Have you visited our blogs lately? Last week, new NPs and nurse veterans battled on the value of floor experience. Our NP & PA Student blogger Terry Clarke, currently enrolled in a fast track NP program, expressed his views on what experienced nurses have going for them and what they still have to learn. Here are a few of the comments your fellow clinicians shared. Weigh in while the conversation is still hot!

• "A recent education provided by instructors who have spent the last 20 or more years wandering through the cloistered and privileged groves of academe may not have prepared the student for the ‘real world'." - Dan
• "I sympathize with nurses in fast-track programs because for the first year or so on the floor working as an RN, I always felt less-than as other RNs rolled their eyes when I told them about my professional track." - Tara
• "Please don't assume that just because I am a twenty year veteran of nursing, that I haven't continued my education and that my knowledge is twenty years out of date." - Donna
• "Nurses please stop eating your young ones. Not everyone is going to be great at what he/she does, but there is always at least one person that makes a difference." - Andy
• "I wholeheartedly agree with those who believe there should be a minimum of RN experience prior to an NP program." - Susan

In PA news, clinicians are sharing their thoughts on the new PA organization, PAs for Tomorrow. One reader is signing up for membership. Are you on board? "I couldn't agree with you more about how we are NOT being represented appropriately. I have been very vocal myself at PA forums concerning recertification and I can tell you that the NCCPA is doing whatever they feel like without any regard to the wishes of the PA body as a whole. To make matters worse, the AAPA is COMPLETELY in the NCCPA's pocket. I really hope this newly formed organization can truly represent us and make a difference," said reader James. We'll have more information in the November issue of ADVANCE for NPs & PAs and online next month. Stay tuned and let us know what you think of the new group!

Spanning both disciplines, on LinkedIn last week, one reader shared an article: "Providing primary care for the poor: Nurse practitioners and physician assistants stand ready to meet the challenge, again." Here's what LinkedIn group members had to say:

• "The sub-districts and rural clinics in Africa are mainly run by PAs and nurses. So, more specialization opportunities should be open for us all so that we give the best, efficient and accurate care to patients." - Ismael
  
• "They don't pay [NPs and PAs] that well [in Africa] which is unfortunate." - Rickae  

If you're not chatting with us on Facebook, Twitter and LinkedIn, "like", "follow" and "connect" with us and start sharing in the conversations! If you are, keep following and spread the word.

Our ADVANCE for NPs & PAs community is always growing and providing better feedback every week. Our social media goal this week is to hit 2,000 fans on Facebook. We're only 28 "likes" away! If you're not already following us, make sure to check out our page and let us know what you think. If you are, share our page with your colleagues and keep the discussion going.

Want to know what you'll be getting as an ADVANCE Facebook fan? Here is a sample of what we posted this week:

• Our student blogger Terry discusses what it's like to be a new nurse in an accelerated NP program. He doesn't always get along with the seasoned professionals in his classes!
• This NP is being detained in Macedonia after being accused of smuggling coins that were given to her as a gift while on a medical mission.
• On the home front, we have published the results of our 2012 Election Survey. Do you agree with the majority of respondents who plan to vote for Mitt Romney, but identify as Democrat?
• If you're an NP student who is about to graduate and enter the field, we want you to blog for us! Contact kwolfgang@advanceweb.com for more information.

Of course, we love to hear from you in all our communities. Our articles were buzzing with thoughtful comments last week. Below are just a few of the articles you commented on:

• "We seem to make it harder and harder for nurses from less-privileged backgrounds to advance their educations and practices. A DNP is nice, but not necessary to NP practice. It's also been watered down so it's no longer a clinical practice degree as it is awarded to administrators and educators who think it's an easy way to a doctorate." - Leslie­
• "I have been working/studying in the medical field for nearly 10 years and make only half of this! I have half a million in debt to education and will likely get just slightly more than the above salaries in job offers next year unless I take nursing home/inpatient/obstetric call and continue this 80 hours/week nightmare. Both NP and PAs have a good life and I am envious." - Jason M., D.O.
• "I have worked 10 years in the Middle East so far and I have an interest in expansion of our profession in other countries." - D. Mark Vradenburg, PA and nurse in the UK

If you're not chatting with us on Facebook, Twitter and LinkedIn, "like", "follow" and "connect" with us and start sharing in the conversations! If you are, keep following and spread the word.

This week, we are celebrating PA Week 2012! The festivities kicked off on October 6 for PA Day, remembering the father of the profession, Eugene A. Stead Jr., MD. We would love to hear how your facility is celebrating. Send your pictures of all the fun to assistant editor Kelly Wolfgang and we'll share with other PAs and NPs on our Facebook page and in this blog next week.

You can also check out our most recent NP & PA Student Blog post by Caroline Pilgrim. Her PA program is using the week to give back to the community and spread the word about the PA profession. Find out how Caroline is celebrating and how you can do the same.

