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Welcome to the ADVANCE for NPs & PAs blogs, part of the Healthcare POV: Blog and Forum Community from ADVANCE. Our blogs offer posts covering timely questions, advice and opinions about nurse practitioners and physician assistants, including career issues, education information, and help for new and student NPs and PAs. A list of our most active posts keeps you abreast of the latest discussions. We tag posts by topic so you can easily find posts that interest you. You can also edit your profile to make it uniquely your own to interact with your colleagues on the blogs. We look forward to hearing your voice.
August 25, 2014 12:53 PM by Katrin Moskowitz of First Year NP

There are days in practice that the hours go by without you realizing it. Patients are in and out quickly, you work hard to complete your charting and tasks become second nature. Then, certain patients come in and make you smile with the things that they say, the mannerisms they exhibit or the way they look at you. Children are the most honest, and how they see the world is eye-opening.

This week I learned ...

August 21, 2014 3:13 PM by Amy Gouley of Dermatology Practice Today

This 57 year old patient presented for a total body skin examine. She was wearing a hat and when asked to remove it the photos below show my findings of Trichotillomania.

The patient reports having the condition since she was 14 years old and has tried every medication possible, including several ...

August 20, 2014 3:40 PM by Keischa Cash of DNP Answers

I had an interesting experience last week when a patient of mine that I referred to ENT within my clinic called to ask to be referred to another provider. Apparently, this patient - who thinks very highly of me and my work ethic - went to see the specialty provider, referenced me as Dr. Cash and the ENT proceeded to bash me instead of addressing the patient's main reason for being there. This turned the patient off, ...

August 20, 2014 2:05 PM by Renee Dahring of Career Coach

I'm seeing a new trend taking hold - it's called "precept to perm." It is hardly a new idea, but it has been given an official name, causing it to trend and become more common. If you are a student, you might have already encountered this phenomenon. If you are a seasoned clinician looking for a new position, it could impact your job search, as well. 

"Precept to perm" refers to the practice of a healthcare ...

August 14, 2014 12:53 PM by Debra Shelby of Dermatology Practice Today

This is a female patient who had been treated for months with antifungals and nystatin powder Q.D. by her primary care provider. The morphology of this rash is moderate erythematous patches/plaques with desquamation located under her breasts. ...

August 13, 2014 3:46 PM by Mina Grasso of Aesthetics Practice Today

Before non-surgical skin tightening was available, the only option to address loose skin was to surgically remove it. Thermage, a non-surgical procedure utilizing mono-polar radiofrequency, provided an option for those wanting to avoid the surgery. This is accomplished by heating the skin externally to a temperature that would stimulate collagen fiber contraction. For those not expecting a "surgical result", repeated ...

August 12, 2014 8:44 AM by Katrin Moskowitz of First Year NP

From August 3-8, I went away to Boy Scout Camp to work as the nurse for the week. This is the first year we have been involved in the organization with my six year old son and the first year that we decided to send him away to resident camp. The mom in me decided that there was no better way to be watchful than to be on the same property as him, but to give him space to grow ...

August 7, 2014 10:37 AM by Amy Gouley of Dermatology Practice Today

88 year-old male presented with a poor healing wound on his right anterior lower leg which had been ongoing for four months.

The lesion presented as a group of pustules that were well circumscribed, annular, and boggy, resembling a ...

August 6, 2014 1:24 PM by Renee Dahring of Career Coach

References can make or break a job offer so it is important you understand how to choose the right references. 

  • You need to be sure that the persons you name as your references have DIRECT knowledge of your work performance. Choosing folks that think highly of you is not enough if they have never actually worked closely with you. This is because the questions that your reference will be asked ...

August 6, 2014 12:53 PM by Julie Schreiner of DNP Answers

Evidence-based practice...we heard about it throughout nursing school and into our master's degrees; you hear the phrase in almost every health profession and in discussions regarding our current healthcare system. However, it wasn't until my DNP education that I truly understood the process of using the evidence to guide care and the importance of being a leader in this type of practice.

One of the most ...

August 5, 2014 9:59 AM by Rachel Matson of NP & PA Student Blog

I'm sitting here at work, trying to figure out what to write about today. As I ruminate, I realize what a great team of people I work with every day and this reminds me of an assignment I recently completed for class. The question proposed for class was, "Do physicians work autonomously?"

As I wrote the assignment it made me think about nurse practitioners and our battle for autonomy in healthcare.

Each ...

August 5, 2014 9:16 AM by Mina Grasso of Aesthetics Practice Today

The most common complaint patients have about tissue fillers is that they don't last long enough. Some patients don't like the idea having to return in 6-12 months to have repeated injections.

ArteFill is an injectable filler that provides long-lasting wrinkle and volume correction. ArteFill differs from other tissue fillers currently available. It is made up of 20% Polymethylmethacrylate (PMMA) and 80% bovine ...

August 4, 2014 1:00 PM by Caroline Pilgrim of First Year PA

You're scanning the EMR and you see four office visits in the past month with the same chief complaint. You walk in the room knowing it's not going to be an average cut-and-dry visit. The patient is frustrated about their bowel, their bladder or their other non-emergent complaint that keeps driving them back to the office, and you have to address them with firm confidence.

I have at least one or two of these ...

July 31, 2014 2:26 PM by Debra Shelby of Dermatology Practice Today

In dermatology, we discuss the importance of identifying and understanding morphology and changes in a rash. Here is a case of a rash with a sudden change in morphology after prescribing medication for her dermatosis.

This geriatric patient was being treated with clobetasol cream B.I.D. for Grover ...

