The Journal for Nurse Practitioners RSS feed: Current Issue. JNP provides a highly credible resource to help nurse practitioners stay current with the clinical and policy concerns affecting their day-to-day practice. In addition to peer-reviewed clinical articles, JNP features continuing education opportunities and opinions and commentary on pressing legislative, regulatory, and clinical practice issues. Popular features include Point-Counterpoint, Legal Limits, Test Your Knowledge crosswords, Prescription Pad, and Decoding Codes. JNP is the official journal of the American College of Nurse Practitioners and includes organizational information in every issue. http://www.npjournal.org/?rss=yesElsevier Inc.en © 2012 American College of Nurse Practitioners. Published by Elsevier Inc. All rights reserved. The Journal for Nurse Practitioners1555-415585May 2012 © 2012 American College of Nurse Practitioners. Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.npjournal.org/article/PIIS1555415511004703/abstract?rss=yesThroughout the United Kingdom laparoscopic cholecystectomy (LC) and laparoscopic hernia repairs (LH) are regularly performed as day cases, with surgery moving away from inpatient hospitalization. The benefits of ambulatory care are well known. It is not only cost effective but allows trusts to better use surgical facilities. What remains controversial is how these patients should be best followed. Opinions differ greatly, with some surgeons providing outpatient appointments for all patients and others providing no follow-up at all.Nurse-Led Telephone Follow-Up After Day Case SurgeryAndrew Miller, Karen Barton, Ahmed Hassn10.1016/j.nurpra.2011.09.005The Journal for Nurse Practitioners 8, 5 (2012)2012-05-01The Journal for Nurse Practitioners2012-05-0185S1555-4155(11)X0015-6In My Opinione7e8http://www.npjournal.org/article/PIIS1555415512001614/abstract?rss=yesIt is a little overwhelming to get a book with over 350 pages of content on a procedure that often is covered in 5 or 6 pages in a common procedures text. But this book, written by a multidisciplinary group of clinicians, covers the gamut of what a doctor, acute care nurse practitioner, physician assistant, clinical nurse specialist, or registered nurse would need to know about tracheostomies. The book covers content not only on doing the procedure itself but also caring for the patient with a tracheostomy that often is omitted from other texts. Each book concludes with a chapter summary, as well as a list of key points that the clinician must remember.Tracheostomies: The Complete GuideMarilyn Edmunds10.1016/j.nurpra.2012.03.004The Journal for Nurse Practitioners 8, 5 (2012)2012-05-01The Journal for Nurse Practitioners2012-05-0185S1555-4155(11)X0015-6NP Bookshelfe9e9http://www.npjournal.org/article/PIIS1555415512001973/abstract?rss=yesThe article, “NPs Should Dispel Misinformation About Immunizations,” in the April 2012 issue had incorrect terminology reported in the second paragraph. The sentence should read, “The best example is the recent epidemic of pertussis (whooping cough) in California.” JNP regrets this error.Erratum10.1016/j.nurpra.2012.04.001The Journal for Nurse Practitioners 8, 5 (2012)2012-05-01The Journal for Nurse Practitioners2012-05-0185S1555-4155(11)X0015-6344344http://www.npjournal.org/article/PIIS1555415512001626/abstract?rss=yes On a recent visit to see my own primary care nurse practitioner (NP), I found her overwhelmed with mastering a new electronic health record format. It had added hours to her busy day to fill out the cumbersome electronic records to ensure compliance with Medicare regulations. What she had to record was not optional and, without effort, could easily dominate the patient-provider relationship. It is easy to see that the tedium of the requirements could make it difficult for her to find pleasure in patient encounters, but this NP always had a smile.Remember Why You Came