Nurse practitioner enrollments are on the rise because many physicians are opting for specialized practices instead of primary care. As patient loads increase, this trend is creating a worsening shortage of primary care providers and a growing demand for nurse practitioners.

Nurse practitioners are advanced practice nurses generally work along with and in place of primary care physicians. They are registered nurses with advanced clinical training and a graduate degree, typically a masters in nursing. Some of their duties include physicals, diagnostic testing, diagnosing, prescribing medications and treatment, and patient care planning and management. Nurse Practitioners readily find work in clinics, doctor’s offices, hospitals, urgent care clinics, emergency rooms, in government agencies, and also practice independently in their own private practices.

According to the American Academy of Nurse Practitioners, there are approximately 135,000 NP’s currently practicing in the U.S. as of 2010. They provide care to the tune of 600 million visits annually.

MSN Direct-Entry Programs

Direct-entry nursing programs provide an opportunity to become a licensed RN, even though you may have a different kind of BA degree such as psychology or biological science. These programs are also commonly referred to as “clinical nurse leader” programs.

Typically, direct-entry MSN programs last 3 years. Year 1 prepares nursing students for RN licensure, while years 2 and 3 focus upon advanced practice areas and nursing leadership. Advanced practice areas in nursing include: Clinical Nurse Specialist (CNS), Nurse Midwifery (CNM), Nurse Anesthetist (CRNA) and Nurse Practitioner (NP).
RN First Assistants (RNFA) are also considered advanced practice nurses.

Clinical pharmacology, health assessment, pathophysiology and health promotion are included in a typical course of study of most NP programs.

Online LPN to BSN Bridge Program

Licensed Practical Nurses have the opportunity to earn an accredited BSN degree completely online without ever stepping foot in a classroom in as little as 12 months through top ranked Indiana State University’s LPN to BSN program.

Upon graduation from the LPN-to-BSN program they can then enjoy higher salary and better job opportunities as registered nurses while using tuition assistance programs to pay for an online nurse practitioner program and become a NP without giving up their job or paycheck in the process.

BSN Fast-Track Programs

There is yet another alternative for those wanting to earn a NP license and certification. But, the first step of course is to become an RN. There are accelerated bachelors of science in nursing programs (BSN) which prepare those with a BA degree in another field for RN licensure. While they typically last only 15-18 months, they are intensive and quite competitive to get into.

After about a year of RN working experience, nurses can apply to the traditional MSN school and complete NP training. While the accelerated BSN route may be quicker to obtaining the RN license, it still takes about the same time when figuring in the pre-nursing coursework, plus the year of work experience required by traditional MSN schools.

Employment Outlook For Nurse Practitioners

Due to the increase in the elderly population and shortage of primary care physicians, the demand for NP’s is growing as a more cost-effective solution to healthcare. This is especially true for rural, underserved areas. The median annual salary for NP’s in the U.S. is $85,200, with top earners making $113,000 according to CNN Money. Many states are now accepting nurse practitioners as Medicaid providers, reimbursing at the rate of physicians. Congress has also passed legislation for NP reimbursement under Medicare.

Career Advancement/Specialization

Nurse practitioners specialize in many different areas. Specialization allows NP’s to focus on providing healthcare services to a particular population or area of practice. The University of California San Francisco School of Nursing boasts 10 areas of specialization for NP’s: Acute Care NP, Adult NP, Family NP, Midwifery-Women’s Health NP, Pediatric NP, Neonatal NP, Acute Care Pediatric NP, Psychiatric NP, Gerontology NP, and Occupational Health NP. According to the U.S. Department of Labor Bureau of Labor Statistics, family practice is the most common specialty area.

NP’s also practice within sub-specialties such as neurology or orthopedics. Those who specialize are certified nationally by the American Nurses Credentialing Center of the American Nurses Association.

Could A Nurse Practitioner Career Be Right For You?

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By Sherry Jones Mayo, RN, EMTP, DAAETS
Diplomate, American Academy of Experts in Traumatic Stress

Whenever there is a disaster somewhere, at least a dozen e-mails find their way to my inbox from all over the country with the same question: “So … you going?”

It isn’t that I’m a master of disaster (relief), but having deployed to Jackson, MS after Katrina, national disasters have become part of my portfolio. I’ve also responded many times at a moment’s notice after planes fell unceremoniously out of the sky. Something about people in emotional pain tugs at this old trauma nurse’s heart, and whether pain is relieved with medications, hand-holding, or simply talking to someone who is hurting and has had their entire world-view changed in a moment, I’m often there.

My own world-view changed after Katrina. I had been training for years to respond in a number of ways: I could be part of a ground crew, air crew, medical team, or crisis response (Critical Incident Stress Management) team. Whatever the hat, and sometimes those hats changed in the middle of the game, I was ready (I thought). Anyone who has responded to mass disaster will probably tell you it is not what they expected, but responders prepare to the best of their ability, and the rest is as unpredictable as the winds.

When Katrina’s hurricane winds whipped into frenzy, I began assembling my crisis response crew with the aid of my second in command, Chaplain Don Brown (an ex-flight medic). We considered the logistical challenges, the limitations of how many folks we would deploy, where our responders lived, how long it would take to get to the disaster site (and by what method of travel), how long folks could stay, and how many checkboxes each candidate filled (in terms of qualifications) so that we might get the most ‘bang for our buck’ with each person sent. I wore at least five hats: National Director for the department, Team Leader once on site, Interventionalist at my assigned base, Nurse (advising ground teams in the field), and go-fer when not wearing the other four hats. All the ducks were in a row.

