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PULMONARY EMBOLISM

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DEFINITION

Pulmonary embolism is the blockage of pulmonary arteries by thrombus, fat or air emboli and tumour tissue.

It is the most common complication in hospitalized patients.

An embolus is a clot or plug that is carried by the bloodstream from its point of origin to a smaller blood vessel, where it obstructs circulation.

ETIOLOGY AND RISK FACTORS

Virtually all pulmonary embolisms develop from thrombi (clots), most of which originates in the deep calf, femoral, popliteal, or iliac veins.

Other sources of emboli include tumours, fat, air, bone marrow, amniotic fluid, septic thrombi, and vegetations on heart valves that develop with endocarditis.

Major operations, especially hip, knee, abdominal and extensive pelvic procedures predispose the client to thrombus formation because of reduced flow of blood through pelvis.

Traveling in cramped quarters for a long time or sitting for long periods is also associated with stasis and clotting of blood.

CLINICAL FEATURES

Severity of clinical manifestations of pulmonary embolism depends on the size of the emboli and the size and number of blood vessels occluded. Most common manifestations are

Anxiety

Sudden onset of unexplained dyspnea

Tachypnea or Tachycardia

Cough

Pleuritic chest pain

Hemoptysis

Crackles

DIAGNOSTIC TESTS

IMAGING STUDIES

CXR

V/Q Scans

Spiral Chest CT

Pulmonary Angiography

Echocardiography

LABORATORY ANALYSIS

CBC, ESR

D-Dimer

ABG’S

ANCILLARY TESTING

ECG

Pulse Oximetry

COMPLICATIONS OF PULMONARY EMBOLISM

Sudden cardiac death

Obstructive shock

Pulseless electrical activity

Atrial or ventricular arrhythmias

Secondary pulmonary arterial hypertension

Cor pulmonale

Severe hypoxemia

Right-to-left intracardiac shunt

Lung infarction

Pleural effusion

Paradoxical embolism

Heparin-induced thrombocytopenia

Thrombophlebitis

MEDICAL MANAGEMENT – PULMONARY EMBOLISM

Emergency Management

Nasal oxygen

IV infusion for medication

Perfusion scan

ABGs and ECG

Small dose of Morphine

Intubation and mechanical ventilation

MEDICATIONS

Anticoagulants are prescribed when pulmonary embolism is diagnosed or suspected

Heparin

Warfarin

Rivaroxaban

Fondaparinux

Most commonly the patient will take an anticoagulant for at least 3 months after pulmonary embolism to reduce the risk of having another blood clot.

SURGERY

Surgical management of acute pulmonary embolism (pulmonary thrombectomy) is uncommon and has largely been abandoned because of poor long term outcomes. However, recently, it came back again with the revision of the surgical technique and is thought to benefit certain people.

Chronic pulmonary embolism leading to pulmonary hypertension (known as chronic thromboembolic hypertension) is treated with a surgical procedure known as a pulmonary thromboendarterectomy.

NURSING MANAGEMENT OF PULMONARY EMBOLISM

Evaluation of risk factors on admission and during hospital stay

Encourage maximal mobility, range of motion and ambulation when appropriate or leg compression devices if on bed rest.

Administer anticoagulant medication – heparin continuous IV drip until Coumadin started and PT/INR is therapeutic

Monitor liver function when patients receive anticoagulants

Monitor Lab for anticoagulants effectiveness (Heparin-PTT q 6 hours till in range then q day)

Assess for symptoms of bleeding and heparin-induced thrombocytopenia (HIT)

IVC Filter – vena cava filter

Pulmonary Embolism PDF

 

Pulmonary Embolism

Polycystic Kidney Disease

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Definition:.    

1. Hereditary disease characterized by cyst formation and massive kidney enlargement

           Adult form of disorder is autosomal dominant polycystic kidney disease and accounts for 10% of persons in End Stage Renal Disease (ESRD)

Pathophysiology:

     1.    Renal cysts are fluid-filled sacs affecting nephrons; cysts fill, enlarge, multiply thus compressing and obstructing kidney tissue; renal parenchyma atrophies, becomes fibrotic.

      2.    Cysts occur elsewhere in body including liver, spleen.

Two Types of Polycystic Kidney Disease

     1.    Autosomal Dominant Polycystic Kidney Disease

–         Shows signs between 30 and 40

–         Only one parent need it to pass it

–         90% of patients with PKD have this type

     2.    Autosomal Recessive Polycystic Kidney Disease

–         Early symptoms

–         Less common

–         Both parents must have abnormal genes

–         If both parents are carriers the child has 25% chance of having it

 

Etiology and Pathogenesis:

The polycystic kidney disease (PKD) proteins now known as polycystin 1 (PC 1) and polycystin 2 (PC2) play a critical role in the normal function of the primary cilium that is essential to maintaining the differentiated phenotype of tubular epithelium

Disordered function of polycystins is the basis for cyst formation in PKD by permitting a less differentiated tubular epithelial phenotype.

 

Manifestations:

     1.    Disease is slowly  progressive; symptoms develop in age 30 to 40’s

     2.    Common manifestations include

Flank pain

Microscopic or gross hematuria

Proteinuria

Polyuria and nocturia (impaired ability to concentrate urine)

UTI and renal calculi are common

Hypertension from disrupted renal vessels

Kidneys become palpable, enlarged, knobby

Symptoms of renal insufficiency and chronic renal failure by age of 50 to 60’s

 

Diagnostic Tests

1.    Renal Ultrasonography: Primary choice for diagnostic; assesses kidney size, identifies and locates renal masses; cysts,  tumors, calculi

2.    Intravenous pyelography (IVP): evaluate structure and excretory function of kidneys, ureters and bladders

3.    CT scan of  kidneys: detects and differentiates renal masses

 

Complications:

Hypertension 60 to 100% (Cardiovascular complications are the major cause of mortality in patients with ADPKD)

Infection (second most common cause of death for patients with ADPKD)

Gross hematuria 50%

Nephrolithiasis 20 to 25%

Renal failure 50% by age 60 (PKD1) and 85% in lifetime

Polycystic liver disease

Cerebral aneurysms (occur in 4 to 10% of patients)

 

 Management:

No specific medication is available for ADPKD. However, pharmacotherapy is necessary to accomplish the following:

Control blood pressure: Drugs of choice are ACEIs or ARBs

Control abnormalities related to renal failure

Treat urinary tract infections

Treat cyst infections: Gyrase inhibitors (eg. Ciprofloxacin,  chlormaphenicol, clindamycin,  levofloxacin); dihydrofolic acid inhibitors (TMX/SMP)

Treat hematuria: possibly analgesic plus copious oral hydration

Reduce abdominal pain produced by enlarged kidneys

Prevent cardiac valve infection in patients with intrinsic valve disease

Mx-SURGICAL OPTION

 

Surgical intervention in ADPKD includes the following:

      ·       Surgical drainage: usually in conjunction with ultrasonographically guided puncture; in  cases of infected renal/hepatic cysts not responding to conventional antibiotics.

      ·       Open-/fiberoptic-guided surgery: For excision/drainage of the outer walls of cysts to ablate symptoms.

      ·       Nephrectomy: Last resort for pain control in patients with inaccessible cysts in the renal medullae; bilateral nephrectomy in patients with severe hepatic involvement

      ·       Partial hepatectomy: To manage massive hepatomegaly

      ·       Liver Transplantation: In cases of portal hypertension due to polycystic liver or hepatomegaly with nonresectable areas.

READ IN PDF Polycystic Kidney Disease 

Neonatal Nurse Practitioner – Qualifications, Salary, Role and Responsibilities

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Neonatal Nurse Practitioner is mainly focused on caring for infants (Tiniest Patient). Nurse provides specialized care and management of neonates particularly those who are premature or sick patients in Neonatal Intensive Care Unit (NICU) and intermediate care nurseries.

Neonate Definition

New born or neonate is a child under 28 days of age. This is the period which is crucial for child who is at highest risk of death. Neonates in NICU are premature and low birth weight. Premature infant’s system has not fully developed and adaptation to extrauterine life complicated.

Neonatal Patients

Patient in the neonatal intensive care unit (NICU) are preterm (37 week), term neonates infants and toddlers through 2 years of age. Patients suffered from chronic conditions as a result of complications of prematurity and neonatal patho-physiology.

Neonatal Nurse Responsibilities

Neonatal nurse is responsible to take care infants, it require specialized care and management of neonates particularly those who are premature or sick patients in the Neonatal Intensive Care Unit (NICU) and intermediate care nurseries. It also includes stabilization and management of ill infants.

NNP has additional education and training to provide advanced clinical skills, make critical management decisions, and facilitate consistent family-centered care as members of a multi-disciplinary team

NNP collaborates with program staff, attending physicians, and specialists to acquire and utilize best practice-evidence and resource needed for individual situations and to make adjustments and optimize program delivery.

NNP participates in program committees, quality improvement programs, and lead nursing research initiatives as well as providing education.