to Work TodayMarilyn W. Edmunds10.1016/j.nurpra.2012.03.005The Journal for Nurse Practitioners 8, 5 (2012)2012-05-01The Journal for Nurse Practitioners2012-05-0185S1555-4155(11)X0015-6Editorial347347http://www.npjournal.org/article/PIIS1555415512001729/abstract?rss=yesIn the February issue of JNP, there is an error in the article, “Advanced Practice Nurses in Ohio Community Hospitals.” On page 133 there is a section header: “Addressing the Future DNP Requirement for Certification of APNs by AACN.” This is incorrect. The American Association of Colleges of Nursing (AACN) has recommended that the doctorate of nursing practice (DNP) be the educational program for entry into advanced practice by 2015. AACN also cannot require a DNP. In addition, AACN does not certify advanced practice registered nurses (APRNs).Letters to the EditorLouise Kaplan, Anne E. Teske10.1016/j.nurpra.2012.03.014The Journal for Nurse Practitioners 8, 5 (2012)2012-05-01The Journal for Nurse Practitioners2012-05-0185S1555-4155(11)X0015-6Letters to the Editor348348http://www.npjournal.org/article/PIIS1555415512001699/abstract?rss=yes One of the roles which has emerged for the advanced practice nurse is the acute care nurse practitioner (NP). We celebrate that role in this issue of JNP. It is hard to believe that the first national certification was provided in 1996. It was a mere 16 years ago that the NP was credentialed by a national certification to provide care in an acute care setting. The transformation of the NP role has been evident as more and more NPs cross over into many acute settings.Celebrating the Acute Care Nurse PractitionerJill Olmstead10.1016/j.nurpra.2012.03.012The Journal for Nurse Practitioners 8, 5 (2012)2012-05-01The Journal for Nurse Practitioners2012-05-0185S1555-4155(11)X0015-6Letter From the ACNP President349349http://www.npjournal.org/article/PIIS1555415512001651/abstract?rss=yes As nurse practitioners (NPs) are keenly aware, the landmark 2010 Institute of Medicine (IOM) report “The Future of Nursing: Leading Change, Advancing Health” called attention to 4 key messages and a number of specific recommendations for federal and state governments and other policy makers to enable NPs and other nurses to achieve the full potential of their education and clinical preparation to care for patients. As they become realities, these proposals will have a significant impact on NPs in acute care settings and institutions. The ACNP is working closely with the American Nurses Associations and other national organizations representing advanced practice nurses (APRNs) to urge members of Congress and federal agencies to modernize outdated regulations and eliminate barriers that stand in the way of nursing's future.To Reach the Future, NPs Must Eliminate Obsolete Acute Care RulesDave Mason10.1016/j.nurpra.2012.03.008The Journal for Nurse Practitioners 8, 5 (2012)2012-05-01The Journal for Nurse Practitioners2012-05-0185S1555-4155(11)X0015-6ACNP Forum350353http://www.npjournal.org/article/PIIS1555415512001092/abstract?rss=yesAbstract: Advanced practice nurses (APNs) often care for patients who have risks for postoperative cardiac complications and face noncardiac surgery. Surgical urgency determines the initial preoperative evaluation, and the immediate action before emergency surgery is to identify high-risk patients and provide appropriate risk reduction. An elective surgery in those with active cardiac disease should be postponed until cardiac evaluation and treatment are complete. Asymptomatic patients may be risk stratified, and the revised cardiac risk index is easy to use and widely adopted. APNs have the opportunity to assess patient risk and take appropriate actions to minimize cardiac complications. Preoperative Cardiac Risk Assessment and Medical Management for Noncardiac SurgeryJoanne L. Thanavaro, Barbara J. Fonner10.1016/j.nurpra.2012.02.018The Journal for Nurse Practitioners 8, 5 (2012)2012-05-01The Journal for Nurse Practitioners2012-05-0185S1555-4155(11)X0015-6Features354364http://www.npjournal.org/article/PIIS1555415512001663/abstract?rss=yesThe Journal for Nurse Practitioners Continuing Education Credit Application10.1016/j.nurpra.2012.03.009The Journal for Nurse Practitioners 8, 5 (2012)2012-05-01The Journal for Nurse Practitioners2012-05-0185S1555-4155(11)X0015-6Features365366http://www.npjournal.org/article/PIIS1555415512001638/abstract?rss=yes Cheryl Holly, EdD, RN, is associate professor and chair of the department of capacity building systems at the University of Medicine and Dentistry of New Jersey School of Nursing in Newark. She is also director of the New Jersey Center for Evidence-Based Practice, a collaborating center of the Joanna Briggs Institute. She is certified as a trainer in comprehensive systematic review, and her book, Comprehensive Systematic Review for Advanced Nursing Practice, was recently published. She has published and presented the results of her work nationally and internationally. A peer reviewer for Perspectives on Nursing Education and Nursing Outlook, among other journals, she has reviewed grants and abstracts for Sigma Theta Tau and was appointed to a scientific review panel for the Patient Care Outcomes Research Institute.Is Peer Review Outdated?Donald Gardenier10.1016/j.nurpra.2012.03.006The Journal for Nurse Practitioners 8, 5 (2012)2012-05-01The Journal for Nurse Practitioners2012-05-0185S1555-4155(11)X0015-6Point/Counterpoint368369http://www.npjournal.org/article/PIIS1555415512000578/abstract?rss=yesAbstract: Background: Antimicrobial resistance is an urgent public health problem. There is very limited information regarding nurse practitioners' attitudes, perceptions, and knowledge about antibiotic use and resistance. Methods: Web-based anonymous survey in a university-affiliated hospital. Results: Most respondents agreed that antimicrobial resistance is a problem locally and nationally, were concerned about resistance in the community when prescribing antibiotics, and agreed that more appropriate use of antibiotics would decrease resistance. There is a paucity of knowledge in the management of anaerobic infections and resistant gram-negative bacteremia. Conclusion: Incorporating nurse practitioners into antimicrobial stewardship programs could improve evidence-based practices and antimicrobial use. Nurse Practitioners' Attitudes, Perceptions, and Knowledge About Antimicrobial StewardshipLilian Abbo, Laura Smith, Margaret Pereyra, Mary Wyckoff, Thomas M. Hooton10.1016/j.nurpra.2012.01.023The Journal for Nurse Practitioners 8, 5 (2012)2012-05-01The Journal for Nurse Practitioners2012-05-0185S1555-4155(11)X0015-6Features370376http://www.npjournal.org/article/PIIS1555415512001080/abstract?rss=yesAbstract: Background: Ventilator-associated pneumonia (VAP) and its prevention is a significant concern for ventilated patients in the intensive care unit. Methods: Retrospective chart review that evaluated VAP rates from August and September 2010 (control group). In addition, a chart review evaluated VAP rates from August through September 2011 (experimental group). Outcomes: Implementation of the VAP bundle will decrease ventilator days, length of stay (LOS), and VAP rates. The variables include age, ventilator days, LOS. Design: Single center retrospective chart review in a combined surgical and medical ICU Conclusion: This study provided evidence that the implementation of a VAP bundle reduced LOS. Implementation of Ventilator-Associated Pneumonia Clinical Guideline (Bundle)Jacqueline A. Gallagher10.1016/j.nurpra.2012.02.017The Journal for Nurse Practitioners 8, 5 (2012)2012-05-01The Journal for Nurse Practitioners2012-05-0185S1555-4155(11)X0015-6Features377382http://www.npjournal.org/article/PIIS1555415512001079/abstract?rss=yesAbstract: The purpose of the current study was to evaluate advanced practice nurses' perceptions