Getting Back To The Basics Of Life…

Preparation guidelines dictated that responders deploy with a ‘go-bag’ ready for a week’s assignment. We had everything from bed rolls to food, water, and toilet paper. I cut 24” off my waist-length hair, knowing that hair care was not a priority on a disaster site. There were no showers, many of my team mates lived under the stars, and were it not for MRE’s (military Meals Ready to Eat), only sun-warmed meals made the menu. We returned to a much simpler way of life, and our priorities shifted wildly back to basics.

In nursing school, as with many collegiate programs, we learned about Maslow’s Hierarchy of Needs. Most folks who respond to disasters, who leave home and creature comforts behind, are usually personally and emotionally developed to a point that leans toward the top of Maslow’s needs scale. Self-actualization and following one’s destiny comes crashing down off the top of the needs pyramid as the focus on food, water, and safety take precedence over fulfilling one’s destiny. Those of us restricted to the compound’s headquarters felt a sense of guilt at not being ‘out there’ with the ground teams, or flying above with air crews who witnessed a massive sense of the destruction (and the smell of death). The overwhelming personal internal questionings of “why weren’t we here sooner?” and “why couldn’t we do more?” were consistent among rescuers. We were frustrated at not being able to do more; isn’t that why rescuers go to disaster sites, to make a difference?

Even Little Things Make A Difference

But we did make a difference. Sometimes working with the rescuers meant lending an ear to hear rescuers expressed frustrations about not doing enough to help folks devastated by the loss and destruction. Sometimes, as a nurse, I was able to pull rescuer’s shoulders out of their ears with massages (please, if you are a professional masseuse, offer your chair and services when possible). Sometimes we made coffee or shared rations. Sometimes there were medical evaluations made to determine who needed to have care expedited and who could wait for standard ground transport. What we did on scene was comparatively small in terms of a disaster, but it is amazing how great an impact the small things can have in inordinately large circumstances. There is no small effort when you come to the aid of others, because the heart speaks volumes in immeasurable ways.

So you do the small things, and the things others may consider not so small, but you continue on tirelessly into the night that blends into the next day and the next, and before you realize it a week has passed. You are exhausted, but you keep pushing to do more because there is just so much to do, so many people affected, so much that cannot be fixed or forgotten. When you leave all of the creature comforts of home to enter a place that literally holds nothing to support life, you become someone else. When the devastation is only a relatively short distance from home, as with Katrina, it might as well be a war zone on another continent, because you temporarily lose the reality of the place you left behind. The homes and conveniences we knew were gone, and seeing the impact of a hurricane’s fury left some with a new reality. We formed new connections, adopted new families, adjusted to a new structure, all in a very short time. When the time came to return home, many of us didn’t want to go. Helping people through a disaster situation can be addicting to the rescuers and those who offer much needed emotional support.

Reevaluating Values And Choices

So am I going to Haiti? No; but I gave it a great deal of thought before having to pass on the opportunity. I see pictures that friends have sent home, and the images pull at my heartstrings for those who have suffered such loss, and for the responders who are there to help them. I hope that when the workers get home, their families understand there will be a time of transition necessary to acclimate back to ‘normal’ American living; our lifestyle can seem terribly excessive and wasteful when you’ve come from a place without the most basic creature comforts, a place of nothing.

And that is where my world view was most changed; my family background stressed gratitude for the simple things in life, but coming back from that place of nothing cemented those perceptions even deeper into my emotional psyche. Look around; you have food, water, electricity, clean clothes, the people you love, pets. Things are relatively sanitary and neat, manicured yards are the norm, and you talk to those you know and love simply by reaching for a telephone. You make plans for tomorrow and next week and next summer because the fair expectation is that everything is going to happen as designed, and those days will come and go without incident.

As you ponder and prepare for those future plans, there may be some type of distraction (TV, radio) nearby. Sometimes a lack of silence defers introspection about incidents like disasters and tragedies. It is easy to change a channel or turn one’s head and think, “That is awful, I feel for those people, but I can’t deal with what they are going through.” Maybe you can’t, and that is a fair choice made by each individual asked to respond. If you have the opportunity to go, if you have the skills and flexibility to leave your home and job and family, prepare for a life-changing experience. Responding to a disaster is not what the average Joe imagines if he envisions going to a disaster site as a totally selfless service to humanity. I suppose you could look at it that way, but personally, I see just the opposite, as the probability is that you will receive far more than you could ever possibly give.

About Sherry Jones Mayo, RN, EMTP, DAAETS: Author of Confessions of a Trauma Junkie: My Life as a Nurse Paramedic, a registered nurse and a licensed paramedic with over two decades of experience in emergency medicine, including 14 years as a trauma nurse and 10 years on the road in rural and urban areas. Sherry is a member of, and Approved Instructor for the International Critical Incident Stress Foundation (ICISF), and a Diplomate with the American Academy of Experts in Traumatic Stress. Visit her website to read an excerpt from Confessions.

Could A Disaster Management Career Be Right For You?

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We have a college dropout problem in the United States. We once led the world in the number of college graduates as a proportion of population, but have fallen far behind most of Western Europe and even some Asian countries in recent years.