As we continue rooting for PAs this week, we bring to you an essay by Dave Mittman, PA, "PAs for Tomorrow." Check out the article for information on a new PA group seeking to further advance the profession. You can read more about the new organization in our November issue. If you're not currently receiving our magazine, subscription is free and easy! Go to our homepage to subscribe now.

While you're getting up-to-date on all the latest from ADVANCE for NPs & PAs, check out our salary survey coverage. As the data collection period for the 2012 National Salary Survey of NPs & PAs winds down, we had some great comments on the 2011 results. Reader Roy said, "I hope I'm not the minority in saying that NPs and PAs need to stick together to better work and salary conditions. I think putting other professions down, or comparing who's got more education, or who is better, in my opinion is just divisive, and unprofessional." Find out what else Roy had to say and find out how your salary stacks up by visiting our 2011 Salary Survey Results. Don't forget to take our 2012 survey before Oct. 31, and please encourage your colleagues to do the same.

If you're not chatting with us on Facebook, Twitter and LinkedIn, "like", "follow" and "connect" with us and start sharing in the conversations! If you are, keep following and spread the word.

Last week, NP and PA readers submitted questions to our communities asking for advice from fellow clinicians. Below are a sample - if you have any advice for these NPs and PAs, comment on the respective article or share with us here and we'll make sure to pass along the wisdom. Have something you'd like a clearer answer on? Let us know on our Facebook, Twitter or LinkedIn pages or by visiting www.advanceweb.com/nppa.

Reader Kathy commented on our article "PA Salaries by Specialty 2008-2009," "It is time to renew my contract. I found out another provider in my office who just left was being paid considerably more than I am ($8,500 a year). We work with separate doctors - who determine our salary. I feel I should make at least as much as she was - we have the same responsibilities. It is a large raise to ask for. How can I tactfully let the doctor I work with know that he is underpaying me? I am not supposed to know how much she was making." Can you offer any advice to this PA? For more information on what colleagues in your specialty are making now, check out our 2011 salary survey results.

On the article "Training the Brain Could Help Reduce Pain," reader Joann asked, "Is there anyone doing research with phantom pain in the Las Vegas, Nevada area? I have some questions." Share your knowledge on the subject by visiting the article.

Reader Michael asked on our LinkedIn page regarding the recent dispute between AAFP and AANP, "Would allowing nurse practitioners to provide medical care without a physician present be an answer to the primary care physician shortage in the United States, or would doing so create a two-tiered system of patient care?" ADVANCE recognizes the ability of NPs to practice autonomously, as do 16 states in the country. Check out this interactive NP Scope of Practice Law Guide from Barton & Associates to see a state-by-state assessment of other practice allowances. Here is what some clinicians had to say in response to the LinkedIn question:

• "How would it be a two-tiered system if a collaborating MD is but a phone call away if needed? 85%-90% of all medical conditions can be managed successfully as well as appropriately by nurse practitioners."
• "The physicians have done this to themselves. They are unbelievably greedy and this allows job security for the NPs."
• "Unfortunately some physicians view us as competition, but I hope that professional organizations will continue to fight for our autonomy. However, we as a profession need to be more unified as well."

We encourage you to collaborate with your fellow clinicians regarding the medical, professional and societal issues facing NPs and PAs. If you have any questions or could use a second opinion, please make use of our communities and we will do our best to get you the information you need.

If you're not chatting with us on Facebook, Twitter and LinkedIn, "like," "follow" and "connect" with us and start sharing in the conversations! If you are, keep following and spread the word.

Last week, ADVANCE for NPs & PAs attended the 5th National Doctors of Nursing Practice conference, hosted by DNP, Inc., in St. Louis, Mo. We shared two great photos from the event on Facebook  (here and here) and live tweeted with updates from the conference floor.

Here is some of what we tweeted from @ADVANCEforNPPA:

• #DNPconference2012 panel discussion on affecting outcomes includes Teri Bunker, past ADVANCE NP entrepreneur winner.
• Final #DNPconference2012 keynote Launette Woolforde, #DNP: All eyes are on nursing, and that's a gift for the profession.
• Acc. to the #DNP Inc. outcomes survey, avg. clinical & credit hours in DNP programs have decreased. #DNPconference2012

There are more #DNPconference2012 tweets and photos on our Twitter page - check them out now! Senior associate editor Jennifer Ford also checked in from the conference with details of the keynote speeches from the first two days of the conference.

Did you attend the conference? If so, share some of your highlights with us here or on our Facebook or Twitter pages. If you didn't make it this year, stay tuned for a photo gallery and more detailed news from the conference.

For more information on the DNP, register today for our free DNP Update webinar - live tomorrow, Tuesday, September 25 at 7 p.m. If you can't make it, the webinar will be archived on our site for anytime viewing in about a week.

