vitamin d deficiency: assessing and intervening in this ...editor’s note: “vitamin d deficiency:...
TRANSCRIPT
Fitzgerald Health Education Associates, Inc. NP Certification Exam Preparation and
Continuing Education Visit us online at: www.fhea.com
Volume XIII, Issue V June 2013
Editor’s note: “Vitamin D Deficiency: Assessing and intervening in this common condition,” is a twopart series. Diagnosis and treatment of vitamin D deficiency as well as references for this article will be published in the July 2013 edition of FHEA News.
Vitamin D has long been recognized as essential for the efficient absorption and utilization of dietary calcium as well as for bone and muscle health. Intestinal calcium ab‐sorption is significantly enhanced by the presence of ade‐quate vitamin D and is conversely reduced in deficiency of this important micronutrient. Recent studies have highlighted this important micronutrient’s multiple roles. As an inhibitor of abnormal cellular growth, vitamin D is needed to help with cell differentiation and thereby mini‐mizing abnormal cell proliferation; this abnormality is a key step in cancer development. A stimulator of insulin secretion in response to increased blood glucose, vitamin
Vitamin D Deficiency: Assessing and intervening in this common condition
Inside this issue:
Q&A with Dr. Fitzgerald: What are the most common symptoms associated with postural hypotension?
2
Special Offer of the Month: 10% off Expert Exam: Primary Care Neurologic Exam
2
Important System Update Information 2
NP News in Brief 3
Q&A with Carolyn Bup‐pert, NP, JD: Advice for NPs who are considering practice outside of their certification specialty.
4
Live‐online Continuing Education Presenta‐tions
5
Recently Added Course: NP Review in Hawaii 5
Getting Ready for the NP Certification Exam: A FREE live‐online presentation
6
FHEA Exhibit Locations 6
Contraceptive Pearls: Natural Family Planning 7
Survey Reveals NP and PA Satisfaction 10
"Skin of Color" by FHEA Faculty Victor Czerkasij Published in The Nurse Practitioner
11
FHEA 25th Anniversary Resort Destinations 11
Upcoming Live FHEA Courses 12
NP Certification Exam Review Courses
Family, Adult and AdultGerontology Primary Care Tracks
06/25/13 Los Angeles, CA
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09/06/13 North Andover, MA
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09/20/13 Philadelphia, PA
09/27/13 Orlando, FL
11/06/13 Dallas, TX
Acute Care, AdultGerontology Acute Care Track
06/25/13 Los Angeles, CA
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09/20/13 Philadelphia, PA
11/08/13 Kansas City, MO
11/08/13 Long Beach, CA
Continuing Education Programs
Pharmacology Update
07/23/2103 Cape Cod, MA
09/13/2013 Prague, Czech Rep.
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Suturing for NPs and PAs
06/15/2013 Milwaukee, WI
06/24/2013 Los Angeles, CA by Margaret A. Fitzgerald,
DNP, FNP‐BC, NP‐C, FAANP, CSP, FAAN, DCC
1 Fitzgerald Health Education Associates, Inc. • NP Certification Exam Preparation & Continuing Education (978) 794-8366 • www.fhea.com
(Vitamin D: Continued on page 7)
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Important System Update Information
Routine maintenance is scheduled for June15, 2013. FHEA is committed to providing our customers maximum uptime, reliability and security for our Online Testing and
Learning Site, www.fhea.com/npexpert. Regular system maintenance is critical to achieving this goal and is normally performed the third Saturday of each month.
Question and Answer With Dr. Margaret A. Fitzgerald
Question: What is postural hypotension? Who is at greatest risk for this condition? What are the most common symptoms associ‐ated with postural hypotension? In which position should blood pressure be taken to determine postural hypertension? Dr. Fitzgerald: Postural hypotension, also known as orthostatic hypotension or orthostasis, is defined as an abnormal fall in blood pressure, at least 20 mm Hg systolic and 10 mm Hg diastolic, or both, within three minutes of standing upright. Symptoms of pos‐tural hypotension include faintness, light‐headedness, dizziness, confusion, or blurred vision that occur within seconds to a few minutes of standing and resolve rapidly on lying down. Postural hypotension is not a disorder but rather a manifestation of an un‐derlying cause. This condition is usually classified as acute, with recent onset and clearly a new onset trigger or chronic, longstand‐ing and often as a result of age‐related changes or the use of select medications. In the healthy adult, the process of rapidly going from a supine or sitting position to a standing position results in gravitational stress on the lower extremities; up to ½ to 1 liter of circulating volume pools in the lower extremities and trunk. This results in a decrease in venous return, cardiac output and, therefore, lower blood pressure. In response, the autonomic and parasympathetic reflexes are activated, the blood pressure is quickly returned to normal and the act of going from a supine or sitting position to standing rapidly does not produce any symptoms. The patient’s history is of particular importance and will usually reveal the postural hypotension cause. Even after extensive evaluation, about one‐third of patients with persistent, consistent postural hypotension have no identified cause. In postural hy‐potension, the body’s response to position change is inadequate, usually due to hypovolemia, and an abnormal and occasionally protracted blood pressure response results. The most common causes of acute orthostatic hypotension are hypovolemia (including excessive diuresis), the new use of vasodilating medica‐tions, prolonged bedrest, and adrenal insufficiency. The most com‐mon causes of chronic orthostatic hypotension include age‐related changes in blood pressure regulation, long term use of select medications and autonomic dysfunction.
What are the most Common Symptoms Associated with Postural Hypotension?
