I have always been enthusiastic about continuing my education even as a child. I would take extra courses during the summer because I loved being knowledgeable and learning new skills in my free time. It was no different once I became a registered nurse. Being a RN requires lifelong continuation in education. As of December 2018, 42 states required continuing education courses for RN license renewal. Every year that I have been a nurse I have been required to acquire CEU’s (continuing education courses) credits. I have certifications for many nursing disciplines such Advanced fetal monitoring by AWHOHNN, NCC, Advanced critical life support, Basic life support, Child abuse courses, fire safety and I have even completed 15 hours so far for FNP skills lab. There are tons of classes and courses that are available. By consistently staying on top of my certifications and renewals I have been able to maintain the required number of hours needed for my nursing license. As a nurse I am required to stay abreast of my state Board of Nursing (BON) requirements for my specific practice areas. To continue working as a nurse, I must conform to these requirements for license renewal at set intervals which is most commonly every 2 years. As I transition over to becoming an advanced practice nurse, I plan to do the same thing in being proactive with continuity of education and service. As my career expands, I realize the importance of networking as an advanced practice nurse. I have been able to precept and take courses with other APRNS and even physicians by connecting and networking with like minded individuals who share the same ambitions and passions as me. As I move forward in life I will be sure to always maintain a list of resources that I can utilize when needed.

The COVID-19 virus has been the main focus as of late. This is an unprecedented situation for all of us. Many of us are concerned about the livelihood of ourselves, family and loved ones. The clinical setting, I work in has taken the necessary steps and precautions to keep everyone safe. They have requested that all staff refrain from traveling. All employees/personnel who have traveled 150 miles from their place of work since March 9, or are planning to travel more than 150 miles from their place of work in the future, must complete a travel declaration form. Once submitted, the employee will be notified that they are cleared for work or that they will be contacted by Employee Health for further evaluation (based on the employee’s travel history). If an employee requires further evaluation, a member of Employee Health will reach out directly. That employee will not be eligible to return to work until they have been cleared by Employee Health. Domestic travel, except for cruise travel, is not currently subject to the 14 day quarantine, but the decision could change as the number of COVID-19 cases grows in certain areas.

An opportunity I think my clinical setting could consider is reducing the number of inductions for labor that are typically scheduled. While labor is not something that can always be postponed or avoided, it is imperative to remain proactive as to not put more people at risk. If it is not medically necessary to induce a pregnant woman at this time, I believe we should encourage those women to remain home and continue to help reduce the risk of exposure to the virus until they actually go into labor or reach their due date at 40 weeks’ gestation or are experience a true obstetric emergency.

Communication limitations create situations where medical errors can occur. Such errors may cause serious injury or unexpected death of the patient. Medical errors, especially those caused by a failure to communicate, are a pervasive issue in health care organizations today. Healthcare collaboration is characterized as healthcare professionals taking complementary roles and working together, sharing responsibility for problem-solving and making decisions to develop and execute patient care plans.  An interdisciplinary approach should be applied when considering a model of team work in healthcare. An interdisciplinary approach, unlike a multidisciplinary approach in which each team member is responsible only for the activities related to his or her own discipline and formulates separate goals for the patient. The patient finds that communication is easier with the cohesive team, rather than with numerous professionals who do not know what others are doing to manage the patient care. Compromise can come with its own set of challenges but, most of these hurdles can be overcome with an open attitude and feelings of mutual respect and trust. A study determined that improved teamwork and communication are described by health care workers as among the most important factors in improving clinical effectiveness and job satisfaction.

Some key diagnostic tools I have used in clinic so far have played a vital role in diagnosing my patients.

Flu test

It’s quick and easy. While they may only take 10-15 minutes to detect the presence of influenza virus antigens, rapid flu tests are not failproof. This is even after new, stricter rapid flu test standards passed by the FDA in February 2018. Effectiveness varies depending on the type of diagnostic test used and the type of influenza that is circulating  and this can cause false negative and, to a lesser extent, false positive testing results. Still, if your symptoms resemble the seasonal flu, it might be helpful to check for flu viruses and rapid flu testing is the quickest way.

Rapid strep test

A rapid strep test involves a quick throat swab. Within minutes, the testcan show the presence of group A streptococcus bacteria, which can cause strepthroat and other infections (including scarlet fever, abscesses, and pneumonia).