Nurse provides education to AHS personnel delivering neonate care through specific outreach programs (ACORN and NRP) or through organized events such as workshops and simulation.

 NNP act in a preceptor capacity and provide mentorship to new NNP’s, NP students and other healthcare providers.

Qualifications for Neonatal Nurse Practitioner

Neonatal Nurse should be active or eligible for registration as neonatal nurse practitioner with the association of Registered Nurses of State Board.

They need permission to practice indicating child population (neonatal) stream of practice.

Nurses need to have current Basic Cardiac Life Support – Health Care Provider (BCLS – HCP)

Neonatal Nurse should have minimum of 3 years of full time (or equivalent number of hours) clinical experience as a NNP level III NICU experience.

NP needs to provide proof of active registration of NP practice permit with CARNA and to maintain registration throughout the duration of employment.

Additional Qualification Required

  1. Neonatal Resuscitation Program (NRP) Certification
  2. Experience with the development and/or implementation of evidence based practice. Experience with program development.
  3. Experience with clinical or scientific research
  4. Microsoft Office Suite Knowledge

SKILLS NEEDED FOR NNP

NNP need to have knowledge, skills, caring and compassion are all necessary competencies of nurses working in the neonatal intensive care (NICU)

NICU nurse to be able to anticipate, identify and manage these complications.

Neonatal Nurse Practitioner – Qualifications, Salary, Role and Responsibilities
Neonatal Nurse Practitioner

Types of Neonatal Nurses

Neonatal patients is served by two neonatal APRN roles – the neonatal nurse practitioner (NNP) and Neonatal Clinical Nurse Specialist (NCNS)

NCNS – Scope of Practice

Scope of Practice for NCNS involves collecting data relevant to the three spheres of influence: patient, nurse and system.

NCNS don’t provide direct patient care the majority of the time; will ensure the highest quality of care is provided to all patients and families.

Neonatal APRN – Scope of Practice

NICU rely on the neonatal APRN to play a vital role in caring for critically ill neonates. APRN participate in wide variety of complex patient care activities (includes all levels of neonatal inpatient care in both academic and community-based settings, transport, acute and chronic care, delivery room management; and outpatient settings.

This practice is multifaceted and includes integration of research, education, practice and management with a high degree of professional autonomy in independent or collaborative practice.

APRN need to have advanced health assessment skills, critical decision-making, diagnostic reasoning, and advanced clinical competencies.

Salary for Neonatal Nurse

Registered Nurse (RN) work in Neonatal Intensive Care Unit (NICU) average salary is $72,876 annually. Highest pay for Neonatal Nurse Practitioner is between range 60,570 to 123,285 $.

In California, Nurses earn more about 60.90$ per hours than the other states of America.

Top States Highest Paid Salary for Neonatal Salary

California – Annual Salary: $112,474

New York –   Annual Salary: $110,298

Vermont – Annual Salary: $109,489

Maryland – Annual Salary: $105,652

Massachusetts – Annual Salary: $102,703

Nevada – Annual Salary: $101,793

West Virginia – Annual Salary: $100,480

Alaska – Annual Salary: $99,804

North Dakota – Annual Salary: $98,334

Idaho – Annual Salary: $98,859

Montana – Annual Salary: $98,469

Washington – Annual Salary: $98,190

Wyoming – Annual Salary: $97,001

Nebraska –  Annual Salary: $96,953

Hawaii – Annual Salary: $96,386

Connecticut – Annual Salary: $96,205

Virginia – Annual Salary: $96,100

Pennsylvania – Annual Salary: $94,230

Arizona – Annual Salary: $94,189

Rhode Island – Annual Salary: $94,005

New Hampshire – Annual Salary: $93,749

Delaware – Annual Salary: $93,190

Louisiana – Annual Salary: $92,750

Oregon – Annual Salary: $92,461

Minnesota – Annual Salary: $91,093

South Carolina – Annual Salary: $90,986

Colorado – Annual Salary: $90,678

Iowa – Annual Salary: $90,270

Kansas – Annual Salary: $90,125

South Dakota – Annual Salary: $90,006

Tennessee – Annual Salary: $89,740

Indiana – Annual Salary: $89,550

Oklahoma – Annual Salary: $89,289

Kentucky – Annual Salary: $89,240

Ohio – Annual Salary: $88,908

Utah – Annual Salary: $88,387

New Jersey – Annual Salary: $88,156

Alabama – Annual Salary: $85,180

Wisconsin – Annual Salary: $83,593

Georgia – Annual Salary: $83,470

Texas – Annual Salary: $82,830

New Mexico – Annual Salary: $81,504

Maine – Annual Salary: $81,372

Michigan – Annual Salary: $81,297

Mississippi – Annual Salary: $81,200

Missouri – Annual Salary: $81,153

Illinois – Annual Salary: $79,483

North Carolina – Annual Salary: $79,192

Arkansas – Annual Salary: $78,900

Florida – Annual Salary: $78,248

Neonatal Nurse Role

Nurse provides a high standard of care for the neonate and family across the health continuum. Nurse possesses knowledge of the stages of fetal and neonatal development, the effects of maternal health, pregnancy, and birth on the developing fetus and neonate, and transition to extrauterine life.

 Neonatal nurse is skilled in neonatal resuscitation and the care of neonates who are ill and/or premature.

Neonatal nurse care based on principles of developmentally supportive care (DSC), family centred care (FCC) and culturally sensitive care.

Strategies used by nurses are adult learning to teach, empower and share information to the family.

Nurse will be team up with collaborators and make interprofessional healthcare team, professional organizations, clinical practice facilities and/or academic institutions.

Neonatal Nursing Process

Nursing Process includes four domains of neonatal Nurses such as practice, education, research and leadership.

Neonatal nursing practice includes therapeutic care, health surveillance, health promotion, illness prevention, shared decision-making.

Nursing practice involves continuous assessment, is comprehensive and holistic, and uses all available and appropriate resources for the neonate and family.

Practice involves the identification of actual and potential problems, the evaluation of outcomes of care, and the continuous revision of the plan of care in response to changes in the neonate’s and family’s status.

Practice is collaborative within the interprofessional team.

Infant Acuity Levels Care

LEVEL – 1 Continuing Care

(Infant only requiring PO or NG feedings, occasional enteral medications, basic monitoring may or may not have a heparin  locks for meds.)

LEVEL – 2 Requiring Intermediate Care

(Stable infant on established management plan, not requiring significant support. Examples: room air, supplemental oxygen, or low flow nasal cannula, several meds)

LEVEL – 3 Requiring Intensive Care

(Infant is stabilized, through requires frequent treatment and monitoring to assure maintenance of stability. Example: ventilator, CPAP, high flow nasal cannula, multiple IV meds via central and peripheral line)

LEVEL – 4 Requiring Multisystem Support

(Infant requires continuous monitoring and interventions. Example: conventional ventilation, stable on HFV, continuous drug infusions, several IV changes via central line)

LEVEL – 5 Unstable, Requiring Complex Critical Care

(Infant is medically unstable, and vulnerable, requiring much simultaneous intervention. Examples: ECMO, HFO, nitric oxide, frequent administration of fluids, medication)

Notes: PO – by month, NG – nasogastric, CPAP – Continuous Positive Airway Pressure, IV – Intravenous, HFV – High Frequency Ventilation, ECMO – Extracorporeal Membrane Oxygenation)

Shortage of NNP

There are huge shortage neonatal nurse practitioners in United States. Nurse and patient ratio is very less for level 4 and 5 nursing care compare to level 1, 2 and 3.

Acuity Level               Patient-to-Nurse Ratio

Continuing Care         2.78

Intermediate Care      2.48

Intensive Care              1.92

Multi-system support 1.39

Unstable/complex critical care 1.04

Common Conditions in the NICU

These are common conditions of Infant requiring special care in NICU

  1. Intraventricular hemorrhage (IVH)
  2. Patent ductus arteriosus (PDA)
  3. Persistent pulmonary hypertension (PPHN)
  4. Apnea and Bradycardia
  5. Respiratory Distress Syndrome (RDS)
  6. Transient tachypnea of the Newborne (TTNB)
  7. Sepsis
  8. Necrotizing enterocolitis (NEC)
  9. Fluid and electrolyte balance

Advanced Practice Registered Nurse (APRN) – Role and Responsibilities

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Nursing professionals are individuals employed in nursing professions which includes Registered Nurse (RN), Licensed Practical Nurse (LPN) and Licensed Vocational Nurse (LVN).

Advanced Practice Registered Nurse (APRN) – Definition

Advanced Practice Registered Nurses are Nurse Practitioner, Certified Registered Nurse Anesthetist, Certified Nurse Midwifery and Clinical Nurse Specialist.

APRN’s role is to coordinate patient care and provide primary and specialty healthcare. The scope of practice will be varied according to countries and each country nursing practice varies state to state.

Advanced Practice Registered Nurse (APRN) – Definition, Role and Responsibilities

ROLES AND RESPONSIBILITY OF APRN 

APRN accepts responsibility and accountability for health promotion and maintenance as well as the assessment, diagnosis and management of patient problems (includes administration and prescription of pharmacologic and nonpharmacologic interventions.