Last week, we also launched a new LinkedIn group: NPs & PAs in Corrections Settings. The group will house discussions specific to those clinicians working in corrections, such as this one: a lively discussion with more than 10 comments between many clinicians. It is also a great place to network for those who may be interested in joining or are new to the specialty.

One of our New Grad NP bloggers, Beverly Clayton, is currently working in corrections and frequently blogs about her experiences. To get a taste of the life of an NP in a corrections facility, check out some of her recent posts: Repurposing Treatments and Patient Appreciation.  

These posts are just a sample of what's going on in the ADVANCE for NPs & PAs community. For more of the latest comments from your colleagues, check out the thread on our article Rethinking Pain Assessment, the post from a Netherlands NP on our article NPs in Orthopedics and all of our blogs.

ADVANCE for NPs & PAs is covering the 5th National Doctors of Nursing Practice conference, hosted by DNP, Inc., here in St. Louis, Mo. The conference kicked off yesterday afternoon with a presentation by DNP Inc. director David O'Dell, DNP, FNP-BC, on results of 3 years of surveys of DNP graduates. O'Dell pointed out some notable and sometimes surprising trends in DNP education that the survey showed, including that BSN-to-DNP enrollment decreased in 2012, choice of a clinical focus is decreasing as leadership and education are becoming more popular, and the numbers of credit hours and clinical hours in DNP programs seems to be decreasing. These results prompted a lot of discussion, and O'Dell reminded attendees that only 247 DNP graduates responded to the survey, so while the results are interesting, we should keep that small number of respondents in mind. 

Day 1 closed with a keynote talk by Marie Annette Brown, PhD, RN, ARNP, FNP, FAAN, who discussed the pioneering days of the DNP degree. Brown helped to pave the road for the DNP in 2003 by participating in testimony to create the first practice doctorate in nursing at the University of Washington, where she is on faculty. She encouraged attendees to revisit the idea of a nurse practitioner elevator speech and create one for the DNP, because educating colleagues and the public about the DNP is going to continue to be important. 

"This is a long-term transition," said Brown. "Living through the transition of certificate to master's degree [for nurse practitioner certification] helps me speak with confidence that this can occur in a respectful way that will continue to involve all of us." The DNP is an essential foundation for advanced practice nurses to enter practice and become nursing leaders, she added. 

Respect among NPs of all ages and educational backgrounds has been a strong theme. Today's keynote presenter, Margaret Rhoads Scharf, DNP, PMHNCNS-BC, FNP-BC, PMHNP, discussed the role of the DNP in nursing education. She discussed the questions that DNP graduates in academia are facing now and that collaboration and respect among PhD, MSN and DNP nurses, as well as among students and experienced clinicians, is essential for nursing to bridge the gap between evidence and practice. 

"We want stakeholders to think of us first for practice improvement," said Scharf. Attendees thanked her for her inspiration in the Q&A afterward.

The conference continues through tomorrow, September 21, 2012. Read live tweets by following us at @ADVANCEforNPPA.  

Last week, readers commented on two of our recent orthopedic articles. In response to "After Your Patient's Knee Replacement," reader Thomas said, "Nice article Jennifer - I had my TKR in 2010 and you described my overall experience quite well. Patients do really tend to forget that they lost their joint mobility slowly over a sustained time frame, and that the ligaments and tendon can be slower [than they want them to be] to resume their previous flexibility and length, resulting in soreness and stiffness, despite interoperative attempts to maximize mobility."

On our article "NPs in Orthopedics" author Michael Zychowicz, NP, describes his path to the specialty and offers advice for getting started and navigating barriers in the field. Reader Gloria commented, "I would [want] to hear where you are going to obtain your DNP specializing in orthopedics. This is my goal and a dream for me, I love orthopedics." Do you specialize in a field that's difficult to break into? If so, share your story with us! Comment on the article or check out our Writer's Guidelines for submitting your own article.

Our Aesthetics Practice Today blog last week focused on online patient reviews. Blogger Kimberly Cray asked, "Who is to say that the person is an actual patient? There are a lot of unprofessional, not to mention false, things people could post that could affect your reputation and practice. How are these regulated? And do sites exist that are sponsored by highly rated physicians?" Reader Karen commented, "In my role as a medical assistant, I see that many patients are increasingly interested in knowing what others in the community think of a particular physician, want to know about wait times, how closely a doctor listens, etc. We need to give patients credit that they can sift through the various sites and acquire the information they need to make informed decisions." What has your experience been with online patient reviews?

On Facebook, we shared a reader's post in our forum. "Any recommendations for online review class for the PANCE exam? Has anyone used the Kaplan or UMDNJ (mycme.com) for a review class?" Facebook fan Stephanie shared, "Just took my PANCE. UMDNJ was very helpful. Email them for the student discount." If you've recently completed the exam or preparatory work, share your advice on the ADVANCE for NPs & PAs Facebook page today.

