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Clinicians Forum FAQ

Discussion in 'Clinicians [ RN / NP / PA ]' started by Blue Dog, Mar 25, 2007.

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  1. Blue Dog

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    Clinicians Forum Frequently Asked Questions (FAQ)

    What is a Registered Nurse (RN)?

    A registered nurse is a health care professional responsible for implementing the practice of nursing through the use of the nursing process, in concert with other health care professionals. Registered nurses work as patient advocates for the care and recovery of the sick and maintenance of the healthy. In their work as advocates for the patient, RNs ensure that the patient receives appropriate and professional care. RNs use the nursing process to assess, plan, implement, and evaluate nursing care of the sick and injured.

    What is the scope of practice of an RN?

    In the United States, practice limits are determined by a set of laws known as the Nurse Practice Act of the state or territory in which an RN is licensed. Each state has its own laws, rules, and regulations governing nursing care. Usually, the making of the rules and regulations is delegated to a state board of nursing, which performs the day-to-day administration of these rules, qualifies candidates for licensure, licenses nurses and nursing assistants, and makes decisions on nursing issues. The scope of practice for a registered nurse is wider than for a licensed practical or vocational nurse (LPN or LVN) because of the level and content of education as well as what the Nurse Practice Act says about the respective roles of each.

    In the hospital setting, registered nurses are often assigned a supervisory role to oversee tasks performed by LPNs and unlicensed assistive personnel, such as nursing assistants. However, the RN remains responsible for the safety and care of the patient.

    RNs are not limited to employment as bedside nurses. Registered nurses are employed by physicians, attorneys, insurance companies, private industry, school districts, ambulatory surgery centers, and fire departments, among others. Some registered nurses are independent consultants who work for themselves, while others work for large manufacturers or chemical companies.

    What are the educational and licensure requirements for an RN?

    In the United States, there are three routes to initial licensure as a registered nurse. The shortest path (and the most widely utilized) is a two-year Associate of Science in Nursing, a two-year college degree referred to as an ADN; this is the most common initial preparation for licensure in the U.S. Often in competitive metropolitan areas within the US, two-year programs can require several prerequisite courses which ultimately stretch out the degree acquiring process to about 3 years.

    Another method is to attend a diploma program, which lasts approximately three years. Students take between 30 and 60 credit hours in anatomy, physiology, microbiology, nutrition, chemistry, and other subjects at a college or university, then move on to intensive nursing classes. Until 1996, most RNs in the US were initially educated in nursing by diploma programs.

    The third method is to obtain a Bachelor of Science in Nursing, a four-year degree that also prepares nurses for graduate-level education. For the first two years in a BSN program, students usually obtain general education requirements in the same manner as ADN and diploma graduates, then spend the remaining time in nursing courses. Advocates for the ADN and diploma programs state that such programs have a more "hands-on" approach to educating students, while the BSN is an academic degree that emphasizes research and nursing theory. Nursing schools must be accredited by either the National League for Nursing Accrediting Commission(NLNAC) or the Commission on Collegiate Nursing Education (CCNE) in addition to the accreditation of the college or university.

    Completion of any one of these three educational routes allows a graduate nurse to take the NCLEX-RN, the test for licensure as a registered nurse, and is accepted by every state as adequate preparation so long as the graduate attended an NLNAC-accredited school.

    What graduate opportunities are available for RNs?

    Advanced education in nursing is done at the masters and doctoral levels. A Master of Science in Nursing or a Master of Nursing takes about three years of full-time study to complete and prepares the graduate for specialization as a nurse practitioner (NP), a clinical nurse leader (CNL), a certified registered nurse anesthetist (CRNA), or a clinical nurse specialist (CNS). Nurse practitioners work in fields as diverse as midwifery, family practice, psychiatry, gerentology, or pediatrics, while a CNS usually works for a facility to improve patient care, do research, or as a staff educator. Doctoral programs in nursing prepare the student for work in nursing education, healthcare administration, clinical research, or advanced clinical practice. Most programs confer the Ph.D in nursing, but some confer the Doctor of Nursing Science (DNS or DNSc), Doctor of Science in Nursing (DSN), or the Doctor of Education (Ed. D.). Doctoral programs take from three to five years of full-time study to complete.

    What is nursing board certification?

    Professional nursing organizations, through their certification boards, have voluntary certification exams to demonstrate clinical competency in their particular specialty. Completion of the prerequisite work experience allows an RN to register for an examination, and passage gives an RN permission to use a professional designation after their name. For example, passage of the American Association of Critical-care Nurses specialty exam allows a nurse to use the initials 'CCRN' after his or her name. Other organizations and societies have similar procedures.

    The American Nurses Credentialing Center, the credentialing arm of the American Nurses Association, is the largest nursing credentialing organization and administers more than 30 specialty examinations.

    What is a Nurse Practitioner (NP)?

    NPs are advanced practice nurses who diagnose and treat a wide range of health problems. Besides clinical care, NPs focus on health promotion, disease prevention, health education and counseling. They help patients make wise health and lifestyle choices.

    How long have NPs been providing health care?

    NPs have existed for more than 40 years. The first NPs were educated at the University of Colorado in 1965. Programs soon spread across the U.S. As of 2006, there are about 115,000 practicing NPs. Close to 6,000 new NPs are prepared each year at over 325 colleges and universities.

    How are NPs educated?

    NPs have graduate, advanced education and clinical training beyond their registered nurse preparation. Most have master's degrees and many have doctorates.

    Where are NPs licensed to practice and how are they licensed?


    NPs are licensed in all states and the District of Columbia. They practice under the rules and regulations of the state in which they are licensed. Most NPs are nationally certified in their specialty area.

    Where do NPs practice?