The number of students at four-year institutions who complete their studies within six years of starting has fallen to about 40 percent, according to the U.S. Department of Education. At two-year institutions, the number of students who complete their programs within three years stands at about 20 percent.

Why is this happening? Many studies have aimed to get to the bottom of this problem. A recent study takes the novel approach of asking the students themselves why they didn’t — or couldn’t — finish college. Microsoft founder Bill Gates has been interested in issues surrounding education in America for many years now. His charitable organization, the Bill and Melinda Gates Foundation, recently helped fund a study by Public Agenda.

Called “With Their Whole Lives Ahead of Them,” this report consists of interviews with 600 young adults who didn’t finish college. Their responses and views were then compared with those of college graduates to determine possible causes for the college dropout epidemic.

College costs up 400 percent over 25 years

According to the Public Agenda report’s findings, the major reason for dropping out of college was probably the most obvious one: cost. College attendance costs have risen an average of 400 percent in the last 25 years, while average incomes have only increased by about 150 percent.

More students work and study than ever before

The second reason for failure to finish college was more surprising. Many students who failed to graduate from college cited the need to work or uphold family responsibilities.

In a 2009 report called “Work Less, Study More and Succeed,” researchers from the Demos Foundation concluded that the proportion of full-time college students younger than 24 who also work had increased from 34 percent in 1972 to 52 percent in 2000. The US Department of Education’s 2007-2008 National Postsecondary Student Aid Study found that 45 percent of students at four-year public institutions worked more than 20 hours a week. At two-year institutions, 61 percent of students were working at least 20 hours a week. And 23 percent of college students were also parents. It’s no wonder that taking college courses — and meeting college costs and living expenses — conflicted with these responsibilities.

Online education: Flexible scheduling for working students

When asked by Public Agenda what would have helped them stay in school, most working students said that more flexible class scheduling would have enabled them to meet their working and family responsibilities while continuing to study, with 57 percent suggesting moving more classes online.

This makes sense: online college courses are about as flexible as it gets in terms of scheduling. While you’ll still have to turn in your homework on time and meet deadlines, you’re not tied down to a fixed class meeting time, and can study whenever or wherever you want, as long as you have Internet access.

Well-designed online degree courses make it possible for you to receive your course materials in a variety of media (podcasts, video, etc.) and also encourage you to interact with students and professors beyond e-mail. This convenience could make online education an attractive prospect for many students with responsibilities that don’t fit the traditional campus schedule.

But just because it’s easier to get to your classroom when you study online doesn’t mean earning your degree is easy. Online education costs about the same as on-campus education. Schools still have to pay instructors, house servers, produce course materials (including videos) and provide administrative as well as academic support to students. An online degree program will also be just as demanding academically as a traditional classroom-taught degree.

And if you’re worried about whether online education is as effective as traditional classroom teaching, don’t be. A 2009 Department of Education meta-analysis, “Evidence-Based Practices in Online Learning,” found that online education actually results in small but significant improvements in performance over traditional classroom instruction.

If you’re one of the many working non-graduates who really wants to earn or complete your degree, online college education’s convenience could help you get there.

Information in this article was provided by AIU Online, an online university offering career-focused degrees at the associate, bachelor’s, and master’s levels. Find out more at www.aiuonline.edu. (AIU does not guarantee employment or salary.)
Courtesy of ARAcontent.

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Is the rise in autism over recent decades linked to a harmful prenatal environment? Evidence may point that way, says New York Times writer Nicholas D. Kristof in a February 2010 article published in the Dayton Daily News. Medications and common products such as shampoos and cosmetics may affect unborn children adversely, according to the article. For example, 11 percent of children born to women who took the anticonvulsant valproic acid early in pregnancy were autistic.

Whatever the reason, it’s certain that we hear far more about autism in the news today than 70 years ago, when it was first identified. And according to nurse Linda Lajterman, who has 20 years of expertise in disability management, what we hear may not always be the full story.

“Of the millions of dollars that goes to autism causes most is used for research and very little, if any goes to the families living with it now,” says Linda Lajterman, RN,CCM, CDMS, ABDA, CLCP. “[Kristof's article] shows they are onto something, but why is it taking so long and why is so little money being given to the families?” she asks.

According to Lajterman, her home state of New Jersey has the highest rate of autism in the nation, yet families struggle to obtain necessary services for their autistic children. “Families are constantly fighting with schools for proper placement and home programs,” Lajterman says.

For example, current standards of treatment recommend at least 25 hours of one-on-one therapy, yet school programs may provide only 1 or 2 hours. Families that can afford it pay out-of-pocket for extra therapy and programs, but what happens to autistic children from families with limited economic means? For autistic children, therapy is not a luxury, it’s a necessity. Without enough therapy at a young age, the 1 in 94 children diagnosed with autism may be unable to work or live independently and may require long term residential placement. “Advocates and lawyers are often brought in to help the families fight,” says Lajterman. “There are some pro bono attorneys who try to help, but they have large case loads.”

As if the outlook for families with autistic children weren’t challenging enough, the situation recently became intensified. On February 11, 2010, an emergency spending reductions order signed by the New Jersey governor resulted in Autism New Jersey losing $155,000, normally provided through a longstanding contract with the State’s Division of Developmental Disabilities (DDD). In an attempt to reverse the budget cut, petition signatures from parents are pouring in, accompanied by comments like, “Our income is greatly reduced, due to our inability to find child care,” and “Without the crucial support of DDD funds for services our son and family will suffer the consequences.”