We shared a job fair in Lewes, Del. last week on LinkedIn. It is taking place at the Beebe Medical Center on Sept. 18 and 19. To learn more about Beebe and its job openings for NPs and PAs, check out the Where We Work column in our September issue.While you're there, you can browse articles on cancer screening, antibiotics in nursing homes and postherpetic neuralgia. You can also earn CME/CE credits by reading and taking the quiz for "Clinical Management of Early and Midstage Dementia."

If you're not chatting with us on Facebook, Twitter and LinkedIn, "like," "follow" and "connect" with us and start sharing in the conversations! If you are, keep following and spread the word.

Last week, a reader commented with praise for both NPs and PAs on our 2012 National Salary Survey of NPs & PAs. "I am proud to see PAs and NPs getting along in the medical field. Both are great professions. I was an RN for 13 years prior to becoming a PA. I have been a PA for 8 years. I chose PA, because in 2001, NPs were basically involved in OB/GYN, or peds or family practice. I wanted to do surgery, which I did, when I finished school. Our training was much harder than the NP program, as I researched both. Our boards are written by MDs, and NPs by nurses. However, I have some friends that are GREAT NPs. Both professions rock!!" reader Kimberly said. If you haven't taken it yet, share your salary information now! Your input is essential to our accurate reporting.

PA Harriet and her husband are seeking your advice on opening a clinic. "My spouse and I are PAs interested in opening a clinic in Florida. It would include corporate health and family practice. Any assistance or suggestions would be greatly appreciated. I have picked up several books to read but it would be great to hear from someone who has been through the process." Head over to our PA-Owned Clinics Resource Center to lend your advice.

A California NP is also seeking some clinician input. "I live in California where national certification has never been required to work as an NP. I graduated from a certified University as an NP in 1998, because this was prior 2005, I'm told I can never take the exam to become nationally certified. So, if California does decide CA NPs have to be nationally certified to work in CA- what happens to myself and others who have been working in our practice fields for years but are not certified?" reader Katherine asked on our article What NP Graduates Need to Know About Certification. Do you have any experience with national certification? Share your comments and resources.

On LinkedIn, we shared a comment from Tim Ralph, president of the Canadian Association of PAs, who says that PAs "have never been and will never be" independent practitioners. We received multiple comments from clinicians around the country. Here are just a few:

• "As an APRN, I would say get a new president, I know many outstanding and autonomous PAs, I have full trust in their abilities."
• "People have to remember that PAs are new in Canada. I was in class at the Inter-service Physician Assistant Program at Fort Sam Houston, TX in 2001 when representatives from the Candian Army made their first visit to the program to see if they wanted to create a similar program."
• "This is the same problem that established U.S. PAs have, and we need our leaders to envision a bolder definition of PAs which better represents what we do: practice medicine."

Connect with our LinkedIn page to see more comments and follow along with other popular discussions, including clavicle fractures, the independence of PAs, and more.

On Facebook last week, we shared the courageous story of an FNP who risked her life to save others while deployed in Afghanistan. The story was our most popular post of the week, and for good reason. We are proud to share the accomplishments of both NPs and PAs. If you know a practitioner who deserves a moment of recognition, share with us on our Facebook page.

We love to get feedback from our readers. If you're not chatting with us on Facebook, Twitter and LinkedIn, "like", "follow" and "connect" with us and start sharing in the conversations! If you are, keep following and spread the word.

In our recent Opinions & Essays article "PAs: The Need Is Great, the Time Is Now," author Sharon Bahrych, PA-C, MPH, responded to reader Tina's concerns about choosing the correct career path. "Yes, you are definitely not alone in your feelings at this stage of your career. Try to find a local NP group that meets once a month for CME, you might find an older NP mentor that way," Sharon advised. She also added a follow-up to her article: "The repercussions haven't stopped yet." Check out the article and comments section to find out exactly what had physicians walking out the door in support of their fellow clinicians.

Readers also weighed in on the article "5 Traits All Influential Leaders Possess" last week. Reader Leon said, "I would offer three(3) additional points. (1)Have a vision and communicate it effectively. (2)Always maintain and enhance the self-esteem of others. (3)Never ask others to do something that you will not do." Do you have any other points to add? What have you learned as a healthcare leader?

James commented on our 2012 National Salary Survey of NPs & PAs last week with his experience as an NP in a hospital setting. "I've always seen a subtle knee-jerk reaction by doc's when they think nurses are becoming uppity," he said. Click here to find out what else James had to say and take our 2012 survey! Your answers determine our results, so your participation is crucial.

Last week readers also continued the debate on convenient care. "I began to feel self conscious about my field of work whenever I associated with other local ARNP's & PA's & began to feel that I was not doing much more than the school nurse! I want to be a 'real boy' (like Pinocchio!) and work within a broader scope of practice," reader "C" commented on our article "The Forked Tongue of Convenient Care."

Other readers agreed. "I certainly see your concern, I too work at a convenient care and find myself having to refer pt's to the main clinic for things that do not fall within our 'protocol' to treat; it can be quite frustrating at times," J said. Have you ever considered working in a retail health clinic? Would these first-person accounts on the job dissuade you? Let us know in the comments section.

