DiversityNursing Blog

As a Nurse Practitioner, the state you live and work in has different laws and regulations that impact your practice. There are 3 different authorization categories -- Full Practice, Reduced Practice, and Restricted Practice. Here are the details and states for each practice.

The American Association of Nurse Practitioners defines each category below.

Full Practice
State practice and licensure laws permit all NPs to evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing. This is the model recommended by the National Academy of Medicine, formerly called the Institute of Medicine, and the National Council of State Boards of Nursing.

Reduced Practice
State practice and licensure laws reduce the ability of NPs to engage in at least one element of NP practice. State law requires a career-long regulated collaborative agreement with another health provider in order for the NP to provide patient care, or it limits the setting of one or more elements of NP practice.

Restricted Practice
State practice and licensure laws restrict the ability of NPs to engage in at least one element of NP practice. State law requires career-long supervision, delegation or team management by another health provider in order for the NP to provide patient care.

Full Practice States

• Alaska
• Arizona
• Colorado
• Connecticut
• Hawaii
• Idaho
• Iowa
• Maine
• Maryland
• Minnesota
• Montana
• Nebraska
• Nevada
• New Hampshire
• New Mexico
• North Dakota
• Oregon
• Rhode Island
• Vermont
• Washington
• Wyoming

Reduced Practice States

• Alabama
• Arkansas
• Delaware
• Illinois
• Indiana
• Kansas
• Kentucky
• Louisiana
• Massachusetts
• Michigan
• Mississippi
• New Jersey
• New York
• Ohio
• Pennsylvania
• South Dakota
• Utah
• Virginia
• West Virginia
• Wisconsin

Restricted Practice States

• California
• Florida
• Georgia
• Missouri
• North Carolina
• Oklahoma
• South Carolina
• Tennessee
• Texas

The demand for NP’s with Full Practice authority continues to increase rapidly as more Doctors choose to pursue other specialties rather than family medicine or primary care.

Do you have any comments you’d like to share about these regulations?

In 2018, approximately 52 children died after being left in an overheated vehicle. That is the highest number in the past 20 years, according to the National Safety Council.

Emergency Room Nurse Maria Striemer, RN, BA, witnessed a child in her care almost die from heat exhaustion after being accidentally left in a hot car.

The air temperature inside vehicles rises dramatically. According to an article from the Journal of Emergency Medical Services, the air temperature inside a vehicle parked in the sun with variable outside temperatures increased by approximately 20˚ in 10 minutes. By 20 minutes, the inside air temperature was 29˚ higher than ambient temperatures. By 60 minutes, a variety of vehicle types and ambient temperatures will reach similar peak interior temperatures of 140–180˚ F.

Even a brief entrapment in a vehicle can expose a child to heatstroke. The shortest recorded fatal exposure was 15 minutes. The core body temperature of deceased victims was between 102.9–109˚ F.

Maria knew there had to be a simple solution to prevent these tragedies from happening. She and her engineer husband, Grant, used their 3D printer in their basement to create the "Backseet Buddy".

The Backseet Buddy is a silicon device placed on a child’s car seat designed to pair with an app on an iPhone or Android. Using Bluetooth technology, the device and app can detect when a phone has moved more than 50 meters from a car seat with the sensor still activated and sends an alert to the phone.

Maria and Grant received a patent and are meeting with venture capitalists. They hope to bring the product to market in 2020.

“I have many first-time parents telling me they have fears of being sleep deprived or distracted, and how badly they want this product. It would be amazing if it were in the hands of parents before they leave the hospital,” Maria said.

Nursing can be a tough profession. There may be days that stress you out and make you feel bad about yourself. You might question if this is the right job for you or if you're good enough to be a Nurse. Here are a few tips to improving your confidence and staying positive during difficult times.

Fake it till you make it?

An American Sentinel University article discusses the popular mantra and says, "Clearly, as a Nurse you cannot ethically fake skills or knowledge you don’t have. What you can do is to convey confidence that you don’t necessarily feel, by flipping the script. For example, when you don’t know what to do for a patient in distress, don’t focus on your knowledge gap- instead, try to feel confident about your ability to leverage whatever resources you need to figure out the next steps."

Never Stop Learning

No one knows everything but constantly learning and growing your knowledge will make you feel more confident. Always ask questions if you're unsure about something. Try taking workshops or individual classes in areas that you’re not familiar with or want to expand your skillset. Knowledge is power!

Don't Compare Yourself

Sometimes our insecurities can come from watching someone do a great job and wonder if you're doing good enough. Instead of comparing how you work and what you have to others, be proud of the skills you do have and tell yourself you are doing a great job and you are doing the best you can. 

