Bethel University has announced the launch of a new Doctor of Nursing Practice (DNP) degree program, available in fall 2018. The DNP program is intended to prepare advanced practice nurses for roles in administration, public policy, advocacy, and specialized care.
Bethel has launched several other healthcare programs in recent year including a physician assistant program in 2015, and a variety of other nursing programs at the undergraduate and graduate level. According to Bethel.edu, the Bureau of Labor Statistics estimates that demand for nurse anesthetists, nurse midwives, nurse educators, and advanced practice nurses with DNP degrees is expected to grow by 31 percent in the next 10 years.
The DNP program will be offered primarily online, putting students on the cutting edge of medical trends with courses in biostatistics, epidemiology, informatics, and healthcare economics and policy. Students will apply evidence-based research, critical thinking skills, and learn to understand nursing from a business perspective to prepare them for roles in hospital management and academia.
Jane Wrede, program director and associate professor of nursing, tells Bethel.edu, “The DNP degree is focused on leadership and transformation in the workplace. Its purpose is to prepare advanced practice nurses to be leaders and change agents in their professional settings.”
Bethel University has pursued initial accreditation of the Doctor of Nursing Practice program by the Commission on Collegiate Nursing Education. To learn more about the launch of the new DNP program, visit here.
Master’s students in the Duke University School of Nursing (DUSON) have the opportunity to enroll in a new major in Psychiatric Mental Health as of the Spring 2018 semester. This newest major being offered is for Advanced Practice Registered Nursing (APRN) students interested in pursuing a specialty nursing track.
Duke believes in the importance of specialty education programs to ensure that nursing students who go into specialty areas have the formal training they need. Students enrolling in the Master of Science in Nursing (MSN) program at Duke have the opportunity to choose from one of eight majors, and to pursue an additional specialty track if they are interested. Each major and specialty has its own course requirements and formal clinical rotation requirements that must be met to earn a specialty certificate.
The Psychiatric Mental Health program is the eighth and latest major offered for nurse practitioner students. Majors are also available in gerontology care, family nurse practitioner, neonatal and pediatric nurse practitioner, and women’s health nurse practitioner. The MSN program also recently added two new specialties in Endocrinology and HIV/AIDS, and a pediatric mental health specialty is set to be launched in the near future.
Beth C. Phillips, PhD, MSN, RN, CNE, tells Nursing.Duke.edu, “To think about why we do a new program – it’s not because we have a faculty member who would be great at it, so let’s create a new program. We create a program based on community need – local, national or global. The newest major, for example, was added after we recognized there was a scarcity of mental health providers in the state. Behavioral concerns and the addiction crisis in our country demanded a more advanced and skilled workforce in nursing.”
With specialty nursing becoming more and more prevalent, Duke is “aiming to identify community health care needs and respond proactively to meet those needs,” according to Nursing.Duke.edu. Creating new programs is a long process for the university, involving tracking legislature and literature to see what needs are already being met by the healthcare community, and which are not. Once new areas are identified, the university has to hire new staff and create partnerships with clinical sites, in addition to approving new financial resources through the Dean.
To learn more about Duke Nursing’s latest nurse practitioner major in Psychiatric Mental Health, visit here.
I have been placing percutaneous intravenous central catheters (PICCs) in neonatal patients for almost 25 years, and I admit taking apart the process seems a bit daunting. One of the most important factors for successful insertion is good planning.
The first thing I do is identify the patient. Any neonate who is less than 1,250 grams, requiring antibiotics or total parental nutrition for more than 5 days is an obvious candidate. An infant over 1,000 grams requiring frequent blood draws could be considered for a larger PICC as the unit I work in uses the line for blood drawing as well as fluids and antibiotics. The patient should not have active bacteremia or fungemia.
Once I identify the patient, I review the current fluid status and recent complete blood count. A platelet count over 50,000 and normal hematocrit are preferable, and if out of acceptable range, it’s best to take time to correct these before attempting the procedure.