On our New Grad NP blog, writer Beverly asked readers to help her come up with creative solutions for treating patients on a budget. Among her tools were mayonnaise, shampoo and pencil erasers. Reader Amanda offered, "Pediatric ostomy bags over leaky paracentesis sites!" Do you have any suggestions to turn this NP into MacGyver?  Share with us in the comments section!

All comments are reposted here verbatim, without editing. We love to get feedback from our readers. If you're not chatting with us on Facebook, Twitter and LinkedIn, "like", "follow" and "connect" with us and start sharing in the conversations! If you are, keep following and spread the word.

Last week, retail clinics were a hot topic. On Twitter, we retweeted an article from @Health_Affairs: "New Web First online now. Retail Clinic Use Growing Rapidly http://tinyurl.com/9e4jh9y  (Free access for two weeks)." The article highlights the benefits of convenient care, such as longer hours. However, our article The Forked Tongue of Convenient Care has some clinicians rethinking a career in retail health.

"I've heard from other practitioners of this same type of restrictive care in retail clinics. The restrictions are not state based, but rather from the company that owns the clinic. I think these types of restrictions are unethical at best and dangerous at worse. I can't imagine charging these patients for the visit if all the provider can do is refer. Now the retail clinic has taken their money. Now they may not be able to afford another provider. I too thought I'd ‘retire' to practice in one of these clinics, but I think I'll pass," reader Di said. What is your opinion of convenient care? Let us know in the comments below.

Job settings resonated with other readers through the article "Competencies and Job Functions of Acute Care NPs in Florida." One Florida NP weighed in: "Having been lucky enough to have Dr. Kleier as a teacher back in 1997 for Fundamentals of Nursing, she is correct in that schools teaching nurse practitioners need to address the advanced technical competencies that hospitals and other care facilities require in order for nurse practitioners to practice to our fullest capabilities." Do you agree with Tracey?

One new NP found inspiration last week in our Opinions & Essays column, "PAs: The Need Is Great, the Time Is Now." Reader Tina said, "It is too often at this point in my career that I question ‘did I make the right decision?' I love what I do, but some days are rough. I feel like I am a ‘middle man' and patients and physicians are at one end of the spectrum. Sometimes patients will request to see me only while others feel I am incapable to care for them because I am not a doctor. I feel like some doctors embrace my role and will come to me for advice while others disregard me all together." Find out what else Tina had to say and share your thoughts here. Do you have an opinion you'd like to share? Check out our Writer's Guidelines and send in your submission.

Our New Grad NP blog saw some NPs applying for jobs as medical transcriptionists last week. "I too am an NP and recently thought about pursuing a part-time career in medical transcription in hopes of starting a new family and being able to have ‘some' control over my work schedule," reader Tina said. Blog contributor Bev added, "I just applied for a home position as a medical transcriptionist, it's not like I don't have enough to do!" Check out blogger Elizabeth's views on medical transcription to find out what had these NPs considering a second career.

All comments are reposted here verbatim, without editing. We love to get feedback from our readers. If you're not chatting with us on Facebook, Twitter and LinkedIn, "like", "follow" and "connect" with us and start sharing in the conversations! If you are, keep following and spread the word.

On Facebook last week, we shared a reader question: "Would any of you kind folks happen to know anything about transferring from Florida to Arizona as a nurse practitioner? There is a prescribing requirement that states 'you shall submit written evidence of 45 contact hours of education in pharmacology or clinical management of drug therapy within the three year period immediately preceding this application.' I take this to mean that I don't need the hours as I have been in practice for 6 years. Sorry I was on hold for 30 minutes with the AZ board of nursing and still no response after leaving a message and 45 hours of pure pharm is a lot to do in the next few weeks before the move."

NPs and PAs weighed in, offering their advice: "Im pretty sure its required education and not practice. Like seminars or conferences or classes. The Az State board is very slow but you really need to get your information there. The girl who heads up the Advanced Practice problems is based Teresa I believe. I run an urgent care in Phoenix. You really need to speak with someone. But Im pretty sure its education," Cathy said. Charlotte added, "You will need 45 hours of pharmacology through contact hours. Any you have attended that give part or all credit to this will count. Can use online classes as well."

Do you need advice from your colleagues, but you're not sure how to reach them? Send us a Facebook message and we'll relay it to our readers.

On Twitter, we shared the great news that @_Kelsaayyee, @OneDNP and @eyeseeyouarein are all taking the next steps to becoming NPs and PAs. We love sharing good news from future providers. If you know someone who deserves a shout out, let us know @ADVANCEforNPPA.