Stand Up to Bullies

Unfortunately, we know bullying exists in the Nursing profession, but you don’t have to succumb to it. Being bullied can effect your self-esteem big time. Bullies feed off of low self-confidence and a passive communication style. Try to hold your head high, make eye contact, and stand up for yourself by speaking with a strong sense of self.

Don't Seek Gratitude

An article by Transition Nursing states, "Unfortunately, as Nurses we are often the last to be “thanked”. You know this to be true and you’ve most likely experienced it. You work hard for your patients, but not every patient will express gratitude. They may be dealing with a new and traumatic diagnosis and because of it, they are not themselves. Remember why you got in to this profession. Be firm in your belief that you have contributed, helped, and cared.

Perfection isn't Real

You are human and no one is perfect. It’s best to admit your flaws and when you've made a mistake. Confident people are able to admit when they are wrong. You cannot convey or build confidence by covering up or denying your role in a mistake, or by reacting defensively. Learn from it and move on.

In your Nursing career, have you experienced self-esteem issues? What helped you overcome those difficult times? Please share with us.

Nursing is an emotionally fulfilling career providing many ups and downs. Hopefully more ups than downs! It isn't an easy path, but if you are called to Nursing, it’s worth it. Some of the best things about being a Nurse are experiences that you won't find in many other jobs. Here are a few reasons why Nurses love being Nurses.

Relationships

Many times you form strong relationships with your patients. You spend all day taking care of their every need. During the course of your shift, you're usually working with the same patients so you form a special bond with them. Being able to get to know someone and help them when they're at their most vulnerable and sick is a really wonderful, gratifying feeling.

Never Boring

In this fast paced environment there's rarely a boring day at work. You’re juggling many important balls and pulled in many directions so there's no time to get bored. There's always something that needs to be done or someone to assist.

Job Security

Job security is another great thing about Nursing. According to the Bureau of Labor Statistics, nearly 3 million Registered Nurses work in the US right now. BSL predicts the country will also add half a million new RN jobs by 2026 due to the aging baby boomer population and an "increased emphasis on preventative care". 

Schedule Flexibility

You can choose a schedule that works for your lifestyle. In the hospital environment, shifts include day, night and weekends. You can also choose what days. There are part-time nursing positions and weekend only programs. Throughout your career, you'll be able to adjust your schedule based on the kind of life your living.

Friendship

The relationships you build with fellow Nurses can last a lifetime. Nursing is usually a very team-oriented profession therefore, you have plenty of people to help you through difficult situations. Over time, your colleagues can become some of your very closest friends. Friendships can form with some patients too.

Career Flexibility

You can change your career path without changing your career. Businesses that employ Nurses include hospitals, private medical practices, schools (School Nurse and Nurse Educators), insurance companies, etc. With additional education and training, you can change your specialty. For example, you could go from being a Clinical Nurse Specialist to a Pediatric Nurse.

Career Satisfaction

Many Nurses tell us they love helping and making a difference in someone's life every single day. They say this is the Nursing profession’s biggest reward.

Do you have a reason why you love being a Nurse that we didn’t include? Please share it with us!

Hyden, Ky - Frontier Nursing University (FNU) hosted its 9th annual Diversity Impact Student Conference in Hyden, Ky., June 6-9, 2019. The annual Diversity Impact Student Conference was hosted by the FNU Diversity Impact Program and had more than 60 students, alumni, faculty and staff in attendance.

The theme of the 2019 event was "Every Voice, Every Story: 80 Years and Beyond" which is in line with the celebration of the 80 years of service that FNU graduates have provided to mothers, babies, and families across the globe.

FNU's Diversity Impact 2019 conference opened the door for nurse-midwifery and nurse practitioners students to foster collaborative discussions, address health disparities, and find proactive solutions to improve minority health among underrepresented and marginalized groups. Students engaged in team-building activities, cross-cultural and intercultural workshops, and they learned about nurse-leadership strategies on how to effectively care for diverse populations within their communities.

This year’s Diversity Impact Event includes an inspiring lineup of internationally-known speakers including:

-FNU president Dr. Susan Stone, DNSc, CNM, FAAN, FACNM
-Keynote Speaker Nicolle L. Gonzales, BSN, RN, MSN, CNM
-Premier Speaker Dr. Heather Shlosser, DNP, APRN, FNP-BC, PMHNP-BC
-Nena R. Harris, Ph.D., FNP-BC, CNM, CNE
-Jane F Houston FACNM, DNP, CNM
-Kalena Lanuza, DNP, FNP-C
-Dr. Sheri Sesay-Tuffour, CEO of American College of Nurse-Midwives (ACNM)
-Devon Peterika, MS, BA
-Ralph Newell and Sydnee Reese, Diversity in Higher Education Workshop

Learn more about FNU's Diversity Impact Program here.

