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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.
September 19, 2014 3:05 PM by Amy Gouley of Dermatology Practice Today

Last week I was fortunate enough to participate in my fourth CareHarborLA event. The CareHarbor free clinic is held annually in the fall at the Los Angeles Sports Arena.

This four day event is offered to ...

September 19, 2014 2:01 PM by Renee Dahring of Career Coach

Proceed carefully when considering a position with a new clinic or practice that is not yet open or established, especially if the clinic is embarking on a "non-traditional" or "new healthcare model." Jobs like these can turn out to be the best thing you ever did or the biggest nightmare of your career. 

The sales pitch for these types of jobs can be intoxicating. Owners or investors are obviously excited ...

September 19, 2014 12:46 PM by Keischa Cash of DNP Answers

Sometimes being the first of your kind is exciting, and sometimes it can be daunting and confusing. When I received my DNP I felt empowered, but I did not know where I would find my niche in an organization where there were no other doctoral-prepared NPs or PAs. My niche became a satellite clinic where I am the sole provider for health services to clients between the ages of 2 and above. I have a supervising physician ...

September 15, 2014 3:28 PM by Caroline Pilgrim of First Year PA

For the past couple weeks, I have been catching myself in the middle of an encounter and realizing, "Wow, I know what I'm going to do for this patient." I tell them their diagnosis, call in their scripts and make a solid follow-up plan. I walk out of the exam room and wonder, "So is this what being a PA feels like?"

Maybe, but then ten minutes later there's a COPD, CHF patient with some strange neurologic ...

September 10, 2014 11:28 AM by Debra Shelby of Dermatology Practice Today

Recently, I received an evaluation from one the registrants criticizing the NADNP's President's Party given each year at the annual conference. While I feel that I do not need to defend what we do at the conference, I did want to address what I feel is the bigger issue. Each year, NP education is supported by vendors who make it possible for free student registrations, low registration fees, meals, speaker support, etc. ...

September 10, 2014 10:48 AM by Deanna McCarthy of DNP Answers

BSN nurses are getting DNP degrees. What do you think about this? Personally, I am not happy about this fact. I have had my BSN since 1987 and my MSN since 1992. I don't think that a nurse who has had their BSN for only 5 years should be getting the same degree, a DNP, as I am getting when I complete this program.

In trying to rationalize this to myself, I understand that the BSN students have to go ...

September 9, 2014 3:38 PM by Mina Grasso of Aesthetics Practice Today

Looking in the mirror at submental (under the chin) fat, loose, crepey, puckered skin and tight platysmal bands going down the neck can have a psychological impact. Loss of the definition of the jawline and neck can be from a genetic predisposition, weight gain or aging. It is generally considered aesthetically unappealing.

Most seem to be aware of the surgical (facelift) option with or without liposuction ...

September 8, 2014 10:54 AM by Katrin Moskowitz of First Year NP

My experiences with patients have been very positive since I have come into practice. Most are able to communicate their complaints effectively and some may even tell you exactly what antibiotic they want, or what they believe their diagnosis to be. On occasion they may ask for things that are clinically inappropriate and at times may make my eyebrows rise.

In the state of Connecticut, nurse practitioners ...

September 3, 2014 1:07 PM by Renee Dahring of Career Coach

Dear "Supervising/Collaborating" Physician,

Our relationship has to change. 

It's not you, it's me. I have changed. I have grown and matured. I am not the same nurse practitioner I was when we first met. I have been around awhile now; I am no longer a new profession that is trying to find my role in the healthcare world. I have been working hard, and over the last few decades I have gained experience ...

September 3, 2014 12:08 PM by Julie Schreiner of DNP Answers

With the recent death of Robin Williams, mental health has certainly been in the forefront of many minds. It has been highlighted in the news media, conversations and, of course, the hearts of the many fans of the late actor. But what are we doing about this issue in our healthcare system - especially as primary care providers - and how can we as Doctors of Nursing directly handle mental health in our system?

One ...

September 2, 2014 3:17 PM by Caroline Pilgrim of NP & PA Student Blog

There are three little letters that every nurse 'loves' to hear: AMA.

I think I had one of my most difficult patients today in a long time. She wanted to leave against medical advice while actively bleeding from her radial artery. Yeah, it was messy situation in more ways than one. Today just reaffirmed my desire to pursue my degree and step away from bedside nursing.

Sometimes it's the little things ...

September 2, 2014 1:23 PM by Caroline Pilgrim of First Year PA

During your first few months as a PA, you really are trying to take it all in: sponge away as much knowledge as you can, form good habits (like never getting sloppy on the physical exam) and develop a style that will carry you through forty years down the road. It's daunting. Primary care is a crunch and though the PAs are programmed to 'spend more time' with the patients and handle the acute visits, patients can ...

August 28, 2014 2:06 PM by Debra Shelby of Dermatology Practice Today

Dear Dr. Shelby,

My name is Ligita Centorino. I am a family nurse practitioner student in Phoenix, Arizona. I was researching NP national organizations and I was impressed to learn about your developed organization. I have chosen to promote your organization in my school, however, I have some additional questions I was not able to find answers on the website. Would you mind help me by answering those questions ...

August 27, 2014 3:20 PM by Walton Reddish of DNP Answers

Since the Affordable Care Act (ACA) first made headlines, a frequent topic in the media has been the shortage of primary care providers (PCPs) to accommodate the influx of newly insured patients. At the time of its implementation, it was estimated that there would be a shortfall of 45,000 to 60,000 PCPs to provide care for the millions of newly insured Americans (Rosenberg, 2012; "Survey reveals", 2012). The concerns ...

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 ...

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 ...



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.