A Registered Nurse, Certified Disability Management Specialist, Certified Case Manager, Certified Disability Analyst and Fellow, and Certified Life Care Planner, Linda Lajterman hears frequently from desperate parents like these. “I have families calling me all the time looking for help. There are many very generous donors out there who give to autism causes–do they know that the families almost never see it?”

In July 2009, Lajterman founded Crossroads for Growth Inc., a non-sectarian, non-profit organization that seeks to provide relief to New Jersey’s economically challenged families that have children with autism spectrum disorders by assisting them in receiving therapeutic services.

Unfortunately, Lajterman says she often gets turned down for grants and donations: “Many generous individuals donate to autism, but most likely are unaware of how little of their money goes to help families.”

Hopefully, this dedicated nurse’s work on behalf of families with autism will have a positive effect. Please share your story about nursing individuals with developmental disabilities or working with affected families.

Nicholas D. Kristof’s article “Do chemicals cause autism?” can be read at http://www.daytondailynews.com/opinion/columnists/nicholas-kristof-do-chemicals-cause-autism–568405.html?cxtype=ynews_rss.

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“I earned my master’s many years ago, and so most of the clinical information that was cutting-edge then is old-hat now,” says Wendie A. Howland, RN, MN, CRRN, CCM, CNLCP, of Howland Health Consulting, Inc. “But having that degree has opened doors for me in so many ways.”

If you’re ready to put some snap, crackle, and pop back into your own nursing career, take a look at some of the more significant ways earning a Master in Nursing degree made a difference for this experienced nurse.

1. Credibility

A master’s degree adds valuable weight to your opinion. Howland says her MSN degree gave her more credibility while promoting research-based nursing practice, since she had gone through a thesis program and done clinical research in an academic medical center. Because of this credibility, she says, “I was able to implement a policy on nurse-monitored sedation/neuromuscular blockade in a small hospital, based on published research.”

2. Cash

At the beginning of her first clinical specialist job, Howland received a substantial one-time payment that she attributes to her master’s degree. Sign-on bonuses are still common today, despite the recession, and a graduate degree can make you eligible for one.

3. Connections

Advanced degrees can also forge a connection with other degree-holders. “I was hired by a department head with an advanced degree, who took mine as a sign that I was willing to put some critical thinking into a new setting–consulting to the reinsurance industry on catastrophic injury,” Howland explains.

But Is It Really Worth It?

Some naysayers claim that degrees aren’t as important as experience, dedication, or raw intelligence. Howland disagrees.

“I taught nursing for several years,” she says. “Many [students] are second-career students who just want to get to work as soon as possible; that makes them susceptible to the perceived quick-fix of a short degree. ‘We’re all nurses, we all have the same licensure, I don’t need a BS (or more) to be a nurse…’ is how that goes.”

“But wait,” she continues, elaborating on the hypothetical scenario, “You have your ASN and have passed the NCLEX, so you are an RN, same as your colleague who has a BSN. You both feel passionately about prenatal care for underserved, high-risk populations, and an opening comes up in the public health department to do exactly that. You, however, cannot even apply for it, because public health nursing requires a BSN degree.”

In addition to limited eligibility for job applications, nurses without a BSN degree or the equivalent run into other walls. “You are also shut out from staff development, even if you are the go-to person for orienting new people,” Howland says, “from cardiac rehab; from leadership in many settings; from school nursing…. it goes on and on. Students don’t see themselves four or seven years down the road looking for new challenges–or something that’s less challenging to their backs and knees.”

Continuing to Open Doors

“Now, as a Nurse Life Care Planner, my degree and certifications still open doors and give me more credibility with clients,” Howland says.

And there’s no doubt that Howland’s MSN degree has opened a lot of doors. Following a full career in critical care at world-class medical centers (Stanford University Hospital, University of Washington) she embarked on more than a decade’s experience in catastrophic case management and life care planning for catastrophic and high-expense chronic conditions.

She currently works for a case management company, handling what she describes as “largely but not entirely catastrophic cases.” In addition, she runs her own business doing life care planning (www.howlandhealthconsulting.com) and edits a professional journal, the Journal of Nurse Life Care Planning.

Wendie Howland now enjoys a level of freedom and flexibility that many nurses would envy. “I set my own schedule, bill my own time, and travel or work at home as I like,” Howland says. “I can see myself doing this for at least another ten years.”

For more information about Nurse Life Care Planning please visit the the American Association of Nurse Life Care Planners.

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If you, like many other burned-out paramedics, are considering becoming a registered nurse, you probably have some good reasons. Two of the most common reasons paramedics choose to become RNs are better compensation and reduced on-the-job stress. When it comes to compensation, a typical base salary for paramedics will run about $38,000 per year or less, depending on experience and location. To earn this salary, paramedics must work between 45 and 60 hours per week, and the working hours are inconsistent and unpredictable. Compare these figures with the average salary for RNs: about $55,000 per year or more. RNs also enjoy more regular hours and the work is often less stressful.

So now that you’ve decided that a career switch makes sense, it seems the only question left is: what education track should you choose?