After I have identified the patient and assessed the individual factors, I will put in several prep orders. These orders include an intravenous (IV) 20 ml/kg 0.9 Normal Saline bolus, 1 mcg/kg fentanyl, and 0.1mg/kg versed given via IV. The bolus is to be completed immediately prior to procedure, the sedation and analgesia just before the start. I almost always follow this pre-procedure protocol, especially if this is not the first PICC attempt on the patient. Blood vessels in neonates tend to be especially friable and, in my experience, a normal hematocrit, fluid bolus, and appropriate pre-medication minimize that obstacle.
Next, I examine the patient’s vessels and look for the biggest vessel that is suitable for a PICC. I start with extremities as a PICC dressing is maintained easiest on an extremity. Recently, I have preferentially used the right saphenous if it’s suitable. The main reason I have been doing this is that there is more leeway on the placement of the tip of the line than in an upper extremity. Upper extremity lines have a smaller acceptable target area, a higher incidence of line migration; the observation of the tip placement on X-ray is very sensitive to the patient’s arm position when the X-ray is taken. Also, a lower extremity line will often remain in a central position through patient growth.
The procedure of PICC placement is well documented. The few variations I use when I place a PICC include: my own positioning and I cut the catheter to the exact length.
One important pearl I would give to the novice PICC inserter is to practice your IV insertion skills. Proficiency in IV insertion will not guarantee that a PICC insertion will be easier, but without the IV skills, insertion of PICCs in neonates will be less successful.
Like any other procedure, PICC line placement requires patience and practice. The methodology I use has been refined over the 25 years I have been doing this in the NICU. If you are interested and would like to discuss it, please do feel free to email me at Christine.firstname.lastname@example.org.
2017 was an important year for the healthcare industry nationwide, with multiple states enacting new laws to equip advanced practice registered nurses (APRNs) with full practice authority, allowing them to practice to the top of their education scope. APRNs — including nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse midwives — are a critical part of efforts to ensure and expand access to high-quality, cost-effective healthcare across the country.
As we move in 2018, APRNs now have full, autonomous practice and prescribing authority in 25 states and the District and Columbia. In remaining states, APRNs continue to practice under supervision or collaboration with physicians. According to HealthcareFinanceNews.com:
“In 2017, over 20 states reported passage of legislation positively impacting access to and delivery of healthcare nationwide.”
In an effort to respond to the ongoing opioid crisis, several states have also enacted new laws and regulations on the prescribing of controlled substances. California and Oregon passed legislation in 2017 bringing nurses practitioners’ role into line with the federal Comprehensive Addiction and Recovery Act. These new laws clarify the role of nurse practitioners in prescribing buprenorphine, an important part of treatment for opioid use disorders.
To learn more about the national move to grant full practice authority to advanced practice registered nurses, visit here.
Life as a Neonatal Nurse Practitioner (NNP) is like an ocean tide on a gray day! The only certainty is the start and end to the day. We deal with patients and families experiencing the shattering of the hopes, dreams, and plans they imagined when becoming pregnant. In an instant, their life is turned upside down and they enter a foreign world of new terminology, high technology, and their most vulnerable possession… their son or daughter at the hands of strangers. In some cases, there may have been some introduction and preparation of what to expect. However, for the majority, families are just trying to grasp the reality that their infant was born. After all, the birth of an infant is typically a joyous event enveloped with laughter, celebration, and family. Typically, our role is delivering the news of not only how we need to “take your baby to the NICU,” but also rattling off the list of what we did, what they can do, allowing them to see the infant (in some cases through a peephole), and then leaving with a door probably bellowing as it closes behind us.
There are many things to love and hate about being a NNP. There is the black and white task of the position, which may not be the favorite part, yet it is an essential piece to assist in making optimal and safe management decisions. Our day traditionally starts with getting sign-out from the on-call team, dividing up our patient load based on acuity, obtaining pertinent stats from the medical record, and reviewing notes. Next, we join the multidisciplinary team for daily rounds. Since we are part of a teaching institution, this can be an overstimulating feat even as a neurologically intact adult. However, the benefits of daily rounds on each patient certainly outweigh the challenges of parading with what seems like a million people for an eternity. Rounds provide us with critical firsthand observations, vital feedback from nursing staff, and inclusion of the family if present. It is a way for all disciplines to hear the infant’s story, plans, challenges, and successes. Rounds allow us to be facilitators of the medical plan, advocates for the patients, and to mentor/teach other disciplines. After rounds, we pursue the downhill trajectory of our concrete tasks of entering orders, connecting with consults, writing notes, and updating the problem list. This is not the most glamorous part of our role, but vital for consistency and progression of care.