APRN are licensed independent practitioners who are expected to practice within standards established or recognized by a licensing body.

APRN is accountable to patients, the nursing profession and licensing body to ensure that advanced nursing care met.

QUALIFICATION

  • Nurse with graduate degree in Nursing
  • Licensed in advanced role of nursing
  • Pass of National Certification Examination
  • Nurse need to have extensive Clinical Experience and have acquired advanced clinical knowledge and skills prepared to provide direct care to patients

Role of Advanced Practice Registered Nurse

ARPN have full, independent practice authority in most of states of United States and in few states, APRN need to practice under the supervision of physician.

APRN are educationally prepared to provide of variety of services in major six population foci – family/individual across the lifespan, adult-gerontology, pediatrics, neonatal, women’s health/gender-related and psych/mental health. Each APRN role will differ in emphasis and implementation.

APRNs can work in different healthcare settings such as hospitals, physician’s offices, and clinics. There is no part time job for APRNs, most APRNs work full time.

Certified Nurse Practitioner (CNP)

An advanced practice registered nurse (APRN) who usually completed a DNP program or a set of graduate coursework and clinical education beyond that of an RN (MSN). Nurse Practitioner can diagnose medical conditions, order treatment, prescribe drugs and make referrals like physicians. Many states in US, NP don’t need to practice under the supervision of physician.

ROLE OF CERTIFIED NURSE PRACTITIONER (CNP)

CNP can work in direct primary and acute care provided in across settings.

CNPs are members of the health delivery system, practicing independently in diverse areas such as family practice, pediatrics, internal medicine, geriatrics and women’s health care.

CNPs are prepared to diagnose and treat patients with undifferentiated symptoms as well as patients with established diagnoses.

CNPs provide initial, ongoing and comprehensive care which includes taking comprehensive histories, providing physical examinations, other health assessment and screening activities, and diagnosing, treating, and managing patients with acute and chronic illnesses and diseases. (Includes ordering, performing, supervising, and interpreting laboratory and imaging studies; prescribe medication and durable medical equipment; and making appropriate referrals for patients and families)

Clinical CNP care includes health promotion, disease prevention, health education and counseling as well as the diagnosis and management of acute and chronic diseases. CNPs are prepared to practice as primary care CNPs and/or acute care CNPs which have separate national consensus-based competencies and separate certification processes.

Different Types of Nurse Practitioners

Acute Care Nurse Practitioner

Adult Health Nurse Practitioner

Child Health/Pediatric Nurse Practitioner

College Health Nurse Practitioner

Emergency Nursing Nurse Practitioner

Family Nurse Practitioner

Family Planning Nurse Practitioner

Geriatric Nurse Practitioner

Neonatal Nurse Practitioner

Nurse Practitioner (No Specialty)

Obstetrical and/or Gynecological and/or Women’s Health Nurse Practitioner

Psychiatric and/or Mental Health Nurse Practitioners (Include all subspecialties)

School Health Nurse Practitioners

Certified Registered Nurse Anesthetist (CRNA)

An advanced practice registered nurse (APRN) who has usually completed a DNP or MSN program and is board certified in anesthesia.

ROLE OF CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)

A CRNA is prepared to provide the full spectrum of patient’s anesthesia care and anesthesia-related care to individuals across the lifespan, whose health status range from healthy to all recognized level of acuity (includes patient with immediate, severe, or life threatening illnesses or injury)

Care is provided in diverse settings including hospital surgical suites; obstetrical delivery rooms; critical access hospitals; acute care; pain management centers; ambulatory surgical centers; and the offices of dentists, podiatrists, ophthalmologists and plastic surgeons.

Certified Nurse Midwife (CNM)

An advanced practice registered nurse (APRN) who has usually completed a DNP or MSN program and is board certified in midwifery. CNMs specialize in care of the women who are not experienced high risk pregnancies.

ROLE OF CERTIFIED NURSE MIDWIFE (CNM)

A CNM provides a full range of primary health care services to women throughout the lifespan, including gynecologic care, family planning services, preconception care, prenatal and postpartum care, child birth, and care of a newborn.

CNM practice includes treating the male partner of their female clients for sexually transmitted disease and reproductive health. This care is provided in diverse settings, including private offices, and community and public health clinics.

Clinical Nurse Specialist (CNS)

An APRN who usually has completed DNP or MSN program in selected field of nursing leading to board certification as a CNS. CNSs provide specialized care and are responsible for diagnosis and treatment of health, as well as the delivery of evidence based nursing interventions.

Types of Clinical Nurse Specialist

Clinical Specialist in Gerontological Nursing

Clinical Specialist in Medical Surgical Nursing

Clinical Specialist in Pediatric Nursing

Clinical Specialist in Adult Psychiatric and Mental Health Nursing

Clinical Specialist in Child and Adolescent Psychiatric and MHN

Clinical Specialist in Community/Public Health Nursing

Advanced Diabetic Management – Clinical Specialist

ROLE OF CLINICAL NURSE SPECIALIST (CNS)

A CNS is a unique APRN role that integrates care across the continuum and through three spheres of influence: patient, nurse and system. The three spheres are overlapping and interrelated, but each sphere possesses distinctive focus.

The main goal of CNS is continuous improvement of patient outcomes and nursing care.

Key elements of CNS practice are caring, evidence-based practices to alleviate patient distress; and facilitate ethical decision making.

 A CNS is responsible and accountable for diagnosis and treatment of health/illness states, disease management, health promotion, and prevention of illness and risk behavior among individuals, families, groups and communities.

What is the Difference between the APRN and Nurse Practitioner??

APRN mean Advanced Practice Registered Nurse and consist of four roles – Nurse Practitioner, Clinical Nurse Specialist, Certified Nurse Midwife and Certified Registered Nurse Anesthetists. Nurse Practitioner is one among of the other roles of APRN.

List of Nursing Education Programs in US

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In this article, we summarize nursing education programs in USA – List of Programs, Scope and Functions, Course Duration, Mobility Programs (Accelerated Nursing Programs), Supported Nursing Programs, Accreditation in Nursing Education.

NURSING EDUCATION PROGRAMS

1. Practical Nursing Education

2. Diploma Schools – BSN (Bachelor’s of Science in Nursing) and ADN (Associate Degree in Nursing)

3. Post Graduate Education – Master’s Degree and CNL (Clinical Nurse Leader)

Doctorate of Education – PhD (Doctorate of Nursing practice), DNSc (Doctorate of Nursing Science) and ND (Nursing Doctorate) and DNP (Doctorate of Nursing Practice).

PRACTICAL NURSING PROGRAM

This is the oldest form of education given to nurses to train and practice for nurses in hospital, reason for this in older times, there are untrained or poorly trained practical nurse. Presently, Practical Nurse has good basic skills. Practical /Vocational nursing students can learn basic skills of nursing.

After licensing, practical nurse (LPN/LVN) can perform complex nursing duties.

Practical Nurse – Scope and Role

  • Practiced nurses are licensed to practice as (LPN) Licensed Practical Nurse and (LVN) – Licensed Vocational Nurses. They can work under the supervision of registered nurse.
  • Responsible for stable patients and patients with common health conditions
  • Responsible for collecting and reporting abnormal data, offering suggestion for developing and changing nursing care
  • Provide bed side care, teaching health maintenance; participate with healthcare team in evaluating nursing care.

About Practical Nurse Programs

Practical Nurse programs are offered in community colleges. Mostly programs are 12 – 18 months in length. After completion of course, graduate can complete state nursing exam (National Council Licensure Examination for Practical Nurse NCLEX –PN) to be registered as practical nurse. Practical nurses can pursue advanced nursing education after LPN/LVN. They can work as practical nurse and can continue further education. They are employed in long term care facilities, clinics, hospitals and home health care. Practical Nurses has huge demand as there is rising elderly populations, they can work in in-home medical technologies and home health.

DIPLOMA NURSING EDUCATION

Diploma nursing program is also known as Hospital Nursing. In 1909, Dr. Beard introduced nursing program at University of Minnesota. Presently, Diploma nursing program has short length of time. This program is offered in colleges and Universities, they offer students to obtain associate and Baccalaureate Degrees.

Students with diploma nursing degree can be competent in research, leadership and critical thinking.

Associate Degree Nursing Education (ADN)

This program is started because of shortage of nurses in health care sector and to increase number of nurses. This is 2 year course program in nursing and course offered in community colleges affiliated to Universities.

Associate Degree Program nurse’s can acquire enough nursing skills and judgment to provide nursing care but not like Baccalaureate Prepared Nurses.

After Associate degree, students can do Baccalaureate Degree and later they can carry out higher degree in nursing.  

Associate Degree Program – ADN and ASN (Associate Degree in Science) is the easiest way to become Registered Nurse (RN).

Nurse’s role is advocacy, leadership, professional involvement, lifelong learning and evidence based practice.