View Photos from FNU's 2019 Diversity Impact Student Conference

Because you chose to be a Nurse, your vocation is to take care of others. You put a lot of your heart and time into your career. Naturally, you do the same thing outside of work so it is no surprise that many Nurses do volunteer work in their spare time. 

Volunteering not only helps many causes and people, it also gives you a sense of purpose. It makes you feel good to do good.  Additionally, it helps you grow your resume and build on your knowledge. 

If you're looking for something that doesn't use your medical skills, there are plenty of opportunities to help out at your local animal shelter, food pantry, nursing home, church/temple, community clean up organizations, and more! If you'd like to use your Nursing skills, here are a few volunteering opportunities you might like! 

The American Red Cross

90% of the work of the Red Cross is done by volunteers. They rely on more than 20,000 Nurses and other health professionals to bring relief to disaster victims, work in military hospitals, and collect lifesaving blood.

They also develop and teach courses ranging from CPR/first aid to disaster preparedness. And they serve in management, supervisory, and governing roles throughout our organization. To see what opportunities they are offering, click this link.

Bucketts of Love

Their mission is to give deprived, underprivileged Nepali people proper healthcare. People of Nepal are denied access to primary healthcare due to their social status and living situation.

Since 2012 Bucketts of Love has been offering free health camps. They have served thousands of people and provided them with primary care assessments, medication, diabetic testing and more! To learn more about their organization click here. 

Project HOPE

Project HOPE was founded in 1958. Volunteers have remained central to Project HOPE’s mission as the “People-to-People Health Foundation.” They deliver essential medicines and supplies, health expertise and medical training to respond to disaster, prevent disease, promote wellness and save lives around the world. 

They work at the epicenter of today’s greatest health challenges, focused on Maternal, Neonatal and Child Health, Disasters and Health Crises, Infectious Diseases, Noncommunicable Diseases, and Health Policy. To learn more about volunteering click here.

Action For Healthy Kids

The focus of Action for Healthy Kids is to create healthier school environments for children. They do several projects and trainings/workshops each year to promote school health across 50,000+ schools.

Action for Healthy Kids is an organization of over 140,000+ volunteer health professionals. Most are still working, but volunteer their time to be a part of the group. To see how you can volunteer click here. 

International Medical Relief

IMR offers short-term assignments for volunteer medical professionals and dental professionals, students, and non-medical volunteers to conduct medical and dental clinics that provide free, expert care and health education in areas where it is limited or difficult to obtain.

IMR was founded on the belief that knowledge of basic health facts and access to healthcare should not be the prerogative of select nations, regions, or classes, but should be shared by as many people as possible. During our clinics, we partner with local medical and dental professionals to share knowledge about diagnoses and treatment. We also provide community health education so that people are empowered to provide for their own health, as well as for the health of other community members. To learn more about volunteering click here. 

By volunteering, no matter how big or small, you can change a person's life for the better. Now what could be more rewarding than that? 

If you have a volunteering opportunity not listed, please share it here. We also welcome your volunteer stories.

The Journal of the American Osteopathic Association published a double-blind study where beagles were 97% accurate at being able to distinguish between blood serum samples from patients with malignant lung cancer and healthy controls.

Researchers believe this may lead to the development of a safe, effective, and inexpensive means for mass cancer screening. The goal is to create a type of over-the-counter screening product, similar to a pregnancy test, in terms of cost, simplicity and availability.

According to the American Cancer Society, lung cancer is the leading cause of cancer death worldwide for both women and men. Thirteen percent of new cancers are a form of lung cancer, and more than 200,000 people in the United States receive a diagnosis of lung cancer annually.

The study says, that early detection provides the best opportunity for lung cancer survival; however, lung cancer is difficult to detect early because symptoms do not often appear until later stages. Current screening methods such as x-ray and computed tomographic imaging lack the sensitivity and specificity needed for effective early diagnosis. Dogs may be able to solve this problem using scent.

According to a Science Daily article, Dogs have smell receptors 10,000 times more accurate than humans', making them highly sensitive to odors we can't perceive. The beagles were chosen for their quality olfactory receptor genes and had 8 weeks of training.