There are essentially two educational tracks for paramedics who want to become RNs. You can get on the waiting list to enter a traditional campus-based nursing program, but once you get in you will probably find it impossible to keep your job as a Paramedic while in nursing school due to the difficulty of fitting your shifts around your school schedule.

On the other hand, you could take advantage of your existing education and experience and choose an accredited online Paramedic to RN Bridge Program which not only lets you skip the waiting lists to start right away, but is also self-paced, which means you can earn a living in the process because you can study whenever and wherever you have the time around your current work schedule.

Paramedic-to-RN programs are a fairly new phenomenon in the history of nursing education. These programs evolved in response to two pressures: the modern tendency of career-switching and the nursing shortage.

“We are going to be short a half-million nurses nationwide by 2011,” explained Dr. Ricki R. Garrett, executive director of the Mississippi Nurses Association (MNA), as quoted in The Mississippi Business Journal (April 20, 2009). The shortage has encouraged nursing schools to create innovative solutions that allow would-be nurses to attain certification more quickly–like Paramedic-to-RN programs.

Yet these programs are not without their critics. One paramedic who asked fellow members of an online forum to recommend a good Paramedic-to-RN program was sarcastically told, “It’s called nursing school. Seriously, you and any patient with whom you come into contact would be better served if you enrolled in traditional nursing program….the education involved in becoming a paramedic doesn’t really translate well into nursing programs.”

A commenter on the EMSVillage.com forum had a similar opinion. “My wife looked into the bridge courses but decided that it made more sense to take take a two year RN program based on the advice of several ER nurse friends….I think that the bridge course will not make you as hire-able compared to a nurse that has a degree from a traditional nursing school.”

This is one situation where the popular wisdom should be taken with a HUGE grain of salt.

Perhaps that was true somewhere in the past when the very idea of a Paramedic-to-RN Bridge Program first came into being, but here’s a news flash – accredited Paramedic-to-RN programs are routinely available at top-tier campus-based nursing schools and also through an accredited online format. Nurse Managers who hire for critical care units and ER’s are thrilled to hire the grads, and as far as anecdotal evidence goes, former paramedics who chose the Paramedic-to-RN route have positive outcomes to report.

“My paramedic background came in useful time and again during my training to become an RN,” says one recent graduate of an online Paramedic-to-RN Bridge program. “I have friends who chose to go the traditional route and we all ended up looking at the same kinds of job offers, so I felt that I was just as prepared as anyone. The only difference is that I graduated sooner and will be spending less time paying off loans than my friends will.”

One nurse manager at a critical care center reports that nearly 20% of the staff have some paramedic training or are former paramedics. “The diversity of experience on the floor means that everyone has something unique to offer,” she says. “We have nurses who are transitioning to become paramedics as well as the other way around. I think the online Paramedic to RN program does a fine job of making sure that students are taught the foundational skills. We certainly don’t have any bias towards one educational path over another when we are hiring new grads.”

So which educational track should you choose? Things to weigh in the balance include the amount of time you’re willing to spend in school, how much money you can afford to spend, and your long-term career goals. Compare campus-based Paramedic-to-RN programs and the online Paramedic to RN Bridge Program to get an idea of the course work and clinical requirements.

There is no right or wrong choice, so don’t let yourself be swayed by others preconceptions or judgments about the best way to educate yourself. Whatever educational program you decide to pursue, you can be sure that your paramedic training has given you an excellent foundation on which to pursue your nursing career.

Learn More About the Online Paramedic to RN Bridge Program
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We asked experienced nurses from all over the country to share their most inspiring reads with us. From nurses with specialties ranging from oncology to home health to intermediate care, here are seven popular nursing books to add to your reading list:

1. From Novice to Expert: Excellence and Power in Clinical Nursing Practice
by Patricia E. Benner

Several nurses steered us towards this immensely popular book. Marcia Musgrove, BSN, RN says she appreciates it because it “acknowledges the vast amount of knowledge and experience that nurses gain in their learning journey….When nurses change nursing specialties, they may go right back to being a ‘novice’ and go through the learning curve again as they gain in expertise.”

Infection Prevention Nurse Sallie Jo Rivera, RN, MSN, CIC, adds, “While practicing nursing in my early years I felt frustrated because I didn’t feel like I knew everything I needed to do the best job possible for my patient. From Novice to Expert reinforced for me that life-long learning is important and that it takes time to grow and mold and become the most effective you can be in your role. Those thoughts helped me to cope with my frustration as I have practiced nursing.”

Learn More: From Novice to Expert: Excellence and Power in Clinical Nursing Practice

2. How We Die: Reflections on Life’s Final Chapter
by Sherwin B. Nuland

With a decade of hospice nursing under her belt, Paula Schneider, RN, BSN, MPH, CHPN, says that this is her favorite book to help nurses and lay people alike understand disease processes and how they end lives. However, even if your specialty isn’t hospice, don’t let that stop you from reading this compelling text.

Learn More: How We Die: Reflections of Life’s Final Chapter

3. Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying
by Maggie Callanan and Patricia Kelley

This is another popular choice among hospice nurses such as Nancy Costea, RN, CHPN, who has been continuously employed in the field since 1979 in a variety of settings. She turns to Final Gifts time and again to deepen her understanding of the emotional and spiritual aspects of the dying process. “The real life examples chronicled in the book are clear, engaging, and to-the-point,” she says. “I was privileged to attend a talk by the authors some years ago, and I consider them role models for my own hospice practice.” Final Gifts even inspired Costea to write her own vocational memoir (as yet unpublished).