BACCALAUREATE NURSING EDUCATION (BSN)

This program is offered in Universities to train nurse as skilled practitioners. Objective of this program is to give quality patient care. The course duration is 3 years, it is offered as part time and full time study.

GRADUATE NURSE EDUCATION

After BSN, nurse can pursue master’s degree in nursing; they can choose specialty roles such as pediatrics, infection control, midwifery, anesthesia, public health and nursing education.

Their role is to carried nursing practice and can do research, teaching, administration and clinical areas of nursing practice.

Clinical Nurse Leader (CNL)

CNL can develop methods for improving patient outcomes, coordinate evident based practice, and promote client self care and client decision making.

DOCTORAL EDUCATION

Doctoral education includes DNSc (Doctor of Nursing Science), PhD (Doctor of Philosophy in Nursing), ND and DNP (Doctorate of Nursing Practice).  After Doctorate, nurse can play important role in administrative and teaching and they can conduct research and form nursing theories.

DNSc is Clinical Doctorate and can do clinical practice which is equivalent to PhD. PhD is about research and practice oriented and can conduct research and develop theories.

After DNP (Doctorate of Nursing Practice), nurses can carried out advanced nursing practice and advanced preparation in clinical practice. Their role is to provide and work in advanced preparation in scientific foundation of nursing practice, leadership, evidence based practice, healthcare technologies, healthcare policy, inter professional c0llaboration, clinical prevention, population based health care and advanced nursing practice in specialty areas.

PhD, DNS and DNSc Degree – Research Focused

DNP Degree – Practice Doctorate oriented.

MOBILITY PROGRAMS

Mobility program help nurses to do transition from one nursing degree to other more advanced nursing degree.

Transition of Nursing Programs

LPN – RN, RN – BSN, RN – MSN, BSN – PhD mobility programs.

RN – BSN or RN – MSN Degree programs enable Registered nurse who had in Diploma in Nursing or ADN (ASN) Degree to pursue either BSN or MSN Degree and receive credit for the previous coursework.

Non Nursing Baccalaureate Degree holder can do BSN program. The course period is about 12 – 18 months. (Second Degree, Fast Track or Accelerated Nursing Programs).

Non Nursing Baccalaureate Degree can also take MSN program.

Continuing Education Programs

Most nurses wish to do continuing education programs which result in gaining specialized credentials, certification or continuing education credits.

This program helps nurse to carry out advanced nursing practice. Some of the programs are certified in diabetic education, critical care or wound and ostomy care.

Nurses can obtain continuing education by attending conference or completing online courses or independent studies on particular topics which is relevant to their area of practice.

SUPPORTING MOBILITY PROGRAMS

Distance education technologies are the way for nurses to get advanced education.

Associate Degree RN – Baccalaureate Program

Nurses who did associate degree RN can attend community college to pursue baccalaureate degree, they can work as RN and complete online Baccalaureate course or take program at nearby college or University (or) can do master degree in nursing and can enroll in RN-MSN program.

List of Nursing Programs in US

ACCREDITATION IN NURSING EDUCATION IN USA

Accreditation – A process by which an institution’s (e.g. School of Nursing’s) programs, policies and practices are reviewed by external accrediting body to determine whether professional standards are being met.

National League for Nursing Accrediting Commission (NLNAC) – NLNAC affiliated with National League for Nursing, this commission is an accrediting body for all types of nursing education programs.

Commission on Collegiate Nursing Education (CCNE) – CCNE affiliated with the American Association of Colleges of Nursing, this commission is an accrediting body for Baccalaureate and higher degree nursing education programs.

Structure of Nursing Education

USA Model of Nursing Education works from US Department of Education – Accreditation Body (NLNAC and CCNE), State Board of Nursing – School of Nursing’s.

US Department of Education – Apex Body of US Education

Accreditation Body – National League for Nursing Accrediting Commission (NLNAC) affiliated with National League for Nursing (NLM) and Commission Collegiate Nursing Education (CCNE) affiliated with the American Associated of Colleges of Nursing (ASSCN).

Accreditation Body – State Board of Nursing

School of Nursing is accredited by NLNAC OR CCNE and State Board of Nursing. Both NLNAC and CCNE approved by U.S. Department of Education.

NLNAC accredits all programs of nursing and CCNE can accredit to BSN, MSN and DNP programs.

NOTE TO NURSING STUDENTS

If students going to enroll in nursing program in nursing schools or colleges, look for schools or colleges which is accredited by NLNAC, CCNE Body and State Board of Nursing. If Nursing School has no accreditation, students will be denied to access to scholarship/grants or admission to graduate programs (if nurses are not in graduates of professionally accredited School).

CURRICULUM AND INSTRUCTION IN NURSING EDUCATION

Central to Education is Curriculum and Instruction.

Curriculum – The overall structure of nursing education programs that reflect schools mission and philosophy course of study and program evaluation methods.

Instruction – The teaching and learning strategies and experiences faculty and students engage in to achieve the elements of curriculum.

MAIN TOPICS IN NURSING EDUCATION

Patient Safety

Cultural Competence

Gerontology

Evidence Based Practice

Technology and Informatics

Interpersonal Education

MAIN METHODS IN NURSING EDUCATION

New Pedagogies

Critical Thinking

Distance Education

Simulation

Complete List of State Nursing Board in US – OVERVIEW

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​OVERVIEW OF STATE NURSING BOARD

Every nurses need to aware of state board irrespective of country. State Nursing Board is to regulate safe nursing practice for nurses and give information about nursing programs approval, licensure and nursing enforcement. If nurses have problem with profession and other, they can lodge complaint to nursing board, board will take an action.

Objective of State Nursing Board in USA

1. Regulate safe nursing practice.

2. Give nursing programs approval

3. Give licensure(verification and renewal) to practice nursing in particular state

4. Conduct examination to certify nurse to work in particular state

5. Board frame rules and regulation (Practice Act)

Texas State Board of Nursing

Texas Board of Nursing is established in 1909, serving public for almost 100 years. There are around 350,000 licensed nurses currently practicing in Texas State. Board issues license to more than 27,000 nurses by examination and provide 200 nursing program approvals.

Licensure Programs

Six-month Temporary Permit (used to attend Refresher Programs, Extensive Orientations or Nursing Academic Courses)

 Temporary Licenses (LVN and RN)

 Licensed Vocational Nurses

 Registered Nurses

 Advanced Practice Registered Nurses

 Graduate Nurse and Graduate Vocational Nurse Permits

SERVICES

TIMELY RENEWAL

RELINQUENT RENEWAL

REACTIVATION RENEWAL.

LICENSURE EXAMINATION INFORMATION

https://www.bon.texas.gov/licensure_examination.asp

VERIFY LICENSE

https://www.bon.texas.gov/licensure_verification.asp

RENEW LICENSE

https://www.bon.texas.gov/licensure_renewal.asp

CHECK APPLICATION STATUS FOR LICENSURE

https://www.bon.texas.gov/forms/applstatus.asp

ONLINE SERVICES

https://www.bon.texas.gov/online_services.asp

CNC COURSE CATALOG

https://www.bon.texas.gov/catalog/

OFFICIAL SITE FOR TEXAS BOARD OF NURSING

https://www.bon.texas.gov/

PHYSICAL ADDRESS

Texas Board of Nursing

William P. Hobby Building

333 Guadalupe, Suite 3-460

Austin, TX 78701-3944

CALIFORNIA BOARD OF REGISTERED NURSING

California board of registered nursing is a state owned agency to protect the public by regulating the safe practice of registered nurses.

SERVICES

Applicant services,

Licensure services,

Enforcement program,

Nursing Education Consultant

Information for Applicant

License and Certificate Renewal

License Verification

Nursing Practice

Nursing Programs and Education

Careers in Nursing

OFFICIAL SITE 

 https://www.rn.ca.gov/index.shtml

Physical Address

Board of Registered Nursing
1747 N. Market Blvd., Suite 150
Sacramento, CA 95834-1924

Mailing Address

Board of Registered Nursing
PO Box 944210
Sacramento, CA 94244-2100

FLORIDA BOARD OF NURSING

SERVICES

LICENSURE,

RENEWAL

EXAMINATION

LICENSURE

CERTIFIED NURSING ASSISTANT (CNA),

LICENSED PRACTICAL NURSE (LPN),

REGISTERED NURSE (RN),

ADVANCED REGISTERED NURSE PRACTITIONER (ARNP), NURSING ASSISTANT TRAINING PROGRAM,

PRACTICAL AND REGISTERED NURSE EDUCATION PROGRAM

OFFICIAL SITE 

https://floridasnursing.gov/licensing/

CONTACT INFORMATION 

Mailing Address:
Department of Health
Board of Nursing
4052 Bald Cypress Way Bin C-02
Tallahassee, FL 32399-3252