On our website this week, reader Charmane commented on the article, "The Evolution of my DNP Capstone." She said, "Sallie, what a great picture of the DNP program, as I too was in the same cohort as you, I am quite sure you remember. For me, I did grab a hold to one concept area and let each course shape that subject area into which today my project is everything I thought it could and would be. I agree that the DNP role is still emerging and too would like to encourage other DNPs to let their voices be heard. At some point in the next 6 months I would like to publish my work after I take a little rest. It was a long two years." Are you in a DNP program? What is your opinion of the capstone? Share your thoughts with us here or continue the conversation with Charmane.

We also had many great blog comments! Here is a sample:

• On our NP & PA Student Blog post, "What's in a Name?": "Stacey truer words were never spoken, I get that all the time! ‘so you are like a doctor?' I tell them ‘No, I am a nurse' I like the idea of the public service announcements. I even thought maybe around NP and PA week at least getting a huge billboard along the highway," said reader and New Grad NP blog contributor Bev.
• On our Aesthetics Practice Today blog post, "Blunt Cannula Technique": "The blunt cannula is the wave of the future for injectable fillers. I have completely transitioned to using these cannulas for injection of fillers to all treatment areas. Not only is it safer than traditional techniques, it requires far less 'punctures,' causes virtually no bruising, and is usually painless," said reader Kian.

Head over to our blogs to see what Bev and Kian commented on and get all the latest information on healthcare technology, dermatology, the DNP and more straight from your colleagues.

All comments are reposted here verbatim, without editing. We love to get feedback from our readers. If you're not chatting with us on Facebook, Twitter and LinkedIn, "like", "follow" and "connect" with us and start sharing in the conversations! If you are, keep following and spread the word.

As healthcare providers grapple with the historic June 28 Supreme Court Decision upholding the Affordable Care Act, one thing seems to be clear: it is going to create more jobs. With an estimated 30 million people gaining healthcare insurance coverage as a result of the new law, the healthcare system is already gearing up to accommodate the huge influx of patients.  According to HealtheCareers’ Q2 2012 Healthcare Jobs Snapshot, healthcare jobs across all specialties are expected to grow in the next 8 years.  Some areas — such as nursing and healthcare IT — are already seeing significant growth.

Healthcare networks across the country continue to seek trained physicians and surgeons to combat the ongoing shortage. Amid the changing healthcare landscape, they remain the most sought-after healthcare professionals — accounting for about 40% of HealtheCareers network job openings in Q2. Even with this need, job openings only increased by 1%, the report said.

“Like many healthcare organizations, we have been operating [against] a physician and nursing shortage for quite a while… and our hiring volume has increased significantly,” said Willie French, director, talent acquisition, The Methodist Hospital System in Houston, Texas.

Physician assistants and nurse practitioners seeking employment shouldn’t have too much trouble landing a job, as both of these professions saw significant increases in job openings from Q1 to Q2 — 10% and 16%, respectively. (See The 2012 Job Outlook for NPs & PAs for more information about the NP and PA job market.) And the opportunities don’t seem to be disappearing: Forbes ranked physician assistant studies as the top long-term employment opportunity, according to the report. This increased interest in physician assistants and nurse practitioners comes as no surprise because many hospitals are tackling the physician/surgeon deficit in a new way by hiring NPs and PAs. All states give these professionals the ability to prescribe medication, and employing NPs and PAs has become a popular cost-effective alternative that creatively meets growing patient demands.

In conjunction with these increases, demand for skilled nurses skyrocketed in Q2, with openings increasing by 40% from Q1. Specifically, providers are now seeking more general/surgical registered nurses (a 12% increase in job openings), emergency medicine registered nurses (9%) and nursing assistants (6%). Unfortunately for those finishing their education and looking for an entry level position, most job postings focus on candidates with more than one year of experience and list more stringent job requirements. The report notes that this trend will most likely continue as older generations of skilled nurses retire and leave high skilled vacancies in the workforce.

Healthcare IT positions are on the rise as well with healthcare networks transitioning to electronic medical records and focusing on meeting meaningful use requirements. Although general IT openings increased by only 18%, 30% of those were specific to HIT analysts/systems analysts. The report postulates that HIT analysts will remain much sought-after hires while health systems are still in the process of evaluating potential technology innovations. Tellingly, though, enough healthcare networks are moving forward with their new technology implementation, as systems/network engineers were in high demand in Q2, with position opening growing by 190% from Q1.

HealtheCareers collected their data from their online database of job openings from April 1 through June 30, 2012. Given that their database is comprised of approximately 50,215 healthcare and medical job openings placed by 3,294 hospital and healthcare organizations, the report offers significant insight into industry trends in the job market:  Physicians and surgeons are still the top priority, but physician assistants, nurse practitioners and skilled nurses are all in higher demand as of Q2. Healthcare IT is growing, although it has yet to overtake healthcare provider needs.

To read the full report, click the link provided above, or visit HealtheCareers.

Editor's note: This post was written by Rebecca Hepp, on staff at ADVANCE.