of a prescription drug monitoring program (PDMP) related to their practice. Advanced practice nurses were asked how PDMP information affects patient care and drug diversion, if it inhibits care, and if they value the information. Overall, they felt the PDMP was an effective tool and played a positive role in their practice. Advanced Practice Nurses' Use of Prescription Drug Monitoring Program InformationSteven D. LeMire, Sarah G. Martner, Cheryl Rising10.1016/j.nurpra.2012.02.016The Journal for Nurse Practitioners 8, 5 (2012)2012-05-01The Journal for Nurse Practitioners2012-05-0185S1555-4155(11)X0015-6Features383383http://www.npjournal.org/article/PIIS1555415511004697/abstract?rss=yesAbstract: Dengue fever is a viral illness that is re-emerging worldwide in relation to migration, increasing outdoor activities and travel, and climate changes. It is a vector-borne illness that can be prevented by mosquito repellents and bed nets. Children are the primary victims of the illness. With 100 million infections worldwide and the potential of reinfection, it is imperative that nurse practitioners recognize the illness to prevent complications. Dengue Fever: Re-Emergence of an Old VirusKimberlee D. Decker10.1016/j.nurpra.2011.09.004The Journal for Nurse Practitioners 8, 5 (2012)2012-05-01The Journal for Nurse Practitioners2012-05-0185S1555-4155(11)X0015-6Features389393http://www.npjournal.org/article/PIIS1555415512001067/abstract?rss=yesAbstract: Naloxone is an opioid antagonist that competitively binds to opioid receptors and reverses all of their effects. The indication for use is respiratory depression as a result of known or suspected opioid overdose. Clinicians involved in patient care must use the drug appropriately, rather than as a diagnostic tool, such as to determine the etiology of a change in mental status. This article reviews the pharmacokinetics and pharmacodynamics of naloxone. In addition, the appropriate administration is reviewed using a case study approach. Appropriate Use of Naloxone in the Clinical SettingErin M. McMenamin10.1016/j.nurpra.2012.02.015The Journal for Nurse Practitioners 8, 5 (2012)2012-05-01The Journal for Nurse Practitioners2012-05-0185S1555-4155(11)X0015-6Features394398http://www.npjournal.org/article/PIIS1555415511005101/abstract?rss=yesAbstract: Hypersensitivity pneumonitis (HP) is a rare pulmonary disease that occurs when the body has an exaggerated response to environmental allergens such as bacteria, fungi, animal and plant proteins and low molecular weight chemicals. The disease is divided into 3 categories: acute, subacute, and chronic. The work-up includes a thorough environmental and occupational history and a high clinical suspicion for HP. Prompt diagnosis is important and complete avoidance of the antagonizing antigen is essential to prevent irreversible lung damage. Hypersensitivity Pneumonitis: An Occupational HazardAnn Rutt10.1016/j.nurpra.2011.09.024The Journal for Nurse Practitioners 8, 5 (2012)2012-05-01The Journal for Nurse Practitioners2012-05-0185S1555-4155(11)X0015-6Features399405http://www.npjournal.org/article/PIIS155541551200061X/abstract?rss=yes Several hospitals have hired me recently to audit documentation of services provided by nurse practitioners (NPs). Usually, the purpose is to see whether the documentation supports billing. However, there are additional reasons to audit documentation. Hospitals may want to reduce risk by identifying potential standard-of-care problems and then provide training to correct those problems, or hospitals may be preparing for future accreditation visits and need to identify problem areas. Many of the notes I audited were excellent, detailed, and thorough, covering all of the bases. However, here are 3 areas where I noted deficiencies in medical record documentation by NPs.Three Things to Be Sure to Cover When Documenting Acute CareCarolyn Buppert10.1016/j.nurpra.2012.02.003The