Portable Blood Pressure cuff (sphygmomanometer)

Evidence-based medicine has proven that the measurement of blood pressure is important in determining the overall health of a person. The sphygmomanometer can help diagnose:

• Diabetes
• Hypertension
• Artery hardening
• Arterial plaque
• Hypotension

Urinalysis

A urinalysis is a test of your urine. A urinalysis is used to detect and manage a wide range of disorders, such as urinary tract infections, kidney disease, pregnancy and diabetes. A urinalysis involves checking the appearance, concentration and content of urine. Abnormal urinalysis results may point to a disease or illness.

Otoscopes

Otoscopes are handheld devices that allow physicians to look into the ear canal and view the tympanic membrane through the magnification lens. Otoscopes help diagnose:

• Ear infections
• Tinnitus
• Causes of vertigo or dizziness
• Meniere’s disease
• Swimmers ear

The cons of not using these diagnostic tools would put the provider at risk for misdiagnosing or missing important assessments that can help lead to proper diagnosing of a patient while ultimately lowering the quality of healthcare provided.

Screening is an assessment to “identify apparently healthy people who are at increased risk of a disease or health condition. It is aimed to identify people who would be benefited from further assessment. Screening in clinical practice is about case finding where the physician takes opportunity to request for a screening test that is more likely to result in follow-up as compared to mass screening. Screening should be on a defined target population and in the presence of scientific evidence on the effectiveness of the screening test. In addition, the overall benefits of screening should outweigh harms.

Colo-rectal cancer is the third most common cancer worldwide, with more than 1.3 million (9.7%) new cancer cases and 693,881 (8.5%) cancer mortalities. The physician at the clinic I attend uses and follows the colo-rectal screening guidelines in all of his patients that are of age. Patient education is given on the risks and risk factors and the reasons why screening is so important. He typically writes his patients a referral for a colonoscopy and then tells them to follow up with results following the procedure. For those patients that aren’t up for going out to have the procedure performed he recommends the Colo-Guard kit, this kit allows them to give a sample from the comforts of their own, all that is required is mailing the specimen off. These guidelines were accessed by using evidence-based research sites. I find these sites helpful currently because I can apply what I read into my clinical setting.

Reference

Whitlock EP, Lin J, Liles E. et al. Screening for Colorectal Cancer: An Updated Systematic Review. Rockville (MD): Agency for Healthcare Research and Quality (US), 2008. Available from: http://www.ncbi.nlm.nih.gov/books/NBK35179/.Accessed on September 20, 2014. [Google Scholar]

The clinical setting I’m currently working in is a Family Medicine practice. The practice is run by a Family medicine physician. His office is located in an extremely underserved community. There is a total of 6 rooms where we see patients. This semester differs from my last semester because the settings are entirely different, last semester I strictly rotated in a pediatric clinic only. This practice also sees children, but majority of the patients are adults. This week in clinic was a very good experience for me. The physician loves to teach and explains the reasoning and rationales for every diagnosis and differential when discussing patient treatment plans and problems while frequently asking for my input on everything. I have a strong background in women’s health, I’m currently a labor nurse so most of the things I see in clinic are new to me.  Most of the patients come into the clinic with common diagnosis such as hypertension, diabetes, and high cholesterol. We do a lot of patient teaching and education on preventative care. I’ve learned that describing/ discontinuing a medication is just as imperative as prescribing especially with the older patient population in relation to polypharmacy specifically with blood pressure medications and diuretics. My three learning goals are to become more comfortable seeing the general population not just  only women in the family practice setting, become more confident when seeing patients alone, and expanding my knowledge base overall on family medicine. I’m looking forward to what this semester has in store .

Be yourself; Everyone else is already taken.

— Oscar Wilde.

This is the first post on my new blog. I’m just getting this new blog going, so stay tuned for more. Subscribe below to get notified when I post new updates.

This is an example post, originally published as part of Blogging University. Enroll in one of our ten programs, and start your blog right.

You’re going to publish a post today. Don’t worry about how your blog looks. Don’t worry if you haven’t given it a name yet, or you’re feeling overwhelmed. Just click the “New Post” button, and tell us why you’re here.

Why do this?

• Because it gives new readers context. What are you about? Why should they read your blog?
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The post can be short or long, a personal intro to your life or a bloggy mission statement, a manifesto for the future or a simple outline of your the types of things you hope to publish.

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• Why are you blogging publicly, rather than keeping a personal journal?
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You’re not locked into any of this; one of the wonderful things about blogs is how they constantly evolve as we learn, grow, and interact with one another — but it’s good to know where and why you started, and articulating your goals may just give you a few other post ideas.

Can’t think how to get started? Just write the first thing that pops into your head. Anne Lamott, author of a book on writing we love, says that you need to give yourself permission to write a “crappy first draft”. Anne makes a great point — just start writing, and worry about editing it later.

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