Learn More: Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying

4. Nursing Care of Children and Adolescents with Cancer
edited by Christina Rasco Baggott et al

In 1985, Kathy Trimble started working as a pediatric oncology nurse clinician. The Pediatric Clinical Nurse Specialist at her workplace loaned her a copy of Nursing Care. Over twenty years later, Trimble still calls this text “informational and inspirational,” and says she has gone on to buy every edition. “I have used this text book as a valuable reference. I have used it as a study tool when preparing for my Pediatric Oncology Certification,” says Trimble, RN, BSN, CPON, CPN.

Learn More: Nursing Care of Children & Adolescents With Cancer (3rd Edition)

5. From Silence to Voice: What Nurses Know and Must Communicate to the Public
by Bernice Buresh and Suzanne Gordon

This is a unique book-one that every practicing nurse willl want to read now and every person aspiring to become a nurse MUST read to understand nursing. Alida Wagner, RN, MSN, CNS, CEN. says that From Silence to Voice changed her entire outlook on her role as a professional nurse, and calls it “A very powerful book for nurses about the importance of communicating what we do and portraying an image of professionalism to our patients and the public”

Claire M. Fagin, PHD,RN Dean Emerita, Professor Emerita, University of Pennsylvania, School of Nursing said, “In my own work and my work with other nurses, I’ve discovered how reluctant some of us are to toot our horns and broadcast our accomplishments. Our self-silencing is a detriment to quality patient care and real health care reform. This book can be a catalyst for a new approach by nurses to public education and communication.”

Most of all, this is a book of ideas; refreshingly fresh ideas which I guarantee you will read from front to back. From Silence to Voice makes you take a long, hard look at our wonderful profession and offers some potent suggestions for our future.

Learn More: From Silence to Voice: What Nurses Know And Must Communicate to the Public

6. Beyond Caring: Hospitals, Nurses, and the Social Organization of Ethics
by Daniel F. Chambliss

“[Chambliss] discusses the ways nurses routinize their work in order to make…the intolerable tolerable,” explains Sarah J. Perry, RN, MSN. “I first read Chambliss while in graduate school and found his observations very pertinent to my experience in hospitals over a period of 30 years. I have recommended this book to nurses of varying years of experience, partly for the insights he provides and partly because I came away from it with the sense that Chambliss really likes nurses.”

Learn More: Beyond Caring: Hospitals, Nurses, and the Social Organization of Ethics (Morality and Society Series)

7. Transcultural Nursing: Assessment and Intervention
edited by Joyce Newman Giger, Ruth Elaine Davidhizar

Susan G. Chicano RN, BSN, CMSRN has been a nurse for more than 25 years and now specializes in intermediate care. She says that in her 15 years with Central DuPage Hospital, she has witnessed an increasing diversity in staff and patients. “In order to be excellent and effective in dealing with our patients, clients, and colleagues, we are expected to be transculturally sensitive, informed and trained,” she says. “This book gives us a better understanding of the characteristics, beliefs and health care practices of different cultures and helps us in creating the appropriate patient plan of care.”

Learn More: Transcultural Nursing: Assessment and Intervention

Which books inspired you to become a nurse, helped you deepen your practice, or cast a different light on some aspect of nursing? Please share your picks with other nurses by leaving a comment.

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A disturbed patient who commits suicide while nurses are within range of hearing. A healthy toddler who dies during a minor operation because of a medication overdose. An elderly man whose right hip was replaced instead of his left.

Horror stories like these make headlines. And sadly, while such stories may be sensationalized by the press, there’s no smoke without fire. In 2008, nearly 90 serious medical errors occurred in Utah hospitals and surgical centers alone. This shows an increase of over 50% from the previous year, according to a Utah Department of Health report requested by The Salt Lake Tribune.

Why do mistakes happen? In no particular order, here are three of the main contributing factors to mistakes in nursing workplaces:

1. Lack of Sleep

According to studies cited by Reader’s Digest, over 40% of medical workers say they’ve made fatigue-related errors. In one survey alone, just under 20% of medical workers report “worsening” a patient’s condition because of sleep-related fatigue.

2. Rushing or Over-Busy

In 2007, the ANA and Inviro Medical Devices developed and co-sponsored a study that explored the challenges related to labeling on syringes. The project, called the Study of Injectable Medication Errors, revealed that 78% of nurses believe the key factor related to injectable medication errors is “too rushed/busy environment.”

3. Overworked and Understaffed

“The greatest common risk to patients is the understaffing of nurses,” says Dr. Gary P. Brandeland, MD, Minnesota emergency room physician and author of “The Day Joy Died,” an article published in a 2006 issue of Medical Economics. “A nurse may make a critical mistake, and a patient might die. She has to live with the error, but the real culprit, the root cause often is that she or he was understaffed and overworked and a mistake was made.”

When considering the above reasons for nursing mistakes, keep two things in mind. Firstly, all the reasons are interconnected. Nine times out of ten if you’re rushing you’re also struggling with too much work and you’re also fatigued.

