Virginia NPP

Hi All, I am a Psych NP and wanted to say how glad so many are supportive of showing emotions at rough times, even for male of the species. :wink: It is important not to turn into a robot. I would like to add one thing. Going over the scene in your head and doing the what ifs: what did I say? what should I have said? what if I had done something different? and OFTEN should I have been more aggressive? are a normal part of resolution. As long as it doesn't go on too long. It is great that you can do that here and get support and reassurance. You had the right diagnosis and the doc was wrong, I am sure this is not the first or last time that will happen. In this case however, no one could have saved that patient and you did a good job. Take care of yourself.

Hello All you Sleepless People, As a nurse who over the years worked many different shifts I can sympathize with you. I agree with FireDoc5 advice to AVOID sleeping medications (only work for brief time, many are addictive) and Alcohol (actually makes sleep worse). I am a psychiatric NP and Melatonin works well for many of my patients. My suggestion is start at the lowest dose and go up. Most people use between 1.5 to 5 mg. I also suggest the long acting or time release type ,as it helps you stay asleep. Here are some other hints. Get some ZZZZZs Bedtime Rituals It will help you to have a consistent bedtime ritual. Start to prepare for bed about 1/2 hour before you intend to sleep. Don't just jump in to bed after a hard shift. I know this is tempting. A warm shower or bath before bed will help you relax you. You may wish to do something special such as apply moisturizer to your body. A few minutes to read (something calming) or pray or meditate is a good practice. Recent research has shown that napping can be good for you. However you should avoid naps until you get your insomnia under control. After that you can try adding short naps a little at a time in the early afternoon.

Thanks Dustdevil, Just to clarify, the term Mid-level provider I believe was made up by the Feds for DEA numbers (needed to prescribe controlled substances). I don't think anyone outside of that bureaucracy uses it. In the clinical area we also us the word provider most often. Such as Primary Care Provider, vs Primary Care Physician. by the way you look so familiar, I think I know you from somewhere.......... Virginia

Hello all, I am new to this site and would like to throw in my 2 cents about this discussion. I am also worried about what I see as the deterioration in education of nurses and NPs and use of foreign nurses. In terms of the regulations for NP and PA practice, they vary from state to state. So check your state board for specifics. In general PAs are required to have "supervision" by a physician, while NPs require "collaboration". This may seem like just semantics but supervision is usually more strict and decided by the state. Collaboration is decided by the NP and her MD partner with minimum requirements by the State. NPs are licensed in all states, PAs are licensed in most but not all. What this means is complicated, but in general think of a licensed person as more independent as they function under their own licensing body. (Which also means they can loose their license for unacceptable practice. ) PAs without license function under the MD license. I would also like to comment on the MDs use of the term "physician extenders". This is seen as objectionable and insulting to professionals. It describes NPs and PAs almost as objects. It also does not describe NP or PA role. Midlevel practitioner is a term some states use. Also I agree some what with the MDs recognition of a different mindset, I just think we may mean different things. Nursing has a long tradition of a wholistic approach (long before it became such an overused buzz word. Nurses and NPs are really trained to look at the whole person and intervene as needed. Although the truth is that this is much harder in these days of such pressured practice. Physicians and PAs are trained in the biological model or "medical model". This is more a view of illness as separate from the person and treatment as specific to that illness. They often rely more on medication then NPs. Think disease /cure. Although to be fair, medical schools are finally paying more attention to the concept of the whole person. In practice however, I think much of this is related to the personality and belief system of the provider, although training and education certainly influence them. Sorry to go on and on, hope this is helpful to some. Virginia Duffy PhD NPP www.BehavioralfirstAid.com