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It’s 2016 and APRNs are still not recognized in all of the United States.  

In 2010, the Institute of Medicine released the report, The Future of Nursing, which outlined the need for advanced practice nurses (APRNs) to gain full practice authority in the United States.  This document, a collaboration of the Committee on the Robert Wood Johnson Initiative, set the policy agenda for APRNs to be given full practice authority in the majority of states that did not already have the legislation to support that practice. Full practice authority in every state is necessary to provide consistency in APRN practice, to provide access to healthcare for patients in greater numbers, to reduce healthcare costs and improve preventative health practices.  The IOM points out the disparities and waste in our current system, such as the ability of an APRN to have full practice authority in one state and go to a neighboring state and be unable to prescribe as much as a Tylenol without a physician’s oversight.  The Consensus Model for APRN Regulation, Licensure, Accreditation, Certification and Education set forth the structure in which states could base legislation of APRNs in the hopes to standardize practice.

 

The goal was to implement the model by 2015.Stethoscope-2

As of 2016, twelve states have fully implemented the full Consensus Model through legislation.  Many are close, but some are far from reaching full practice authority for APRNs.  I moved from Oregon, which has full practice authority, to Texas which limits APRN practice and requires burdensome physician oversight.  Instead of serving patients in my rural community, which suffers from disparities in healthcare services, I work in a nursing leader position, with a BSN requirement.   I am working with the state APRNs to advance legislation that will remove barriers to practice, but there is a lot of opposition from another special interest group, physicians.  Some physicians view APRNs as competitors, instead of partners in expanding healthcare services.

Political victories are happening.

West Virginia is on the cusp of expanding APRN practice authority and are waiting for their governor to sign the bill into legislation. Amy Summers, a member of the West Virginia legislature, was the lead sponsor of HB 4334 which expanded APRN authority to practice independently and to expand prescriptive authority.

Summers stated in defense of the bill, “This is not a new idea, this isn’t something that needs studied further. Iowa has allowed full practice authority for 33 years, Alaska 28 years, New Mexico 20 years.  No state has ever repealed full practice authority once it was given.”

I hope that Texas, and the many states that have yet to adopt the Consensus Model, will move towards joining forward thinking states.  States like Oregon, Idaho, Iowa, Utah, Montana, Maine, Nevada, New Mexico, North Dakota, Vermont, Colorado and Hawaii, all of which have given full practice authority to all APRNs.

How does your state measure up? Click here to find out!

 

 

 

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Why Mid-Level is a Dirty Word

A colleague of mine recently described herself as a “mid-level provider.”thumbs-down1

I cringed.

There is nothing mid-level about her.  She has spent over six years in a university and hundreds of clinical hours learning to become a Nurse Practitioner, not half of a physician.  She spent years as a bedside nurse prior to advancing her education to become a NP.  Physicians and nurses have two separate career paths in which they collaborate to care for men, women, and children.

When I first heard the term “midlevel” I wondered if the Advanced Practice Nurse (APRN) is in the middle, who is above and below?  If APRNs are viewed as below physicians, does that make her above registered nurses?  An APRN has advanced assessment skill and practice authority, but she is still a nurse.  She always maintains her registered nurse license.  An APRN does not graduate from or stop being a nurse when she becomes an advanced practice nurse!

Words mean things. Why would anyone want to go see someone for their healthcare needs that is described as “mid-level?”  APRNs produce the same good outcomes as other primary care providers.  Their outcomes are not mid-level, their care is not mid-level, and their experience is not mid-level.

The use of “mid-level” comes from the U.S. government.  They use the terms mid-level and non-physician practitioner to describe APRNS and Physicians Assistants (PA).  The APRN Consensus Model encourages the use of the term Advanced Practice Nurse (APRN) to describe Nurse Midwives, Clinical Nurse Specialists, Nurse Anesthetists, and Nurse Practitioners.    With the implementation of the APRN Consensus Model, throughout the majority of the United States, the use of APRN is increasing. It is being used more in legislative language too.  Despit this progress, the use of “mid-level” is still rampant. We need to encourage the use of APRN in our professional circles.

 

 

Standing together, as healthcare professionals, we can promote the good work of APRNs by using an accurate descriptor.  Our patients are listening.

 

 

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Nurse Burnout: 12 Ways to get Your New-Grad Happy Back

Nurse burnout happens.  No nurse is immune.  If you are a nurse you are at risk for burnout.

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Remember how it felt to be a brand new nurse?

The only thing more shiny than your new stethoscope was your happy face.

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I diagnosed myself with nurse burnout when I started thinking that driving my car off a cliff sounded better than going to work.

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I was able to get back to my nursing happy place and I am in love with nursing again.

Here are some ways to get you back to happy-dancing your way to work.

 

 

1.  BLOG!  I love it and I’m not the only nurse on the interwebs!  If you are not a writer then read nursing blogs.  There are all flavors of nursing blogs, from informative to hysterical.

Some suggestions to get you started: Mine of course!   Adventures of a Labor Nurse   The Nerdy Nurse     Nurse Together     Mighty Nurse     Scrubs     Digital Doorway

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2. Go back to school.  Getting your BSN, MSN or DNP will make you more marketable and open up more options.

Going back to school will reenergize you about nursing.

You will read a LOT about new nursing research, which will get you out of a nursing rut.

You will be so busy making powerpoint presentations and writing discussion posts, you will have no time to think/complain about work.

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3. Get certified in your specialty.  If you are burned out then you probably have been a nurse more than 2 years.  Congrats!

That means that you are qualified to become certified in your specialty.

There is a certification for just about everything nursing related.

Look for your specialty on ANCC or NCC to start.  You will be recognized for your knowledge and add to your credentials.

Maintaining certification means that you will need to keep up continuing education in your speciality, which will prevent you from becoming stagnate.

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4.  Take your vacation days!!  Everyone needs a break.  Nursing is stressful.

If you don’t take vacation for yourself, then take it for your patients.  Being a relaxed and refreshed nurse will benefit them.

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5. Celebrate wins.  We are always focused on what we need to improve and what we are doing wrong.

When you or your team have a win, celebrate!

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6. Take some time for yourself.  Nurses know how important self-care is, but its difficult to find the time. Find it!

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7. Join a committee.  Make changes.  Give your input.  Does your hospital have shared governance or unit representation to make decisions?  If yes, join.  If no, start it! You can change nursing practice.

 

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8.  Be active.  Exercise can help improve mood and is a great outlet for work frustrations.

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9. Go to a Nursing Conference.  

There is nothing better than going to a conference full of nurses.  People think that ComicCon is weird, but they have never been to a nursing conference! We have crazy nurse fun!

It is a great time and it is a place where you are reminded why the heck you became a nurse.

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10.  Spend some time with your work buddies away from the call lights and nurse rounds.

You know you love your team.  An out of work activity can remind you that your work pals are awesome.
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11. Attend a continuing education course or webinar about a topic that interests you.

Will you be inspired by experts talking about the topics that they love.

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12.  Quit.  Not nursing, but quit your job.  Sometimes you really don’t have nurse burnout, but job burnout.

One of the best things about being a nurse is the vast opportunities you have for employment.

If you need a change of pace, location or specialty do it.  Give a proper notice and leave on good terms.

You never know when you may work with those nurses again.  (It will happen.)

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Nursing is a rewarding profession.  If you feel yourself getting disenchanted, actively try to get the magic back.

 

If you are successful you will be back to the new grad feeling which is good for you and your patients.

 

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How do you beat the nurse blues?  Leave your suggestions in comments.

 

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