Secondly, none of these common reasons for making a mistake are directly under your control. As a nurse who’s part of a team, you can’t always control the length of your shifts or the busyness of your environment. You can’t call your workplace and say, “Sorry, but I’ve only gotten four hours of sleep in the past 24 hours, so I’d like to get some sleep even though there are critically ill patients who need me right now.”

Until a gigantic transformation takes place in the nursing world, mistakes will continue to happen. It’s inevitable.

Happily, most of the mistakes made by nurses are not as life-shattering as the one chronicled in Dr. Brandeland’s article, in which a pregnant woman died as a result of a series of errors on the part of the nurse anesthetist. “Little mistakes happen all the time,” writes a nurse blogger at Mediblogopathy. “Big mistakes, thank god, are much rarer and….tend to be the sort of thing you hear about but don’t see.”

Want to avoid the likelihood that you’ll make a big mistake? Get a handle on the little mistakes first. Here are three ways not to react to a mistake, be it ever so small.

1. Play the Blame Game

“One younger nurse on my shift is known for making inconsequential mistakes,” writes a nurse manager from Nevada. “I knew she was becoming a good nurse when I noticed she’d stopped blaming others for her mistakes or coming up with an excuse–how was I supposed to know the correct procedure, I thought Sam had documented that–and so on. She still makes mistakes occasionally but she is putting her energy into learning from her mistakes now instead of pointing the finger of blame.”

2. Stage a Cover-up

Oops! The family wants to know why grandpa needs to stay in the hospital an extra day. You may be tempted to lie about the incorrect medication he was given. Don’t. Not only is it unethical, but the stress you cause yourself and your co-workers by attempting to cover up a mistake will make you tense and brittle–and likely to commit a more serious faux pas.

3. Shoot the Messenger

“As the most experienced nurse in my unit I feel a lot of pressure to be a strong role model to the newer nurses,” reports a critical care nurse with over 22 years of experience. “However I am not infallible and I certainly make my share of mistakes. If an LPN comes to me and says, you made a mistake in transcribing this dose, and I tear her head off, what is going to happen? Nurses are going to be less likely to report mistakes and bottom line is that patients will suffer. Always thank someone who points out a mistake, after all that person just helped you and helped the patient.”

What Mistake You Made Taught You The Most?

“Do no harm” is a good intention to hold. But the reality is that as an overworked nurse, you will do harm somewhere along the way. All you can do is rely on your fellow nurses for checks and balances, learn from your mistakes, and share your stories.

What mistake during the course of your nursing career sticks out in your mind and taught you the most? Why not share it with other nurses and pass along the lesson you learned so you can help others benefit from your experience? Tell us your story…

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Florida now has one of the highest unemployment rates in the nation – 11.5 percent as of November 2009, yet a new report released this month by the Florida Center for Nursing found that Florida’s nursing education programs continued to turn away vast numbers of qualified applicants even while health care employers were also forecasting considerable growth in nursing positions.

The Florida Center for Nursing conducted a survey of nurse employers in six industry groups from July through September 2009 in order to determine their current and future demand for nursing personnel as well as the impact of the economic recession on nurse employment.

All hospitals, psychiatric hospitals, skilled nursing facilities (nursing homes), home health agencies, public health departments, and hospices in Florida were asked about their 2009 nursing vacancies and growth projections through 2012. Employers were asked about vacancies, turnover, future demand for nurses, recruiting difficulty encountered over the past year, and how the current economic recession has affected their nurse staffing and hiring practices.

The resulting Workforce Demand in Nursing-Intensive Healthcare Settings report indicated that despite the current recession, employers reported higher than expected vacancies, turnover, and projected growth in nursing positions. The estimated number of vacant positions as of June 30, 2009 was approximately 6,800 RNs, 1,400 LPNs, and 4,000 CNAs.

Full-time equivalent (FTE) position vacancy rates for RNs were highest within skilled nursing facilities (6.8%), hospices (7.0%), and home health agencies (8.6%). Home health agencies also reported high vacancy rates for LPNs (8.8%) and certified nursing assistants (CNAs, 6.7%). Psychiatric hospitals reported a CNA vacancy rate of 8.9 percent.

These figures reflect a substantial need for nursing personnel in Florida, despite the recession, and they are likely underestimates of the true number of nursing vacancies because not all nurse employers (such as physicians’ offices or prisons) were included in the study.

Employers reported substantial unmet need for budgeted positions. Seventy percent of public health departments reported needing additional budget lines for RNs, as did 55 percent of psychiatric hospitals. Thirty-five percent of hospitals reported needing positions for direct care RNs. Thus, while vacancy rates have declined in these groups, the number of budgeted positions may not be keeping pace with perceived need within these industries.

The skill mix of nurses employed varied by industry group. Within hospitals, 78.1 percent of the nursing staff were RNs, 4.9 percent were LPNs and 16.3 percent were CNAs. Public health department nurse employees were also predominantly RNs. Hospices and psychiatric hospitals had a similar nursing skill mix, almost half of their nursing employees were RNs and over 30 percent were CNAs. Approximately one percent of the nursing staff of hospitals and psychiatric hospitals are Advanced Registered Nurse Practitioners (ARNPs).

Even though growth is difficult to predict in the current economic climate, respondents reported that they did anticipate growth in new positions through 2011. Percentage growth in budgeted positions varies widely by industry. By 2010, hospitals expect to increase their RN staffs by 2.2 percent. In contrast, home health agencies expect to increase their RN staffs by 35 percent. Expected growth in nursing positions through 2011 is estimated to be about 8,200 RN positions, 3,100 LPN positions, and 5,000 CNA positions.