Journal for Nurse Practitioners 8, 5 (2012)2012-05-01The Journal for Nurse Practitioners2012-05-0185S1555-4155(11)X0015-6Legal Limits406407http://www.npjournal.org/article/PIIS1555415512000608/abstract?rss=yesNew Antibiotics UpdateKerry Redman, Lara Frick10.1016/j.nurpra.2012.02.002The Journal for Nurse Practitioners 8, 5 (2012)2012-05-01The Journal for Nurse Practitioners2012-05-0185S1555-4155(11)X0015-6Prescription Pad408409http://www.npjournal.org/article/PIIS1555415512000566/abstract?rss=yes The Centers for Medicare & Medicaid Services (CMS) added several services to their preventive care offerings at the end of 2011. Alcohol screening, depression screening, and intensive behavioral therapy for cardiovascular disease prevention and for obesity are all new screenings. This column covers the first 2 topics; the last topic will be discussed in the next issue. New Medicare Preventive Care OfferingsJan DiSantostefano10.1016/j.nurpra.2012.01.022The Journal for Nurse Practitioners 8, 5 (2012)2012-05-01The Journal for Nurse Practitioners2012-05-0185S1555-4155(11)X0015-6Decoding Codes410411http://www.npjournal.org/article/PIIS1555415512000591/abstract?rss=yes Giant cell arteritis (GCA) affects approximately 1 in 50 adults over the age of 50. Seventy-two is the average age of diagnosis. The disease rarely occurs in younger patients. GCA is an arteritis or vasculitis; the classic feature is inflamed blood vessels. The vessels most frequently affected are the arteries of the head and scalp. Most commonly affected are the temporal arteries, so temporal arteritis is another term for GCA.Could It Be Giant Cell Arteritis?Cynthia Watkins10.1016/j.nurpra.2012.01.024The Journal for Nurse Practitioners 8, 5 (2012)2012-05-01The Journal for Nurse Practitioners2012-05-0185S1555-4155(11)X0015-6Diagnostic Tips412412http://www.npjournal.org/article/PIIS1555415512000554/abstract?rss=yes Dr. Toby Maurer focused her Hot Topics lecture on the approaches and precautions that clinicians should discuss with patients when they ask, “What can I do to look younger?”Cosmetic Procedures: Approaches and PitfallsLaurel Halloran10.1016/j.nurpra.2012.01.021The Journal for Nurse Practitioners 8, 5 (2012)2012-05-01The Journal for Nurse Practitioners2012-05-0185S1555-4155(11)X0015-6Hot Topics413414http://www.npjournal.org/article/PIIS155541551200164X/abstract?rss=yes A 52-year-old Caucasian woman who presented to her primary care practitioner (PCP) with venous thrombosis was evaluated for the cause of her hypercoagulable state. Because she was active, did not have diabetes, was neither of advanced age nor taking hormone replacement therapy, and had no history of immobilization or inflammation, the workup included ruling out cancer, another common cause for acquired hypercoagulability. In the process her skin was thoroughly examined, and she was found to have a large, irregularly shaped, pigmented, 1.5-cm mole with central ulceration on the posterior trunk. As this was highly suspicious for being melanoma that had led to hypercoagulability, the patient underwent immediate biopsy via full wide excision.What Does Venous Thrombosis Have to Do With Dermatology?Jana L. Perun10.1016/j.nurpra.2012.03.007The Journal for Nurse Practitioners 8, 5 (2012)2012-05-01The Journal for Nurse Practitioners2012-05-0185S1555-4155(11)X0015-6Discerning Dermatology415416http://www.npjournal.org/article/PIIS1555415512001687/abstract?rss=yesThe Future of NursingSandy Wilbanks10.1016/j.nurpra.2012.03.011The Journal for Nurse Practitioners 8, 5 (2012)2012-05-01The Journal for Nurse Practitioners2012-05-0185S1555-4155(11)X0015-6Answer Key–Crossword419419http://www.npjournal.org/article/PIIS1555415512001675/abstract?rss=yesAcute Coronary SyndromeSandy Wilbanks10.1016/j.nurpra.2012.03.010The Journal for Nurse Practitioners 8, 5 (2012)2012-05-01The Journal for Nurse Practitioners2012-05-0185S1555-4155(11)X0015-6Test Your Knowledge Crossword420420