MARYLAND BOARD OF NURSING

Official Site

https://mbon.maryland.gov/Pages/default.aspx

SERVICES

Licensure

Renewal

Examination

LICENSURE 

https://mbon.maryland.gov/Pages/licensing-index.aspx

PHYSICAL ADDRESS

MARYLAND BOARD OF NURSING,

4140 Patterson Avenue 

Baltimore, Maryland, 21215-2254

ALABAMA STATE BOARD OF NURSING

SERVICES

Licensure 

Examination 

Endorsement or Reinstatement

OFFICIAL SITE

 https://www.abn.alabama.gov/

CONTACT INFORMATION

ALABAMA BOARD OF NURSING
RSA PLAZA, SUITE 250, 
770 Washington Ave.,
Montgomery, AL 36104

Mailing Address

Alabama Board of Nursing
P.O. Box 303900
Montgomery, AL 36130-3900

GEORGIA BOARD OF NURSING

SERVICES 

Licensure 

Education

OFFICIAL SITE

 http://sos.ga.gov/index.php/licensing/plb/45

CONTACT INFORMATION 

GEORGIA BOARD OF NURSING

214 State Capitol

Atlanta, Georgia 30334

VIRGINIA BOARD OF NURSING

SERVICES 

Licensure (Submit, Renewal and Endorsement or Reinstatement)

Education  

EDUCATION 

Practical Nurse (PN) Pre-Licensure Nursing Program

Registered Nurse (RN) Pre-Licensure Nursing Program

OFFICIAL SITE

 https://www.dhp.virginia.gov/nursing/

CONTACT INFORMATION

Virginia Department of Health Professions
Perimeter Center 
9960 Mayland Drive, Suite 300
Henrico, Virginia 23233-1463

CONTACT

https://www.dhp.virginia.gov/About/contact.htm

NORTH CAROLINA BOARD OF NURSING

SERVICES

Licensure (Submit, Renewal and Endorsement or Reinstatement)

OFFICIAL SITE

https://www.ncbon.com/

MAILING ADDRESS
North Carolina Board of Nursing
P.O. Box 2129
Raleigh, NC 27602-2129

PHYSICAL ADDRESS
North Carolina Board of Nursing
4516 Lake Boone Trail
Raleigh, NC 27607

MINNESOTA BOARD OF NURSING

SERVICES

RN and LPN Licensure (Submit, Renewal and Endorsement or Reinstatement)

Education

EDUCATION OR PROGRAMS

Advanced Practice Nursing Programs

Approved Practical Nursing Programs

Approved Professional Nursing Programs

LICENSURE

https://mn.gov/boards/nursing/licensure/

EDUCATION

https://mn.gov/boards/nursing/education/

OFFICIAL SITE

https://mn.gov/boards/nursing/

CONTACT INFORMATION

Minnesota Board of Nursing 
2829 University Ave SE Suite 200 
Minneapolis, MN 55414 
Phone: 612-317-3000 
Fax: 612-617-2190 
Email: Nursing.Board@state.mn.us

OKLAHOMA BOARD OF NURSING

SERVICES

Licensure (Registration, Renewal, Verification, Endorsement or Reinstatement)

LICENSE REGISTRATION

https://pay.apps.ok.gov/nursing/licensing/app/index.php

LICENSE RENEWAL

https://pay.apps.ok.gov/nursing/renewal/index.php

LICENSE VERIFICATION

https://apps.ok.gov/nursing/verify/index.php

OFFICIAL SITE

https://nursing.ok.gov/

CONTACT INFORMATION

Oklahoma Board of Nursing 
2915 N Classen, Ste. 524 
OKC, OK   73106 
TEL: 405.962.1800 FAX: 405.962.1821

ARIZONA BOARD OF NURSING

SERVICES

License (Registration, Renewal and Verification)

OFFICIAL SITE

https://www.azbn.gov/

CONTACT INFORMATION

Arizona State Board of Nursing
1740 W Adams Street, Suite 2000
Phoenix, AZ 85007

https://www.azbn.gov/board/contact/contact-us

KENTUCKY BOARD OF NURSING

SERVICES

Licensure (Registration, Renewal and Nurse Licensure Compact (NLC)

Education

OFFICIAL SITE

https://kbn.ky.gov/Pages/default.aspx

CONTACT INFORMATION

https://secure.kentucky.gov/formservices/Nursing/Contact

TENNESSEE BOARD OF NURSING

SERVICES

Licensure (Registration)

OFFICIAL SITE

https://www.tn.gov/health/health-program-areas/health-professional-boards/nursing-board/nursing-board/about.html

CONTACT INFORMATION

Tennessee Board of Nursing
665 Mainstream Drive, 2nd Floor
Nashville, TN 37243

NEW JERSEY BOARD OF NURSING

SERVICES

Licensure (Examination, Endorsement and Reinstatement)

Duplicate License, Temporary License and Reactivation License

EDUCATION

Advanced Nursing Practice Certification

OFFICIAL SITE

https://www.njconsumeraffairs.gov/nur/Pages/applications.aspx

CONTACT INFORMATION

New Jersey Board of Nursing

124 Halsey Street 
Newark, New Jersey 07102 

PENNSYLVANIA (PA) STATE BOARD OF NURSING

SERVICES

Licensure (Registration, Renewal and Verification)

OFFICIAL SITE

https://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Nursing/Pages/default.aspx

CONTACT INFORMATION

Mailing Address

State Board of Nursing

P.O. Box 2649, Harrisburg, PA 17105-2649

Physical Address

One Penn Center, 2601 N. 3rd Street

Harrisburg, PA 17110

NEVADA STATE BOARD OF NURSING

SERVICES

Licensure

Certification

OFFICIAL SITE

http://nevadanursingboard.org/

CONTACT INFORMATION

Nevada State Board of Nursing
Las Vegas Office
4220 S. Maryland Pkwy., Building B, Suite 300
Las Vegas, NV 89119-7533 
(702) 486-5800
(888) 590-6726 (toll free)
(702) 486-5803 – General Fax line
nursingboard@nsbn.state.nv.us

Reno Office
5011 Meadowood Mall Way, Suite 300
Reno, NV 89502-6547 
(775) 687-7700
(888) 590-6726 (toll free)
(775) 687-7707   – General Fax line
(775) 687-7729  – Compliance Department Fax line
nursingboard@nsbn.state.nv.us

NEW MEXICO STATE BOARD OF NURSING

SERVICES

Licensure (Registration, Renewal, Verification and Endorsement)

EDUCATION

Approval and Accreditation

OFFICIAL SITE

http://nmbon.sks.com/

CONTACT INFORMATION

New Mexico State Board of Nursing

#710,

6301 Indian School Rd NE,

Albuquerque, NM 87110

LOUISIANA STATE BOARD OF NURSING

SERVICES

Licensure (Registration, Renewal, Verification)

EDUCATION

Advanced Practice Student/Applicant

OFFICIAL SITE

https://www.lsbn.state.la.us/

SOUTH CAROLINA STATE BOARD OF NURSING (SC BOARD)

SERVICES

LICENSURE (REGISTRATION, RENEWAL AND VERIFICATION)

ONLINE NURSING COURSES

OFFICIAL SITE 

https://www.llr.sc.gov/POL/Nursing/

CONTACT INFORMATION

Synergy Business Park; Kingstree Building 
110 Centerview Dr.
Columbia, S.C. 29210

OHIO STATE BOARD OF NURSING

SERVICES

Licensure (Registration, Renewal and Verification)

Education

OFFICIAL SITE

http://www.nursing.ohio.gov/

CONTACT INFORMATION 

Location

17 South High Street, Suite 400
Columbus, OH 43215-3413

Mailing Address

17 South High Street, Suite 400
Columbus, OH 43215-3413

MISSOURI STATE BOARD OF NURSING

SERVICES

Licensure (Advanced, General, LPN and RN)

EDUCATION

IV Therapy Certification Courses

OFFICIAL SITE

https://www.pr.mo.gov/nursing.asp

CONTACT INFORMATION

MISSOURI STATE Board of Nursing
3605 Missouri Boulevard
P.O. Box 656
Jefferson City, MO  65102-0656
573.751.0681 Telephone
573.751.0075 Fax
800.735.2966 TTY
800.735.2466 Voice Relay
nursing@pr.mo.gov

West Virginia Board of Nursing (West Virginia RN Board)

SERVICES

LICENSURE (Registered Nurse and APRN License)

EDUCATION

Continuing Education Providers

OFFICIAL SITE

https://wvrnboard.wv.gov/Pages/default.aspx

CONTACT INFORMATION

West Virginia Board of Examiners

for Registered Professional Nurses 

90 MacCorkle Ave. SW, Suite 203

South Charleston, WV 25303 

Phone: (304) 744-0900 or 1-877-743-NURS(6877) 

Fax: (304) 744-0600 

Web Address: www.wvrnboard.wv.gov

Email: rnboard@wv.gov

IOWA STATE BOARD OF NURSING

SERVICES

Licensure (Endorsement, Duplicate Card or Certificate)

APRN Licensure

OFFICIAL SITE

https://nursing.iowa.gov/

CONTACT INFORMATION

Iowa Board of Nursing
400 SW 8th Street
Suite B
Des Moines, IA  50309

Phone: 515.281.3255
Fax: 515.281.4825

MASSACHUSETTS BOARD OF NURSING

SERVICES

Licensure (Registration (APRN), Renewal and Removal)

OFFICIAL SITE

https://www.mass.gov/orgs/board-of-registration-in-nursing

CONTACT INFORMATION

Massachusetts Board of Nursing
239 Causeway St.,

Suite 500, 5th Floor,

Boston, MA 02114

MISSISSIPPI STATE BOARD OF NURSING

SERVICES

Licensure (APRN, RN, LPN and Nurse Licensure Compact)

OFFICIAL SITE

http://www.msbn.ms.gov/Pages/Home.aspx

CONTACT INFORMATION 

MISSISSIPPI STATE BOARD OF NURSING

713 Pear Orchard Road, Suite 300,

Ridgeland, MS 39157.