Then we enter the world of LOVE it! There is so much to love about being a nurse practitioner, especially in a tertiary center NICU such as ours. No patient is easy or straightforward. Our patient population comes from mothers typically of higher risk—medical, social, mental health, or a combination which accompanies challenges and obstacles separate from the infant. Infants born to these mothers often have multiple medical issues that lead to chronic issues and prolonged hospitalization. The diversity of illness and complications these infants possess challenge us as nurse practitioners to have a high level of knowledge specific to the neonatal population. This fosters our learning on a daily basis to continually be more proficient and knowledgeable; there is constant intellectual stimulation.
Due to the complexities of our infants and families, we are fortunate to collaborate with nurses, social workers, case management, child life, physical/occupation/respiratory therapists, medical staff, and multiple consults. In our facility, we truly have a village participating in the care of our most vulnerable patients and families. As a nurse practitioner we are able to build close relationships with these disciplines, respect their roles, and promote the best patient experience for our families with the hope of optimal outcomes.
A much respected neonatologist used to say “listen to the baby.” As NNPs, we use our knowledge and experience to listen to our babies. However, we also extend that skill to communication with the parents of our infants. We need to establish a sense of rapport with the families. We have the privilege of delivering good news, such as “your baby is going home.” However, sometimes we need to deliver difficult news or be physically present as parents receive difficult news. Typically, we remain present with the family afterwards to provide empathy, clarity, and support.
The role of a NNP extends beyond the NICU. At any time, the ringing of phones signal to us that our presence is needed in Labor and Delivery. We attend all deliveries of preterm infants, infants with identified anomalies, or any delivery where there is a potential risk to the infant whether it is preterm or term. We can be called to General Care Nursery to assess a well infant with an evolving issue or need for further assessment. Further, our role is not limited to our hospital. The NNPs in our facility go on both air and ground transport to pick up critically ill infants requiring escalation of care. Here we use all of our skills to not only stabilize an infant for transport, but also make an initial contact with the family and provide reassurance as we prepare to separate them from their infant.
As a NNP, our days are unpredictable like the tide of the ocean. The knowledge and resources we need to provide the care to our patients and families are vast. The path we take with each infant and family is unpredictable, ranging from a calm rippling stream to a raging tide feeling like a tsunami. But the rewards of seeing infants make progress and parents evolving from being hopeless to feeling empowered and connected makes every day worth it!
The Hawaii State Center for Nursing (HSCN) recently released the 2017 Nursing Workforce Report announcing that the number of advanced practice registered nurses (APRNs) in the state has doubled since 2005. APRNs are registered nurses with graduate education, specialized certifications, and advanced nursing licensure.
The HSCN is a part of the School of Nursing and Dental Hygiene at the University of Hawaii at Manoa. It serves all licensed nurses in the state through partnerships and programs with nursing schools and employers. With a shortage of nurses and primary care providers progressing nationwide, Hawaii will benefit greatly from the increase in APRNs, especially given that half of all Hawaii APRNs work in primary-care related specialities. Many of these APRNs work in remote and rural areas providing primary care services to areas of the state affected by provider shortages.
The increase in APRNs has been largely attributed to the enactment of legislation authorizing APRNs to work to the fullest extent of their education and training, allowing them to work as primary care providers who are licensed to perform health promotion, diagnose and manage acute and chronic illnesses, make referrals for specialized care, and prescribe treatments and medication.
The 2017 Nursing Workforce Report also includes a detailed picture of the nursing workforce, including demographics, employment settings, practice specialties, academic preparation, and areas of practice. To view the full report, visit www.hawaiicenterfornursing.org/data-reports/.