Thomas Quinn, professor at Lake Erie College of Osteopathic Medicine and lead author on this study is nearing completion of a second form of this study. But this time the dogs are working to identify lung, breast and colorectal cancer using samples of patients’ breath, collected by the patient breathing into a face mask.

The goal from this study would be to create a device that someone can breathe into and see a color change to indicate a positive or negative finding.

The U.S. population is growing increasingly diverse. By 2020, the U.S. Census Bureau projects less than 50% of the children in the U.S. will be non-Hispanic and Caucasian. With demographics shifting, health care professionals trained in cultural competence will meet the needs of community health more effectively.  Nurse practitioners earning their Master of Science in Nursing can gain exposure to cultural competency in nursing practice. Trained NPs can help reduce disparities minorities experience, such as lower quality care, through improved awareness.

Culture’s Influence on Health Beliefs and Perception

Culture includes the knowledge, beliefs, and behavior of different groups of people. Elements of culture influence health knowledge and beliefs, as well as behaviors and measures that are taken to promote health. Understanding and respecting different cultures is a critical aspect of providing holistic, effective care.

Nurse practitioners must be culturally competent to be able to effectively listen to their patients’ health concerns, treat their health conditions in ways that are acceptable to the patient, and communicate in ways that are responsive and respectful of the patient’s culture. Here are a few ways that culture and ethnicity influence the care patients receive:

Body Language

Cultural norms highly influence body language. One example is the degree of eye contact with which individuals are comfortable varies. Some cultures express respect by not making eye contact, which can lead health care providers to view the patient as withdrawn, and suspect depression or anxiety if not informed of this difference. Eye contact may also be viewed in some cultures as flirtatious, or even disrespectful.

Experience of Pain and Illness

Different cultures have different ways of coping with illness and pain. These differences influence how, when, and whether individuals seek care. Cultures with an acceptance of pain as part of life may not report their pain to health care providers, and may not consider it a health problem.

Emotional responses to pain are also influenced by culture. Cultures that value stoicism may warrant less outward expression of pain, leading uninformed providers to believe that the individual isn’t suffering. Other cultures expect individuals in pain to react emotionally. Nurse practitioners must be mindful of differences in how cultures view, express and accept pain.

Decision-Making

Decision-making regarding health is also approached differently among ethnic groups. Some cultures value making health decisions as a family, or the individual receiving care will make the decision themselves, or the patient may appoint another family member to make decisions regarding their care. Nurse practitioners must be mindful that the patient may want to discuss options with their loved ones before accepting or declining a health care treatment plan.

Linguistic Barriers

Identifying linguistic barriers is another important aspect of cultural competence. Individuals may be able to communicate basic health needs to the provider, but have difficulty understanding the terminology used in the practitioner's response. NPs must be mindful of this, and also that some patients are not comfortable indicating that they don’t understand. Linguistic barriers can lead to the provider either missing or misinterpreting some of the nuances of the patient’s symptoms.

One way to help identify a linguistic or learning style barrier is through using the teach-back method. After explaining a health condition or treatment to the patient, the nurse practitioner then asks the patient to return the teaching. If they’re unable to do so or demonstrate some difficulty, interpretation services or a different teaching style, such as the use of audio or visual aids, may be necessary. Interpretation services should always be made available to those who speak English as a second language. Interpreters can also help providers better understand cultural differences.

Treatment Tailored to the Patient

Receptivity to cultural differences also influences treatment accepted by the patient. If a provider is not sensitive to or respectful of cultural differences, patients from diverse backgrounds may experience confusion or frustration. This may lead to them initially accepting treatment, but once home they may not follow through because they don’t trust the provider, don’t understand the purpose of the prescribed treatment, or the care plan conflicts with cultural values.

Taking Initiative as a Nurse Practitioner

Improved awareness helps eliminates assumptions made during care and gives voice to patients, so they can adequately express their concerns. Understanding cultural diversity in nursing also helps close the gap in health equity, reducing health disparities affecting minority populations such as higher morbidity rates and lower quality care.

Nurse practitioners are responsible for improving their own cultural competency to ensure that all patients receive effective care. The Agency for Healthcare Research and Quality offers many ideas to improve cultural awareness-one way is by respectfully asking patients about their beliefs in the context of health and treatment.

Nurse practitioners can also benefit from attending courses on cultural diversity in practice, participate in community organizations, and research the norms of different cultural and ethnic groups. Broadening one’s own understanding of culture and how people interact improves the professional ability to make meaningful connections with patients.