NEW YORK STATE BOARD OF NURSING

SERVICES

Licensure (RN, LPN, Nurse Practitioner and Clinical Nurse Specialist)

EDUCATION

Infection Control Training (RNs and LPNs)

Nursing Programs

Child Abuse Training (RNs)

OFFICIAL SITE

http://www.op.nysed.gov/prof/nurse/

CONTACT INFORMATION

NY State Education Department
Office of the Professions
Division of Professional Licensing Services
Nurse Unit
89 Washington Avenue
Albany, New York 12234-1000
518-474-3817, Press 1 then ext. 280 (voice) 
518-474-3398 (fax)

OREGON STATE BOARD OF NURSING

SERVICES

Licensure/Certificate (Renewal)

RN/LPN Licensure

Advanced Practice Licensure

OFFICIAL SITE

https://www.oregon.gov/OSBN/pages/index.aspx

CONTACT INFORMATION

Oregon State Board of Nursing 
17938 SW Upper Boones Ferry Rd. 
Portland, Oregon 97224-7012 

KANSAS STATE BOARD OF NURSING

SERVICES

Licensure (Verification)

EDUCATION

Pre-licensure Undergraduate Nursing Programs

Graduate Nursing Programs

MHT

OFFICIAL SITE

https://ksbn.kansas.gov/

CONTACT INFORMATION 

KANSAS STATE BOARD OF NURSING
Landon State Office Building
900 SW Jackson Street
Suite 1051
Topeka, Kansas 66612-1230

Main: 785-296-4929
Fax: 785-296-3929

COLORADO STATE BOARD OF NURSING

SERVICES

Licensure (Renewal, Verification)

EDUCATION

Approved Education and Accreditation (Nurse Degree Programs)

OFFICIAL SITE

https://www.colorado.gov/pacific/dora/Nursing
 

CONTACT INFORMATION

Colorado Board of Nursing
1560 Broadway, Suite 1350

Denver, CO 80202

Phone: 303-894-2430 | Fax: 303-894-2821

WYOMING STATE BOARD OF NURSING

SERVICES

Licensure (Advanced Practice Nurse, Registered Nurse, Licensed Practical Nurse and Certified Nursing Assistant)

Licensure (Registration and Renewal)

EDUCATION

Pre-Licensure Distance Education Nursing Program Approval

LPN IV Courses

Certified Nursing Assistants

Continuing Nursing Education Courses

OFFICIAL SITE

https://nursing-online.state.wy.us/

CONTACT INFORMATION

WYOMING STATE BOARD OF NURSING

130 Hobbs Ave, Ste B, Cheyenne,

WY 82002 – (307) 777-7601 / FAX (307) 777-3519

WASHINGTON STATE BOARD OF NURSING

SERVICES

Licensure (APRN, LPN, Nursing Technician and (RN) Registered Nurse)

Licensure (Renewal)

OFFICIAL SITE

https://www.doh.wa.gov/LicensesPermitsandCertificates/NursingCommission/NurseLicensing

CONTACT INFORMATION

Washington State Department of Health

Kent Regional Office

20425 72nd Avenue South, Building 2, Suite 310

Kent, WA 98032

Washington State Department of Health

River View Corporate Center, Suite 1500

16201 East Indiana Avenue

Spokane Valley, WA 99216 

HAWAII STATE BOARD OF NURSING

SERVICES

Licensure (Licensed Practical Nurse, Registered Nurse, Advanced Practice Registered Nurse)

Licensure (Verification)

EDUCATION

Nursing Programs

OFFICIAL SITE

http://cca.hawaii.gov/pvl/boards/nursing/

CONTACT INFORMATION

Hawaii State Board of Nursing

DCCA-PVL P.O. Box 3469 Honolulu, HI 96801

MICHIGAN STATE BOARD OF NURSING

SERVICES

Licensure (Verification)

EDUCATION

Nursing Approved Programs

OFFICIAL SITE

https://www.michigan.gov/lara/0,4601,7-154-72600_72603_27529_27542—,00.html

Illinois State Board of Nursing

SERVICES

Licensure (APN, LPN and RN)

OFFICIAL SITE

https://www.idfpr.com/profs/Nursing.asp#collapse09

CONTACT INFORMATION

Illinois State Board of Nursing

James R. Thompson Center,

100 West Randolph Street,

Suite 9-300
Chicago, IL 60601

ALASKA STATE BOARD OF NURSING

SERVICES​

Licensure (Renewal and Verification)

OFFICIAL SITE

https://www.commerce.alaska.gov/web/cbpl/professionallicensing/boardofnursing.aspx

CONTACT INFORMATION

ALASKA STATE BOARD OF NURSING
550 W 7th AVE, STE 1500
Anchorage, AK 99501-3567

Phone: (907) 269-8160
Fax: (907) 269-8156
Investigations Fax: (907) 269-8195

WISCONSIN STATE BOARD OF NURSING

OFFICIAL SITE

https://dsps.wi.gov/pages/BoardsCouncils/Nursing/Default.aspx

CONTACT INFORMATION

4822 Madison Yards Way

Madison, WI 53705

CONNECTICUT STATE BOARD OF NURSING

SERVICES

Licensure and Examination

OFFICIAL SITE

https://portal.ct.gov/DPH/Public-Health-Hearing-Office/Board-of-Examiners-for-Nursing/Board-of-Examiners-for-Nursing

CONTACT INFORMATION

410 Capitol Avenue, MS #13PHO

P. O. Box 340308

Hartford, CT 06134-0308

INDIANA STATE BOARD OF NURSING

SERVICES

Licensure (RN and LPN)

OFFICIAL SITE 

https://www.in.gov/pla/nursing.htm

UTAH STATE BOARD OF NURSING

SERVICES

Licensure (Registration and Verification)

Licensure

OFFICIAL SITE

https://dopl.utah.gov/nur/index.html

MAINE STATE BOARD OF NURSING

SERVICES

Licensure (Registration and Verification)

OFFICIAL SITE

https://www.maine.gov/boardofnursing/

CONTACT INFORMATION

MAILING ADDRESS

Maine State Board of Nursing
158 SHS
Augusta, Maine 04333-0138

PHYSICAL ADDRESS

Maine State Board of Nursing
161 Capitol Street
Augusta, Maine 04333

TELEPHONE NUMBER: 207-287-1133

MONTANA STATE BOARD OF NURSING

SERVICES

Licensure (RN, LPN AND APRNs)

Nurse Licensure Compact

OFFICIAL SITE

http://boards.bsd.dli.mt.gov/nur

ARKANSAS STATE BOARD OF NURSING

SERVICES

Licensure (Temporary Permits and Renewal)

OFFICIAL SITE

https://www.arsbn.org/

CONTACT INFORMATION

Arkansas State Board of Nursing
University Tower Bldg.
1123 South University
Suite 800
Little Rock, AR 72204-1619

DELAWARE STATE BOARD OF NURSING

SERVICES

Licensure (RN AND LPN – EXAMINATION AND ENDORSEMENT)

OFFICIAL SITE

https://dpr.delaware.gov/boards/nursing/

CONTACT INFORMATION

Cannon Building,
Suite 203
861 Silver Lake Blvd.
Dover, DE 19904

IDAHO STATE BOARD OF NURSING

SERVICES

Licensure – (LPN, RN – Renewal and Reinstatement)

Nurse Licensure Compact)

OFFICIAL SITE

https://ibn.idaho.gov/IBNPortal/

CONTACT INFORMATION

Idaho Board of Nursing
PO Box 83720

280 N 8th Street, Suite 210
Boise, Idaho 83720-0061

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NEW HAMPSHIRE STATE BOARD OF NURSING

SERVICES

Licensure (APRN and Nursing Assistant)

Certification

OFFICIAL SITE

https://www.oplc.nh.gov/nursing/

RHODE ISLAND STATE BOARD OF NURSING

SERVICES

Licensure

OFFICIAL SITE

http://health.ri.gov/licenses/detail.php?id=231

CONTACT INFORMATION

DEPARTMENT OF HEALTH

3 CAPITOL HILL

PROVIDENCE, RI 02908

VERMONT STATE BOARD OF NURSING

SERVICES

Licensure (RN, LPN, LNA)