July 30, 2014 1:16 PM by Walton Reddish of DNP Answers

In 2004, the American Association of the Colleges of Nursing (AACN) proposed that the Doctor of Nursing Practice (DNP) should be the entry level for Advanced Practice Nurses (APN). A year later, the Commission of Collegiate Nursing Education (CCNE) announced that the only doctoral practice degree that the CCNE would accredit would be the DNP (AACN, 2006). As a result of these actions, DNP programs have increased precipitously ...

July 29, 2014 3:29 PM by Johanna Golston of NP & PA Student Blog

The American Association of Colleges of Nursing published the "The Essentials of Doctoral Education for Advanced Nursing" in 2006. There are eight essentials outlining the required competencies of a Doctor of Nursing Practice (DNP) graduate. The second essential pertains to leadership and emphasizes the DNP's ability to facilitate organization-wide practice changes and provide guidance and oversight of nursing staff. ...

July 28, 2014 10:53 AM by Katrin Moskowitz of First Year NP

There are not many things that frustrate me in my clinical practice. Most patients are open, receptive and leave shaking their heads in agreement to your plan of care. What happens once they leave your office is often unknown. You hope that they venture directly to the pharmacy, take their medications as prescribed and their health improves.

What I am occasionally finding is that my hope of 100% patient compliance ...

July 24, 2014 9:43 AM by Amy Gouley of Dermatology Practice Today

These photos belong to an 80-year-old female who presented to our clinic for a total body skin screening. She has a history of Basal Cell Carcinoma on her forehead that was treated with MOHS in 2011.

All of these photos shown are positive for Squamous Cell Carcinoma. Additionally, this patient has two more SCC's not shown. (Hover your mouse over each photo to find out where the carcinoma is located ...

July 23, 2014 8:38 AM by Keischa Cash of DNP Answers

Getting my DNP was challenging, but, unfortunately, my employer was not as supportive as I had hoped of my hard-earned achievement. When I received my doctorate I intended to introduce myself as Dr. Cash to patients and wanted staff to address me as such, as well. I found out this would be harder than I thought.

The organization I work for is highly physician-centered. Yes, they still reference NPs and PAs ...

July 22, 2014 10:21 AM by Mina Grasso of Aesthetics Practice Today

Acne scars may present in a variety of ways. The technical names are boxcar acne scars, ice pick acne scars, rolling acne scars, hypertrophic and keloid scars. Patients ...

July 21, 2014 3:02 PM by Caroline Pilgrim of First Year PA

Primary care is so imperfect. Each day I could probably find as many things to complain about as complaints my patients come in with, and I am beginning to see why burnout can occur. That is, if you don't have the right perspective. As I forge ahead on this year-one journey, I am creating tenets to avoid burnout. I'm honestly not a huge believer in self-help or magical powers of positive thinking, but we all ...

July 16, 2014 11:01 AM by Renee Dahring of Career Coach

Dear Career Coach:  I am a new grad NP with celiac disease and I am unable to eat at restaurants due to potential cross-contamination that inevitably leaves me ill for a week. What suggestions do you have to handle not being able to eat at a restaurant, without coming across like a "major diva" as you mentioned?

Dear Reader:  The structured office interview is how the employer ...

July 16, 2014 10:46 AM by Deanna McCarthy of DNP Answers

After waking up from my nap, (yeah, I know, a nap!) I started thinking about going back to school next month. I have been spoiled this summer - even though I am working, I feel like I am on vacation. This summer followed the most difficult semester that I have ever been through. This past semester I took Pharmacology and Physical Assessment with a clinical component. Do I really want to go back to getting up at 5 ...

July 16, 2014 10:39 AM by Debra Shelby of Dermatology Practice Today

In our programs, we learned about antibiotic abuse and "super bugs." Years of prescribing these antibiotics have come to a point where treating skin infections have become very difficult. The incidence with MRSA has increased and years of treating this infection has made it resistant to many antibiotics. These bugs are bionic and we are the ones that help create them.

Through private practice experience, I ...

July 15, 2014 3:46 PM by Mina Grasso of Aesthetics Practice Today

With the increasing popularity of tissue fillers, patients are looking more youthful in the mid and lower face. When looking at patients with volume augmentation of the mid and lower face, there can be a disruption in the frame of the face where the temporal fossa are hollow and overlooked. The temporal fossa is located just above the cheekbones behind the lateral orbital rim.   

As we age, the temporal ...



The ADVANCE for NPs & PAs blog offers analysis of and links to NP and PA professional issues and current healthcare events.

Share the trials and triumphs on the journey from rookie new graduate to experienced PA.

By reflecting on her own experiences as a PA student, Jenna hopes to reach others interested in the day-to-day life of a PA student.

Share the trials and triumphs of the journey to becoming an experienced NP.

If you're looking for your dream job or just want to know what's out there for NPs today, start here with the expert advice of nurse practitioners who specialize in placing NPs in good jobs.

This blog will highlight the latest technical tools that can be used in clinical medicine as well as tools for teaching clinical medicine in an academic setting.

DNPs and DNP students will share their experience with the doctor of nursing practice.

Read about new technologies that affect you in daily practice.

What are the latest trends in aesthetics? Our bloggers share their insight and experiences in this growing specialty.

Interested in dermatology or challenged by skin presentations in your practice setting? Dermatology Practice Today examines issues in skin care and skin disease.

NP and PA students have a clear voice here. Find out what your student colleagues are experiencing in their programs. Feel free to post comments and questions to add to the discussions.

This new NP will share the ups and downs of her first year in practice.

Share the excitement and nerves of the first year on the job with this new physician assistant.

The Politics of Healthcare covers the latest developments in healthcare policy and legislation.