Oversight not needed
As a recent graduate of a nurse practitioner (NP) program, I appreciated your article “Retail-based clinics: New option for nurses” in the March issue. You provided a good overview of the scope of practice within and the benefits of these clinics. And I was reminded of this unique area of practice, as I consider my employment options.
However, I think the section called “Not everyone is happy” could be misleading. The summary of objections to retail clinics raised by some physicians mentions the need for “oversight by physicians” and “referral to physicians when care is outside a clinic’s scope.”
State regulations, not physicians, determine the scope of practice for NPs. In many states, NPs can practice independently without oversight or collaboration with physicians. Also, when a patient’s care is outside of the scope of any provider’s practice, whether an NP or a physician, the provider must refer the patient to another provider.
Jill Hansen, MN, ARNP, FNP
It’s more than time for nurses to recognize and address the issues that affect our practice and that we all have in common. I think the new American Nurse
Today is making an excellent effort. I find the articles to be a reflection of current issues in nursing practice and am impressed by the diversity of subjects and opinions. Congratulations. I look forward to further thought-provoking reading!
Jean Shinners, MSN, RN, CCRN
Boca Raton, FL
I was pleased to read “Issues up close: Care during crises” in the March issue. I actually felt relieved to learn that ANA is pursuing two initiatives: assembling healthcare professionals and government representatives to create a comprehensive document to guide nurses during a disaster and holding a conference on nursing care during a disaster.
This topic is vitally important. We need to be able to provide the best possible care under the worst possible conditions.
Corrice White, RN
New York, NYGuidance on giving naloxone
In the April issue, the authors of “Are you an ABG ace?” correctly note that naloxone should be given to reverse respiratory depression in case study 1. I’d like to add that the drug should be given very slowly to prevent adverse reactions—such as pulmonary edema, nausea, vomiting, and unnecessary pain.
For best results, mix 1 ml of 0.4 mg/ml naloxone with 9 ml of normal saline solution to make a concentration of 0.04 mg (40 mcg)/ml. Administer the diluted naloxone at 0.5 to 1 ml every 2 to 3 minutes until the patient responds adequately.
Before giving the drug, provide bag-valve mask support to rapidly decrease the CO2 level, which is contributing to the stupor, and to minimize tachycardia caused by sympathic nervous system stimulation from the increased CO2 level and naloxone.
Barbara S. Marion, BSN, RN, CCRN, CPAN
Palos Hills, IL
Covered in cartoons
I just read “The image of nursing: How do others see us? How do we see ourselves?” in the May issue and want to comment on the author’s point about nurses dressing in cartoons. In my 27 years as a pediatric nurse, I’ve found that children respond much better when staff members dress in clothes with familiar characters. Children respond poorly to staff members dressed in solid colors, especially white.
Sherrie Hauser, RN, CPN
Cortlandt Manor, NY
As the article suggests, all nurses can gain a broader perspective by surveying staff, patients, and caregivers about their perceptions. Wearing cartoon characters may provide a benefit to pediatric patients. But it probably doesn’t instill confidence in the frightened parents of a child in a neonatal intensive care unit.
If we each took a short survey of our specific populations and were willing to listen to what our patients and families think, we would take a great step forward in improving our image.
Shelley Cohen, BS, RN, CEN
Looking like a professional
Thank you for addressing one of my long-time pet peeves in “The image of nursing: How do others see us? How do we see ourselves?” For too long now, nurses have been walking around looking like clowns. It’s no wonder we don’t get the respect we deserve from doctors and patients. Indeed, how can you take someone seriously when they are covered in cartoons? If you are a professional, you should look like a professional.
Paul Weslow, RN
Learning like a professional
Yes, we have an image problem, but Snoopy and Sponge Bob aren’t causing it. Our educational requirements are. The definition of a professional dictates an entry educational level of a bachelor’s degree. No other professional group allows less. The entry level for social workers is a bachelor’s degree. For occupational therapists, it’s a master’s degree. Yet nursing clings to the idea that an associate’s degree is good enough.
In the 30 years I’ve been a nurse, our need for a strong, science-based education has grown. Technology is expanding the focus of our practice, and we need to grasp new concepts quickly. Bachelor degree programs provide the needed science base and much more. Associate degree programs don’t. They make students into technicians, not professionals.
As long as nursing allows this educational dichotomy, we will struggle with our identity. Unless we take on all the responsibilities of professionals, including education, the public will have difficulty granting us the respect we want.
Deborah Abramson, BSN, RN, CCRN
Escanaba, MI O
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