 2nd, 2012|nursing perspective|5 Comments
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One Instructor’s Updated Nightingale Pledge

Editor’s note: This post by Lorita Renfro, BSN, RN, proposes an updated version of the Nightingale Pledge. The author is a clinical nursing instructor in the ADN/VN programs at Kaplan College in San Diego and is currently working toward an MSN with an educational focus. Let Lorita know what you think. Would your version differ in any way?

Florence Nightingale in Crimean War, from Wikipedia Commons

As the science of nursing evolves, one aspect of nursing remains the same: the art. We see it when we are inspired to do the best for our patients, develop higher standards, and provide care from our hearts. This inspiration is the basis of all good nursing practice.

The science of nursing is seen in the interventions that provide comfort and protect our patients from harm. In the past, this protection often meant cleaning floors and carrying bed pans. My father believed until the day he died that what I did was to “help the doctors” heal the patients.

This may still be true at times, but the science of nursing is now also represented by innovation, intuition, strength, and the responsibility of being a team member who collaborates in the delivery of […]

2016-11-21T13:09:36-05:00July 31st, 2012|career, nursing perspective|20 Comments
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AJN’s August Issue: A Metaphorical Prison, a Found Manuscript, a Nurse Carries the Torch, More

AJN’s August issue is now available on our Web site. Here’s a selection of what not to miss, including two continuing education (CE) articles, which you can access for free.

Nurses play a crucial role in inpatient programs for anorexia in adolescents, but how do the patients view them? Our Original Research article, “An Inpatient Program for Adolescents with Anorexia Experienced as a Metaphorical Prison,” describes the experience of adolescents in an Australian inpatient behavioral program and how both nurses’ and patients’ perception of the program as a metaphoric prison negatively affected the development of therapeutic relationships between them. This CE article is open access and can earn you 2.5 CE credits.

Health information technology (HIT) is a central aspect of current U.S. government efforts to reduce costs and improve the efficiency and safety of the health care system. But what does this really mean for nurses? “Health Information Technology and Nursing,”  the first article in a series of three on HIT and nursing, will examine the federal policies behind efforts to expand the use of this technology. This CE article is open access and can earn you 2.1 CE credits.

Accord­ing to the U.S. Department of Labor’s Bureau of Labor Statistics, more than 348,000 unlicensed as­sistive personnel were employed in the hospital set­ting in 2011. Our Cultivating Quality article, “Continuing Education for Patient Care Technicians: A Unit-Based, RN-Led Initiative,” explores how one teaching […]

2016-11-21T13:09:36-05:00July 27th, 2012|Nursing|2 Comments
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Making a Case for Therapeutic Hypothermia

Photo © Rick Davis 2011.

One of the articles published in AJN’s July issue that’s proving popular is “Therapeutic Hypothermia After Cardiac Arrest,” by Jessica L. Erb, an acute care NP at the University of Pittsburgh Medical Center Presbyterian Shadyside Hospital, and colleagues Marilyn Hravnak and Jon C. Rittenberger. The article points out that, despite evidence supporting its effectiveness, therapeutic hypothermia is not widely used.

According to the article’s overview, “Irreversible brain damage and death are common outcomes after cardiac arrest, even when resuscitation is initially successful. Chances for both survival and a good neurologic outcome are improved when mild hypothermia is induced shortly after reperfusion. Unfortunately, this treatment is often omitted from advanced cardiac life support protocols.”

The article discusses the efficacy of therapeutic hypothermia, indications and contraindications for its use, various induction methods, associated complications and adverse effects, and nursing care specific to patients undergoing this procedure.

Read the article (it’s open access)—you can earn 2.3 hours of CE credit.—Shawn Kennedy, AJN editor-in-chief

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2016-11-21T13:09:39-05:00July 23rd, 2012|Nursing|2 Comments
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Road Trip: Rehab for the ICU Nurse

Courtesy of the author; all rights reserved.

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Love Song of Frank,” was published in the May issue of AJN.

I took care of Gloria when she was admitted to the ICU after being involved in a high-speed, head-on collision. Although her injuries were very serious, my initial instinct was that she’d recover. I had a good feeling about her; as it turned out, I’d made a mistake in underestimating her mortality.

But everyone did, I think.

For the first few days her plan of care was routine and she progressed as expected. After several surgeries she was being successfully weaned from the ventilator. There was a plan for extubation. Gloria was awake and cooperative with all aspects of treatment.

She had an engaging spirit, and although she was never able to communicate with us well, we became attached to her and quite protective; we often requested taking care of her as our shift assignment, and later become strained and snappish with one another as unexpected complications propelled her along a steep and steady decline. Rehabilitation was ultimately traded for an extended ICU stay; extubation plans were cancelled in lieu of a tracheostomy.

I work among a group of passionate people. We’re determined and diligent. Because of that, a patient’s death in the ICU sometimes feels like a failure. We’re […]

2016-11-21T13:09:40-05:00July 16th, 2012|nursing perspective|4 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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