Most Difficult Nursing Positions To Fill
Nursing Administrators and Supervisor positions were deemed most difficult to fill by four out of the five surveyed industry groups, nurse practitioner positions were difficult to fill among all groups. Infection control nurses were the most difficult to fill specialty in public health and hospice. In hospitals, cath lab nurses and adult critical care nurses were also difficult to fill positions. SNFs needed rehabilitation nurses, minimum dataset nurses, and administrators. Although the number of psychiatric hospital respondents was quite small, they reported Psychiatric/Behavioral RNs and LPNs were difficult positions to fill.

Top Five Growth Specialties Over the Next Two Years
The top five specialties for which growth in budgeted positions is expected over the next two years are as follows: Staff RNs will be needed by SNFs, home health agencies, public health agencies, and hospices. All of these groups, with the exception of public health, also expect to increase the employment of CNAs and LPNs. Public health departments also will need nurse practitioners, case managers, community outreach and school nurses. Because they offer more specialized care, hospitals were given a longer list of staff nursing positions. Many expected growth for adult and pediatric critical care and emergency nurses. Psychiatric hospitals also reported a need for psychiatric RNs.

Although the nursing shortage has eased a bit with the current recession, a greater shortage looms in the near future. Once the recession abates, older nurses will retire and those who rejoined the profession may decide to leave as well. At the same time, an aging population will begin to demand more health care. Therefore, the nursing shortage is likely to intensify over the coming decade. An estimated 40 percent of Florida’s nurses are nearing retirement age, and the center suggests there are not enough nurses coming up through the ranks to replace them.

The Bureau of Labor Statistics (BLS) projects that demand for RNs will increase more than any other type of worker through 2016, with more than new 587,000 RN positions projected during this time in the United States.6 Hence, we expect long-term demand for nurses to increase in response to population trends.

The healthcare industry continues to grow and remains a strong source of new jobs, even in an economic recession, as evidenced by the projected demand for nurses over the next two years. Indeed, RN employment has increased nationwide during the recession.

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For a licensed practical nurse, there are plenty of benefits to becoming a Registered Nurse. An RN degree will provide you with more job opportunities, a higher salary, personal fulfillment, and open the door to greater career mobility and advancement potential. If you’re trying to decide whether to go through a campus based LPN to RN transition program or earn your RN degree online, then these top 5 ways that an online LPN-to-RN program helps you save might just might help you decide which would work best for you.

1. Save Money

Lack of money is often cited by nursing students as their top reason for delaying their applications to RN degree programs. Fortunately, the online LPN-to-RN program will set you back for only about half the cost of identical programs at brick-and-mortar universities. The quality of the program is equally good, so you don’t need to worry about getting a substandard education. This is not one of those situations where “you get what you pay for.” Online nursing programs normally cost the nursing school less than traditional campus based programs would, and those savings are passed on to students like you.

2. Save Time

LPN’s can earn an RN degree in less time than it would take at a traditional school through the accredited online LPN-to-RN program. However, you also have the choice of spreading your degree out over a longer period of time if that’s more convenient for you. Do you plan to balance your current LPN job with nursing school? If so, an online program means you won’t have to spend your valuable weekends and evenings sitting in a classroom. You can turn in homework, take tests and interact with your classmates through the course of your day, whenever you have spare time. You will be able to manage your time more efficiently, giving you more time to spend with family and friends or relax on your own.

3. Save Even More Money

Student nurses often complain that their largest school-related costs after tuition are incidental expenses. These include nursing textbooks, note-taking supplies, printer cartridges, on-campus meals, child care and transportation. The online LPN-to-RN program reduces all of those incidental expenses at least partially, and many of them are eliminated completely. For example, you’ll never have to print out homework assignments. Instead, you’ll upload all your assignments to the course website. You’ll never have to hire a sitter while you attend evening classes; you can schedule your classtime for the hours when your kids are at school or practicing extra-curricular activities.

4. Save Energy

Traditional universities use up vast energy resources in a number of ways. Students have to get to and from the physical location, so non-renewable fossil fuels are emitted. Night classes require megawatts of additional electricity. Buildings are stocked with printers, computers, scanners, and other electronics, all using huge amounts of energy, even when they’re idle. To deal with the students on campus, brick-and-mortar universities must maintain an appropriate number of staff members, all of whom also use transportation and campus resources. Choosing an online LPN to RN program not only cuts your own energy usage, but it contributes to an educational paradigm that wastes fewer physical resources and is more efficient for everyone.

5. Save Your Sanity

Driving back and forth from class to work to home to work again….forgetting to bring your textbook…standing in long lines at the registrar’s office….who needs it? Online programs save your sanity by injecting a healthy dose of simplicity into your life. As a busy working LPN, you probably have enough stress in your life. An online LPN-to-RN program lets you focus on the educational content and practical skills rather than being distracted by annoying administrative red tape and unexpected inconveniences.

Learn More About The Online LPN-to-RN Program

LPNs / LVN’s earn your RN license in as little as 12 months and start enjoying better earnings, increased responsibility and authority, more job options, and far more opportunities for career advancement. Request additional information to speak with a program adviser: Online LPN to RN Program

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