OFFICIAL SITE

https://www.sec.state.vt.us/professional-regulation/list-of-professions/nursing.aspx

CONTACT INFORMATION

Director

89 Main St, 3rd Floor

Montpelier VT 05620-3402

SOUTH DAKOTA STATE BOARD OF NURSING

SERVICES

Licensure (Registration, Renewal and Verification)

Nurse Licensure Compact (NLC)

OFFICIAL SITE

https://doh.sd.gov/boards/nursing/

CONTACT INFORMATION

4305 South Louise Ave Suite 201
Sioux Falls SD 57106-3315
Tel: (605) 362-2760
Fax: (605) 362-2768

NORTH DAKOTA STATE BOARD OF NURSING

PHONE: 701.328.9777

CONTACT INFORMATION

919 South 7th Street, Suite 504
Bismarck, ND 58504

US State Board of Nursing

 

CERTIFIED NURSE PRACTITIONER REQUIREMENTS and SCOPE OF PRACTICE

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APRN (Advanced Practice Registered Nurse)

APRN is the common title gives to an individual licensed to practice advanced practice registered nursing in one of the following roles: Certified Nurse Practitioner (CNP), Certified Registered Nurse Anesthetist (CRNA), Certified Nurse-Midwife (CNM) and Clinical Nurse Specialist (CNS).

NURSE PRACTITIONERS

Nurse Practitioners are Registered Nurses who have met additional nursing education, experience and exam requirement set by the College. The person who registered with college can call themselves as “Nurse Practitioner” or “NP”

COMMON NAMES or INITIAL FOR NURSE PRACTITIONER

CRNP – Certified Registered Nurse Practitioner

CANP – Certified Advanced Nurse Practitioner

ANP-C – Advanced Nurse Practitioner-Certified

CPNP- Certified Pediatric Nurse Practitioner

CANP – Certified Adult Nurse Practitioner

APRN – Advanced Practice Registered Nurse

Scope of Nurse Practitioners or NP

NPs are authorized to diagnose, order and interpret diagnostic tests , and prescribe medications and other treatment of clients.

NP practice includes health promotion with the aim of optimizing the health of people, families, communities and populations. When NP work with diverse client populations, they can work in different practice settings such as acute care, primary care, rehabilitative care, curative care and supportive care, and palliative/end-of-life care.

The College registers NPs with one or more of the following specialty certificates:

Nurse Practitioners – Primary Health Care (NP-PHC)

Nurse Practitioners –Pediatrics (NP-Pediatrics)

Nurse Practitioners-Adult (NP-Adult)

Each specialty certificate refers to a specific client population and not a clinical area or a practice sector. The college does not the clinical areas or practice sector in which NPs work.

List of Activities of Nurse Practitioners in Clinical Settings

Health Assessments

NPs integrate an evidence-informed knowledge

base with advanced assessment skills to obtain the

information necessary for identifying client diagnoses,

strengths and needs.

Diagnosis

NPs are engaged in the diagnostic process and develop

differential diagnoses through identification, analysis,

and interpretation of findings from a variety of sources.

Therapeutic Management

NPs, on the basis of assessment and diagnosis, formulate

the most appropriate plan of care for the client and

implement evidence-informed therapeutic interventions

in partnership with the client to optimize health.

Collaboration, Consultation and Referral

NPs identify when collaboration, consultation

and referral are necessary for safe, competent and

comprehensive client care.

Conflict of Interest

NPs recognize and ethically manage actual, potential

and perceived conflicts of interest.

NURSE PRACTITIONER –  WORK 

APRN can serve as primary or acute care provider and functions in a population focus. Population focus includes

1. Family/Individual across the lifespan

2. Adult –gerontology

3. Neonatal

4. Pediatrics

5. Women’s Health/gender-related

6. Psychiatric/Mental Health

Certified Nurse Practitioner Requirements and scope

APRN – SCOPE OF PRACTICE

In addition to the RN scope of practice and APRN role and population focus, APRN scope of practice includes

1. Conducting an advanced assessment

2. Ordering and interpreting diagnostic procedures

3. Establishing primary and differential diagnoses

4. Prescribing, ordering, administering, dispensing and furnishing therapeutic measures

5. Delegating and assigning therapeutic measures to assistive personnel

6. Consulting with other disciplines and providing referrals to health care agencies, health care providers and community resources.

7. Wearing identification which clearly identifies the nurse as an APRN when providing direct patient care.

8. Nurse practitioners require education and training consistent with professional standards and commensurate with the APRN’s education, certification, demonstrated competencies and experience.

APRNs are licensed independent practitioners within standards established or recognized by the Board of Nursing (BON). Each APRN is accountable to patients, the nursing profession and the Board of Nursing for

a. Complying with the requirements of this Act and the quality of advanced nursing care rendered.
Recognizing limits of knowledge and experience.

b. Planning for the management of situations beyond the APRNs expertise and
Consulting with or referring patients to other health care providers as appropriate.

NURSE PRACTITONERS or APRN REQUIREMENTS

The Board of Nursing shall by administrative rules, set standard for the establishment and outcomes of APRN education programs, including clinical learning experiences, and approve such programs that meet the requirements of the ACT and BON rules.

Common Requirements for NPs

Master Degree in Nursing or Doctorate

RN License certified by National Certifying Agency

Certification

Continuing  Education

All NPs are RNs with education beyond the basic requirement for RN licensure. Many NPs (Nurse Practitioners) has master’s degree and some has Doctorates. To be NPs, nurse practitioners should have masters in 24 states of United States.

Requirements to become NPs will differ according to state level qualifications. In Alaska, NPs must have completed a one year academic course, have an RN license, be certified by a national certifying agency and 30 hours of continuing education every 2 years.

In Pennsylvania, NPs must have an RN license, a master’s degree, certification by national organization, must provide evidence of continuing competence in medical diagnosis and therapeutics – 30 hours of continuing education per year and 45 hours of advanced pharmacology.

In 35 states, the NPs require taking and passing a national certification exam and especially adult and pediatric NPs require a master’s degree to sit for national certification exam.

Certified Registered Nurse Anesthetist (CRNA) Salary in Healthcare Industry

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Nurse Anesthetist (CRNA) – USA 

Nurse Anesthetist administer anesthesia, monitor patient’s vital signs, and oversee the patient’s recovery from anesthesia. Nurse may assist anesthesiologist, surgeons, and other physicians or dentists.

There is around 42,620 nurse’s work as Nurse Anesthetist, annual wage is $169,450 in United States.

Percentile Salary for Nurse Anesthetist (Per Annum)

10% of Nurse Anesthetist earn – $110,520

25% of Nurse Anesthetist earn – $140,750

50% of Nurse Anesthetist earn – $165,120

75% of Nurse Anesthetist earn – $194,990                                  

Nurse Anesthetist can work in different health industry such as offices of Physicians, General Medical and Surgical Hospitals, Outpatient Care Centers, Offices of Other Health Practitioners and Colleges, Universities and other Professional Schools.

Certified Registered Nurse Anesthetist (CRNA) Salary in Healthcare Industry

Salary of Nurse Anesthetist – Industry Wise (Per Annum)

Offices of Physicians – $162,430

General Medical and Surgical Hospitals – $184,590

Outpatient Care Centers – $194,440

Offices of Other Health Practitioners – $159,230

Colleges, Universities and Professional Schools – $148,210

Top Paying Industries for Nurse Anesthetist (per Annum) 

Outpatient Care Centers – $194,440

General Medical and Surgical Hospitals – $184,590

Specialty Hospital (Except Psychiatric and Substance Abuse Hospitals) – $178,920

Federal Executive Branch (OES Organization) – $168,580

Offices of Physicians – $162,430

Top Paying States for Nurse Anesthetist (Per Annum)

Montana – $252,460

Wyoming – $250,610

California – $217,230

Oregon – $207,480

Iowa – $198,140

Top Paying Metropolitan Location for Nurse Anesthetist (Per Annum)

San Francisco-Redwood City-South San Francisco, CA Metropolitan Division – $243,390

Providence-Warwick, RI-MA – $238,030

San Diego-Carlsbad, CA – $237,960

Oakland-Hayward-Berkeley, CA Metropolitan Division – $230,290

Spokane-Spokane Valley, WA – $227,700

Vallejo-Fairfield, CA – $223,460

Sacramento-Roseville-Ardan-Arcade, CA – $217,070

Wheeling, WV-OH – $205,250

Akron-OH – $203,790

Toledo, OH – $201,910

Top Salary in Non-Metropolitan Areas for Nurse Anesthetist (Per Annum)

Northeast Iowa nonmetropolitan Area – $288,780

South Central Wisconsin nonmetropolitan Area -$253,240

South Indiana nonmetropolitan Area – $219,660

West Kentucky nonmetropolitan Area – $217,070

Western Wisconsin nonmetropolitan Area – $215,660

Nurse Anesthetists?? Job Profile, Qualification and Salary

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Nurse Anesthetists

Nurse Anesthetists administer anesthesia, monitor’s patient vital sign and oversee patient recovery from anesthesia. They may assist anesthesiologists, surgeons, other physicians, or dentists.