    NPs practice in rural, urban, and suburban communities. They practice in many types of settings. These include clinics, hospitals, emergency rooms, urgent care sites, private physician or NP practices, nursing homes, schools, colleges, and public health departments, to name a few.

    What services do NPs provide?

    From treating illness to advising patients on maintaining a healthy lifestyle, NPs provide a full range of services.

    NPs may:
    • Order, perform and interpret diagnostic tests such as lab work and x-rays
    • Diagnose and treat acute and chronic conditions such as diabetes, high blood pressure, infections and injuries
    • Prescribe medications and other treatments
    • Manage patients' overall care
    • Spend time counseling patients
    • Help patients learn how their actions affect their health and well-being

    NPs specialize in many areas, including:
    • Acute Care
    • Adult Health
    • Family Health
    • Gerontology Health
    • Neonatal Health
    • Oncology
    • Pediatric/Child Health
    • Psychiatric/Mental Health
    • Women's Health

    NPs also often practice in sub-specialty areas such as:
    • Allergy & Immunology
    • Cardiovascular
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Hematology & Oncology
    • Neurology
    • Occupational Health
    • Orthopedics
    • Pulmonology & Respiratory
    • Sports Medicine
    • Urology

    What is a Physician Assistant (PA)?

    Physician assistants are health care professionals licensed to practice medicine with physician supervision. As part of their comprehensive responsibilities, PAs conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel on preventive health care, assist in surgery, and in virtually all states can write prescriptions. Within the physician-PA relationship, physician assistants exercise autonomy in medical decision making and provide a broad range of diagnostic and therapeutic services. A PA's practice may also include education, research, and administrative services.

    Because of the close working relationship the PAs have with physicians, PAs are educated in the medical model designed to complement physician training. Upon graduation, physician assistants take a national certification examination developed by the National Commission on Certification of PAs in conjunction with the National Board of Medical Examiners. To maintain their national certification, PAs must log 100 hours of continuing medical education every two years and sit for a recertification every six years. Graduation from an accredited physician assistant program and passage of the national certifying exam are required for state licensure.

    How did the Physician Assistant profession begin?

    In the mid-1960s, physicians and educators recognized there was a shortage and uneven distribution of primary care physicians. To expand the delivery of quality medical care, Dr. Eugene Stead of the Duke University Medical Center in North Carolina put together the first class of PAs in 1965. He selected Navy corpsmen who received considerable medical training during their military service and during the war in Vietnam but who had no comparable civilian employment. He based the curriculum of the PA program in part on his knowledge of the fast-track training of doctors during World War II.

    How is a Physician Assistant educated?

    Physician assistants are educated in intensive medical programs accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). The average PA program curriculum runs approximately 26 months. There are currently more than 130 accredited programs. All PA programs must meet the same ARC-PA standards.

    Education consists of classroom and laboratory instruction in the basic medical and behavioral sciences (such as anatomy, pharmacology, pathophysiology, clinical medicine, and physical diagnosis), followed by clinical rotations in internal medicine, family medicine, surgery, pediatrics, obstetrics and gynecology, emergency medicine, and geriatric medicine.

    After graduation, PAs are required to take ongoing continuing medical education classes and be retested on their clinical skills on a regular basis. A number of postgraduate PA programs have also been established to provide practicing PAs with advanced education in medical specialties.

    What are the prerequisites for applying to a PA program?

    PA programs look for students who have a desire to study, work hard, and to be of service to their community. Most physician assistant programs require applicants to have previous health care experience and some college education. The typical applicant already has a bachelor's degree and approximately 4 years of health care experience. Commonly, nurses, EMTs, and paramedics apply to PA programs.

    What areas of medicine can Physician Assistants work in?

    Physician assistants (PAs) are found in all areas of medicine. They practice in the areas of primary care medicine - that is family medicine, internal medicine, pediatrics, and obstetrics and gynecology - as well in surgery and the surgical subspecialties. Physician assistants receive a broad-based education in medicine.

    Where do PAs "draw the line" as far as what they can treat and what a physician can treat?

    What a physician assistant does varies with training, experience, and state law. In addition, the scope of the PA's practice corresponds to the supervising physician's practice. In general, a physician assistant will see many of the same types of patients as the physician. The cases handled by physicians are generally the more complicated medical cases or those cases which require care that is not a routine part of the PA's scope of work. Referral to the physician, or close consultation between the patient-PA-physician, is done for unusual or hard to manage cases. Physician assistants are taught to "know their limits" and refer to physicians appropriately.

    Can PAs prescribe medications?

    All fifty states, the District of Columbia, and Guam have enacted laws that authorize PA prescribing. In California, PA prescriptions are referred to as written prescription transmittal orders.

    What is the working relationship between a physician and a physician assistant?

    The relationship between a PA and the supervising physician is one of mutual trust and respect. The physician assistant is a representative of the physician, treating the patient in the style and manner developed and directed by the supervising physician. The physician and PA practice as members of a medical team.

    What's the difference between a PA and a physician?

    One of the main differences between PA education and physician education is not the core content of the curriculum, but the amount of time spent in formal education. In addition to time in school, physicians are required to do an internship, and the majority also complete a residency in a specialty following that. PAs do not have to undertake an internship or residency.

    A physician has complete responsibility for the care of the patient. PAs share that responsibility with the supervising physicians.

    Where can I go to learn more about NPs and PAs?

    SDN is geared primarily towards doctorate-level medical fields (MD, DO). However, there are other Internet discussion forums dedicated to NPs and PAs.

    Allnurses.com is pretty much the go-to forum for nursing.

    The PA Forum focuses solely on PAs.

    Sources:
    http://en.wikipedia.org/wiki/Registered_Nurse
    http://www.aanp.org
    http://www.aapa.org
     
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