On Facebook last week, we began the month of August with new images from our current issue. The cover article, "Head Lice Update," describes the life cycle of head lice, how the organisms can be removed, and the proper protocol for allowing children with lice to attend school. Check out our new cover image and let us know what you think, then follow up with the article for more information!

Readers had much to say about our blogs last week. Our New Grad NP blogger Beverly wrote about a letter of appreciation she received from an inmate at the correctional facility where she works. Beverly expressed the joy she received from the letter, a great reminder to the decency of people, even in the most chaotic of environments. Facebook follower Jessie said, "I work in correctional medicine, and can completely relate." Reader Renee (who also happens to be our Career Coach blogger) added, "A couple weeks ago I recieved what I think was appreciation from an inmate. He said ‘I don't care what anyone says - you guys do a good job!' lol." What is the nicest thing a patient has done for you? Share your positive messages from patients in the comments below.

On our DNP Answers blog this week, Catherine Nichols, MSN, ANP-BC, a DNP student and adult nurse practitioner, addressed a reader question regarding camaraderie between NPs with a DNP and those without. Reader James commented through Facebook, "Those NPs with years of experience and nearing the end of their careers probably won't go the DNP route! The younger folks probably will, however I would rather be treated by an NP with 20 plus years experience than a new DNP who doesn't have very much hands on experience!! As a matter of fact if I was given a choice between either one I would go with the experienced one!!" Do you feel a wall between MSN-prepared NPs and DNP-prepared NPs? Has it affected your career or work relationships? Let us know!

This week on our Innovative Healthcare Technology blog, tech writer Jason Hunter addressed cloud computing in healthcare. Reader John commented, "The fact that the healthcare industry is beginning to use cloud technology is a testament to how powerful cloud computing is. Despite the security concerns, the efficiency the technology gives you is worth the risk. In fact many companies have really done a good job at addressing those security risks." At ADVANCE, we are moving toward the latest technology with our ADVANCE for NPs & PAs iPad app. Check it out now and download it for free!

In our NPs in Orthopedics article, writer Michael Zychowicz, NP, discusses the expanding role of NPs in the field. Reader Amy commented, "Thank you so much for this post. It describes my career path almost to a tee. I have been in Orthopaedics for 8 years now, starting with an ICU/ED background as well. Orthopaedics is a rewarding field and my job has evolved to combine a hospital based position with some pediatric orthopaedics in the clinic setting. Often, I see the kids that had a reduction done by me in the ED, back in clinic. Nothing is more rewarding than to follow a patient from the date of injury to full recovery!" What is the most rewarding part of your job?

All comments are reposted here verbatim, without editing. We love to get feedback from our readers. If you're not chatting with us on Facebook, Twitter and LinkedIn, "like", "follow" and "connect" with us and start sharing in the conversations! If you are, keep following and spread the word.

On Facebook last week, we shared the Aesthetics Practice Today blog, "Maintaining Facial Balance with Liquid Facelifts." Blogger Mina Grasso described the impressive effects of this treatment but warned clinicians to outline clear expectations to their patients. Facebook fan Shane commented, "I do these all the time. Patients never, ever have truly realistic expectations at first visit. I find that financial issues are usually part of the equation. I also am a 'patient' and it is simply our nature to want more. On a positive note, I love performing the liquid lifts. I personally use a combination of Juvederm, Sculptra and Botox.

"Instant and gradual changes that most patients appreciate even if it's slightly less than expected at first. I counsel and practice with the philosophy that one should look like they were born with the 'look' we are trying to achieve, very natural, never over done. I'm sure anyone who performs these will agree with the following, ‘Oh that's too much, I look weird' ... 2 weeks later ... 'Can you put more in, it's all gone'! Ahh, the joy of psychotherapy through cosmetic treatments ..." Have you used the liquid face lift treatment on your patients? Let us know what patients thought and how you prepared them for the results!

On Twitter, we retweeted @AANP_NEWS: "Congrats to AANP member Darrell Owens, first NP to receive prestigious Cambia Sojourns Award - http://ow.ly/cyyup" Owens, of Seattle, Wash., won the honor, which focuses on palliative care, for having published over 20 review and research articles, a reference book on the provision of palliative care for people with liver disease, and the first ever chapter on palliative care in the 3rd edition of the Fundamentals of Disaster Management. Congratulations to Darrell Owens on his healthcare achievements! If you know an NP or PA who deserves a minute in the spotlight, let us know by tweeting @ADVANCEforNPPA and sharing the news!

We also tweeted to ask readers what they thought of a Colo. NP's decision to stop prescribing artificial birth control, and we had some differing responses. @HarrisonReedPA replied, "Every patient population I ever work with needs protection from STDs also. Faith-based contraception doesn't help them much." @OneDNP replied, "NFP is a viable option & promotes body awareness. Valdez discloses her philosophy so the consumer is aware & informed." 