Nurse Anesthetists has different title based on their working environment, education and experience. Some of the job title is

1. Chief Certified Registered Nurse Anesthetist (Chief CRNA),

2. Staff Nurse Anesthetist, Nurse Anesthetist,

3. Senior Certified Registered Nurse Anesthetist (Senior CRNA),

4. Certified Registered Nurse Anesthetist (CRNA),

5. Staff Certified Registered Nurse Anesthetist,

6. Anesthesia Service (Staff CRNA, Anesthesia Service),

7. Chief Nurse Anesthetist,

8. Professor/Nurse Anesthetist,

9. Associate Professor Program Director Nurse Anesthesia,

10. Staff Certified Registered Nurse Anesthetist (Staff CRNA)

United States of America – Nurse Anesthetists

In United States, according to 2016 employment survey, there is 41,800 nurse anesthetists are employed. In 2026, the employment will rise to 48,600. Annually, there are 2,800 jobs are available in United States.

Nurse Anesthetists Salary

In United States, median wages or salary for Nurse Anesthetists is $165,120 per year.  Salary is differed according to the location, for example 10 % location, Nurse Anesthetists, receives $110,560.

25% Location – $140,750 per year

75% Location – $194,990 per year

90% Location – $208,000+ per year

Top paying States for Nurse Anesthetists per Annum

Montana – $252,460

Wyoming – $250,610

California – $217,230

Oregon – $207,480

Iowa – $198,140

States with the highest concentration of jobs for Nurse Anesthetists per annum

South Dakota – $184,810

Tennessee – $147,180

Alabama – $166,950

West Virginia – $186,870

Minnesota – $180,430

Education Qualification

Education Qualification for Nurse Anesthetists is Bachelor Degree or Master Degree or Doctoral (PhD) or Professional Degree.

Minimum education qualification for Nurse Anesthetists is Bachelor degree. Most working environment, master degree or Doctoral (PhD) is preferred.

Nurse Anesthetist - Job Profile, Qualification and Salary

List of Working Place where Nurse Anesthetists can be employed

1. Offices of Physician

2. General medical and surgical hospitals

3. Outpatient care centers

4. Offices of Other Health Practitioners

5. Colleges, Universities and Professional Schools

Nurse Anesthetists, their role in Hospital

  • Implement advanced life support techniques.
  • Select medical equipment for addressing patient needs.
  • Prepare medications or medical solutions.
  • Prepare medical supplies or equipment for use.
  • Administer blood or other fluids intravenously.
  • Administer intravenous medications.
  • Monitor patient conditions during treatments, procedures, or activities.
  • Prescribe medications.
  • Collect medical information from patients, family members, or other medical professionals.
  • Examine patients to assess general physical condition.
  • Record patient medical histories.
  • Treat medical emergencies.
  • Develop medical treatment plans.
  • Process healthcare paperwork.
  • Analyze patient data to determine patient needs or treatment goals.
  • Analyze test data or images to inform diagnosis or treatment.
  • Operate diagnostic imaging equipment.
  • Administer anesthetics or sedatives to control pain.
  • Examine medical instruments or equipment to ensure proper operation.
  • Maintain medical equipment or instruments.
  • Collaborate with healthcare professionals to plan or provide treatment.
  • Operate diagnostic or therapeutic medical instruments or equipment.
  • Administer basic health care or medical treatments.
  • Maintain medical or professional knowledge.
  • Collect biological specimens from patients.
  • Train medical providers.
  • Clean medical equipment or facilities.

US (RN) Registered Nurse’s Salary, Role and Responsibilities

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REGISTERED NURSE (RN) 

Registered Nurse provides and coordinates patient care, educate patient. They provide advice and emotional support to patients and their family members.

SALARY IN UNITED STATES

According to Bureau of Labor Statistics (United States), the median annual salary or wages for Registered nurse $70,000 in May 2017. The lowest earnings of Registered Nurse are $48,690 and highest earnings are more than $104,100.

Top Industries in United States, Registered Nurse’s Salary (annual)

  1. Government – $75,900
  2. Hospitals – state, local and private – $72, 070
  3. Ambulatory Healthcare Services – $66,300
  4. Nursing and Residential Care facilities – $62,320
  5. Educational Services – State, Local and Private – $60,300.

ROLE AND RESPONSBILITIES

  • Assess patients’ conditions
  • Record patients’ medical histories and symptoms
  • Observe patients and record the observations
  • Administer patients’ medicines and treatments
  • Set up plans for patients’ care or contribute information to existing plans
  • Consult and collaborate with doctors and other healthcare professionals
  • Operate and monitor medical equipment
  • Help perform diagnostic tests and analyze the results
  • Teach patients and their families how to manage illnesses or injuries
  • Explain what to do at home after treatment

NATURE OF WORK

Most nurse work as part of a team with physician and other health professionals. Few registered nurses have opportunity to oversee licensed practical nurses, nursing assistants and home health sides.

Registered nurses role and duties will be defined based on where they work and the patients they work with. Depending upon areas of practice, registered nurses can work either in single department or multiple departments in hospital. Their work nature will be depend on area of practice, if registered nurses are expertise in one or more practice, their role will be extended to multiple departments.

Sources (BLS, UNITED STATES)

Addiction nurses care for patients who need help to overcome addictions to alcohol, drugs, and other substances.

Cardiovascular nurses care for patients with heart disease and people who have had heart surgery.

Critical care nurses work in intensive-care units in hospitals, providing care to patients with serious, complex, and acute illnesses and injuries that need very close monitoring and treatment.

Genetics nurses provide screening, counseling, and treatment for patients with genetic disorders, such as cystic fibrosis.

Neonatology nurses take care of newborn babies.

Nephrology nurses care for patients who have kidney-related health issues stemming from diabetes, high blood pressure, substance abuse, or other causes.

Public health nurses promote public health by educating people on warning signs and symptoms of disease or managing chronic health conditions. They may also run health screenings, immunization clinics, blood drives, or other community outreach programs.

Rehabilitation nurses care for patients with temporary or permanent disabilities.

Clinical Nurse Specialists – it’s come under Advanced Practice Registered Nurse (APRNs). Clinical Nurse Specialists can work in multiple specialties. They can provide both direct and indirect care. Indirect care has leadership roles, they may educate and offer advice to other nursing staff.

Nurse Educators,

Healthcare Consultants,

Public Policy Advisors,

Researchers,

Hospital Administrators,

Salespeople for pharmaceutical and medical supply companies,

Medical writers and Editors.

Registered Nurse - Salary and Roles

List of Working Place where Registered Nurse can be employed

  1. Hospitals – government and Private.
  2. Ambulatory healthcare services
  3. Nursing and residential care facilities
  4. Government
  5. Educational services – Government and Private.

Ambulatory healthcare services includes physician’s office, home healthcare and outpatients care centers.

Government sector includes nursing military services. Travel nurses can provide care in patient homes and Public health nurses may work in community centers, schools and other places.

Qualification to Become Registered Nurse

  1. Bachelor of Science Degree (BSN) in Nursing (OR)
  1. Associate Degree in Nursing (OR)
  1. Diploma in Nursing.

To practice as registered nurse, nurse need to be licensed by state or nursing council.

Qualification for Clinical Nurse Specialists (CNS)

Clinical Nurse Specialists must have master degree in nursing and have one or two years experience as a Registered Nurse. To conduct research, CNS needs a doctoral degree in Nursing.

Licensure Examination

Nurse need to pass licensure examination to work as registered nurses. For examples, in United States – Nurses need to pass the National Council Licensure Examination (NCLEX – RN). Every country has different licensure examination, if nurse prefer to work in particular country, they need pass the examination to be qualified as Registered Nurses.

Certifications

In addition to Licensure Examination, registered nursing positions may require certification in cardiopulmonary resuscitation (CPR), basic life support (BLS) certification, and/or advanced cardiac life support (ACLS). 

Clinical Nurse Specialists need to earn specialty certification from state board of nursing.

PROMOTIONS

For promotions, nurse need to have good experience, good exposure to clinical skills and continuous education. In management, nurse can climb up to higher positions.

Assistant Clinical Nurse Manager

Charge Nurse

Head Nurse

Assistant Director of Nursing

Director of Nursing

Vice President of Nursing

Chief Nursing Officer.

 

Registered Nurse to Nurse Anesthetists, Nurse Midwives or Nurse Practitioners

Registered Nurse can become Nurse Anesthetists, Nurse Midwives and Nurse Practitioners. These are advanced nursing practice (APRNs). APRNs need to have master degree or doctoral degree in nursing. APRNs can provide primary and specialty care and may prescribe medications to patients.

Researchers

Registered Nurses can be researchers in colleges and Universities. They need to have doctoral degree in Nursing (PhD) to conduct research in Nursing field.

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