References:

Agency for Healthcare Research and Quality. (2015). Consider culture, customs, and beliefs: Tool #10. https://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/healthlittoolkit2-tool10.html

National Institute of Health. (N.d.). NIH fact sheets - Health disparities. https://report.nih.gov/nihfactsheets/viewfactsheet.aspx?csid=124

Peacock, S., Patel, S. (2008). Cultural influences on pain. Reviews in Pain: British Pain Society, 1(2), 6-9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4589930/.

United States Census Bureau. (2018). Older people projected to outnumber children for first time in U.S. history. https://www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html

Holly Rinehart, RN, BSN, is a registered nurse and writer for the Carson-Newman University blog. She specializes in emergency and perioperative nursing and cherishes the opportunity as a nurse to help serve and comfort those in vulnerable positions. In her free time, she enjoys traveling and telling nurse stories to anyone who will listen.

Nurses see firsthand how facilities are being used every day. They observe what furniture is being used or not used by visiting families and friends. They see how patients move about the hallways, patient rooms, stairs, elevators, cafeterias, bathrooms, etc. Nurses see the pros and cons of the infrastructure of the building(s) and should have a say in how they're built in order to provide the best care possible. 

"Input from Nurses and other healthcare professionals are mirroring the health professions' renewed focus on quality and safety in their designs. Nurses might not know how to read architectural drawings or use computer-assisted drafting tools, but they have a very important role to play in helping plan and design physical spaces that support the delivery of safe, effective patient care.", said Matt Freeman a spokesman for the Robert Wood Johnson Foundation.

According to the Robert Wood Johnson Foundation briefing, some design choices being used across the country as a result of input from Nurses include:

• Ventilation and filtration systems to improve air quality and remove allergens, pathogens and more;
• Ergonomically designed patient rooms, including patient lifts and handrails, as well as beds and Nursing stations designed to reduce patient falls and staff injuries;
• Decentralized unit layouts so as to increase the time Nurses spend at the bedside;
• Better lighting to ward off medical errors;
• More natural sunlight, in part because studies show that it helps blunt the perception of pain, improves the quality of sleep and leads to shorter hospital stays, while allowing Nurses to better assess skin tone;
• Noise reduction features, such as carpet, acoustical tiles, handheld pagers as a substitute for overhead systems, to improve sleep and reduce stress;
• Better way-finding systems, including maps, landmarks, signage, information kiosks, directories and more, to help patients and visitors while allowing staff to focus on their clinical duties instead of giving directions; and
• Access to nature, water features and works of art, all to reduce stress.

With a new work space, a new work flow should follow. The Nursing team at Stamford Health in Stamford, CT, helped design their new hospital. Ellen Komar, MPA, BSN, RN, NEA-BC, Vice President of Patient Care Services and Chief Nursing Officer said “Old, inefficient habits are not allowed to invade our new workspace. Given such a different layout, the way we work will have to change. A few members of our Nursing team are retooling every workflow process."

It takes time and resources, but this kind of collaboration between Nurses and architects provides the opportunity to give patients the best possible care.

Are you a Nurse who has been involved in the design of your new facility? Do you have some great design ideas you’d like to share? Please comment below, we would love to hear them!

There are many specialties available to Nurses and choosing the right one can be a difficult decision. If you can work under pressure in a fast-paced and often-stressful environment while staying calm and collected, Emergency Nursing might be for you. For some people, working in the ER can be intimidating but, for others rewarding.

According to former trauma and transport Nurse Pat Carroll, “The Nursing duties are the same wherever you work, except in the Emergency department, everything is compressed.” She shares that ER Nurses are often evaluating and treating patients almost simultaneously, and they work with a team of specialists, such as radiologists and orthopedic experts, to provide the highest-quality care.

A new study shows the demographics and other findings of the Emergency Nursing workforce.

• There are an estimated 167,375 providers of direct patient care in the Emergency/Trauma/Transport Nursing workforce.
   
• 43% of the workforce is under 40 years old.
   
• 78% of the workforce are women.
   
• Compared to the overall Nursing workforce, Transport Nurses are more likely to be male.
  
  
• 78% of the RNs surveyed hold a BSN or higher.
   
• 58% hold specialty board certification.
  
  
• 65% are satisfied or very satisfied with their jobs and the work they do.
  
  
• $77,500 is the median salary for Emergency/Trauma/Transport Nurses working full-time.

Working as an Emergency Nurse can be nerve-racking and emotionally draining. It also requires working long hours in a dangerous environment due to exposure to different types of pathogens and patients. However, if you’re looking for a fast-paced Nursing career where new challenges await you daily, and you can truly make a difference, Emergency Nursing may be the perfect specialty for you.

If you are an ER Nurse we would love to hear about your experiences, please comment below!