On our website last week, readers discussed working on call and computer technology. Our blogger Beverly Clayton discussed the struggles of balancing work and a personal life while being on call for 24 hours straight in her latest blog. "I remember the first time I got my paycheck as a PA. Handwritten with taxes taken out and it was more than I ever thought I would make in my life. You could see how financially oriented I was. After working 80 hours a week on rotations a year before for free (actually I had to pay tuition) I found it amazing someone would actually pay me for doing what I did for free. Took a few years to get over but I did," reader Dave said.

Turner added, "Hi Bev, I have been in a position of being on call although it sounds like you take the cake! I found an app for my phone (oncallapp.net) that really helped me screen calls as I found I was also short to friends and family when they called when I was working. Hope it helps J" How do you prepare for your time on call? Do you believe the financial benefits outweigh the personal strain? Share your advice with Beverly and let other clinicians know what to expect when going on call!

Readers also shared their opinions on computer technology in our article, "It's Elementary: 'Watson' Technology Won't Replace Physician Assistants." Reader Naga said, "I am really surprised when i read that artificial intelligence and other technology (which is only going to be better in the near future) can not eventually replace doctors.I think that most docs are really sure about their profession and that is bad.we will see more automation in all fields and that is only beginning..." Do you think technology will one day replace the value of the human mind? Is it possible for computers to properly diagnose and treat patients? Let us know your thoughts!

All comments are reposted here verbatim, without editing. We love to get feedback from our readers. If you're not chatting with us on Facebook, Twitter and LinkedIn, "like", "follow" and "connect" with us and start sharing in the conversations! If you are, keep following and spread the word. 

Last week, New Grad NP blogger Samantha Damren posted the struggle she encounters working with multiple physicians: memorizing the preferences and practices of each. On Facebook, reader Amber said, "20 in my emergency physician group ... can get frustrating!" On our blog, more readers weighed in. Here are some of their comments:

• "I have the same problem in my practice! Starting an job in ER medicine for the first time was anxiety provoking enough. Then, on top of learning the ins and outs of a new specialty I had to learn the personal preferences of the nine different physicians who take turns signing my charts.  The good news- it didn't take me very long to start to identify and adapt to the personal preferences of the physicians I work with.  I feel lie working with multiple physicians has actually allowed me to become a better provider.  I can take the best advice and practices from each physician, combine them into my own practice style making me a much better NP."
• "I too had the same experience recently with six MDs and me. I did decided to leave the practice after a year b/c I was the first NP in the practice and I was tired of defending my position and education to staff (...sigh). However while working in the practice I did decided to take pieces of clinical knowledge from each physician and make it work for my practice, so I did what I thought was best for the patient and didn't let their personal preferences guide my practice. Often I had to defend my rationale, but I figured I am a provider too and can make sound medical decisions. In the end I had great outcomes by mixing their preferences and all was good for the patients."

Have you encountered the same problems as an NP or PA? How did you deal? Let us know in the comments or offer your advice to Sam on our blog page!

On Twitter, we shared a tweet from @healthythinker: "Nice to see NPR covering #mhealth mobile #health app regulation by FDA http://www.npr.org/blogs/health/2012/07/10/155977692/when-does-an-app-need-fdas-blessing?sc=tw ... Mainstream media covering #healthcare tech #hcsm." Healthcare apps were a huge highlight for us this week as we introduced the ADVANCE for NPs & PAs app! It is available now for free for iPad and Android tablets. We would love your feedback on our newest venture! If you've already downloaded the app, let us know what you think!

"Retail Healthcare or 'convenience care' isn't healthcare at all. In fact, if a Physician Assistant or Nurse Practitioner is interested in ruining their career, work in that field. I lasted there only for a few months. Retail healthcare is only about one thing, 'profit margins' for the retail pharmacy chains. They are not about patients. As an example, at the urgent care centers and hospitals in the charlotte area, we as providers are bombarded and literally screamed at by multiple patients who have been told the '______clinic' cannot treat my pneumonia only to find out that the NP or PA misdiagnosed the patient and sent them to urgent care. The fact that they have CLINIC and "medical clinic" inside pharmacy is a huge problem because it implies that the clinic is able to deal with medical problems. If I had a dime for every mother that brought a child in with a runny nose who demanded the 'z-pack' or an antibiotic, I'd be in business. The worst part is that if you deny the mother of the patient antibiotics, you will be disciplined by a Nurse Practitioner Manager of Operations since they will never put Physician Assistants in those roles. The customer is always right in this situation because the clinic sits under the umbrella of the store. This isn't healthcare. This is a disgraceful means to charge the public extra money to be seen for often times things that they cannot treat. By the time the patient gets to the ER, he/she would already paid hundreds in co-pays. What kind of patient care is this?"

All comments are reposted here verbatim, without editing. We love to get feedback from our readers. If you're not chatting with us on Facebook, Twitter and LinkedIn, "like," "follow" and "connect" with us and start sharing in the conversations! If you are, keep following and spread the word.