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Expert Exam: Primary Care Neurologic Exam by Wendy L. Wright, MS, ANP‐BC, FNP‐BC, FAANP
To evaluate a patient for orthostatic hypotension, blood pressure and heart rate are measured after five minutes in the supine posi‐tion and at one and three minutes after standing; the patient should be asked about symptoms of orthostasis while in the stand‐ing position. In patients unable to stand, this evaluation can be conducted by having the patient change position for a supine to sitting position using the same time parameters listed above. Marked increase in heart rate (greater than 100 beats per minute or by more than 30 beats per minute from baseline) is suggestive of hypovolemia as a cause. Hypotension without a compensatory increase in heart rate (less than 10 beats per minute over base‐line) suggests autonomic impairment. References Lanier, J., Mote, M, Clay, E. Evaluation and Management of Or‐thostatic Hypotension, American Family Physician. 2011 Sep 1;84(5):527‐536. Merck Manual for Health Professionals. Orthostatic Hypotension, available at http://www.merckmanuals.com/professional/cardiovascular_disorders/symptoms_of_cardiovascular_disorders/orthostatic_hypotension.html, accessed 5.27.13.
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June 2013
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NP News in Brief
Cinnamon Challenge Causes Growing Calls to Poison Centers Healthcare providers stated the dangers of the cinnamon challenge have caused increased calls to poison centers. The cinnamon chal‐lenge consists of swallowing a tablespoon of ground cinnamon in 60 seconds without drinking any fluids. Most young adults who have done it have only experienced temporary side effects but ac‐cording to Steven E. Lipshultz, MD, this stunt has led to calls to poi‐son centers, emergency departments and in severe cases hospitali‐zation for a collapsed lung. In recent studies on animals, Dr. Lip‐shultz and his team have discovered swallowing that amount of cinnamon can cause lesions, scarring and inflammation of the air‐ways and lungs and can have lasting effects like pulmonary fibrosis. People with asthma, pulmonary cystic fibrosis, chronic lung disease, or a hypersensitivity to the spice should be especially concerned. The cinnamon challenge is often attempted by people ages 13 to 24. As of August, more than 50,000 YouTube videos have been posted of people trying the cinnamon challenge and these videos have at‐tracted millions of viewers. The increase in the number of views of the cinnamon challenge videos has caused an increase in calls to the American Association of Poison Centers. Within the first 6 months of 2012, the center received 178 challenge‐related calls, which is more than triple their calls from the year before. Of those calls, 69% were internal misuse or abuse and about 17% required medical attention. Read more New York Bill will Give NPs More Autonomy The Nurse Practitioners Modernization Act would allow NPs to di‐agnose and carry out certain procedures without the collaboration of a licensed physician. Currently, NPs are licensed and certified by the State Education Department to diagnose illnesses and physical conditions without being supervised, but they cannot do any of this without mandatory collaboration with a physician. Stephen Ferrera, executive director of The Nurse Practitioner Association of New York State, said this bill will abolish the written collaboration agree‐ment with physicians. Assemblyman Richard Gottfriend stated that a collaborative agreement between an NP and a physician is out‐dated and that this new bill will help support and enhance the NP profession. If the bill is passed, not all NPs would be affected. NPs with less than 3 years of experience in practice or less than 3,600 clinical hours would still need to collaborate with a physician. Pa‐tients would not notice any change other than NPs will be able to practice without physician oversight. According to the bill, 13 states allow NPs to practice with complete independence and the outcomes are good. The concern now is if it will pass the state Sen‐ate. Read more
What Traits are Potential Employers Seeking in NPs? According to HealtheCareers.com, there are five traits that potential employers are on the lookout for when seeking nurse practitioner (NP) candidates. It is important for NPs to have good physical endur‐ance because they have to be able to stand on their feet for long peri‐ods of time, since they will be seeing patients for the majority of their shift. Along with having good physical endurance, good mental endur‐ance is also a must. An NP must always be prepared for any unex‐pected emergency. They must be able to assess the problem and take the appropriate steps. It is also crucial to always have patience. Ap‐proximately 90 million adults in the United States (US) have limited health literacy. This means that NPs regularly see patients who have trouble understanding and reading healthcare information. Addition‐ally, NPs must have a caring nature in order to be successful. Because of all the responsibilities an NP has, employers want someone who really cares. Patients want someone who is sympathetic to their health concerns, problems and needs. With certain patients, treat‐ments and conditions, NPs must be encouraging. Encouraging pa‐tients to succeed and change their lifestyles will assist in improving overall health. Read more
NP Certification Tracks
In accordance with the recent implementation of the Consensus Model for APRN Regulation, FHEA is
offering the following NP Certification Exam Review and Advanced Practice Update courses:
Family Adult‐Gerontology Primary Care
Adult‐Gerontology Acute Care
Adult Psychiatric/Mental Health Pediatric Women’s Health
Click Here for More Information
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Question and Answer With Carolyn Buppert, NP, JD
the board of nursing approves, I believe working outside your area of education and certification is very risky, and I wouldn’t advise any NP to proceed in this manner. This advice, not to practice outside of the NPs area of educa‐tion and certification, applies to adult NPs treating chil‐dren, geriatric NPs treating younger adults, pediatric NPs treating patients age ≥12 years , family NPs working in intensive care units, and psychiatric NPs treating medical patients.
A more prudent practice is work on and achieve addi‐tional education and certification via a formal, recog‐nized program. Carolyn Buppert is a health care attorney. Her legal clients include medical practices, institutions, nonprofit organizations and individual clinicians throughout the United States. She is a frequent contributor to various health care publications. She is the author of eight books, most of which cover the legal aspects of NP practice. Carolyn serves on Medscape's panel of experts. She lectures extensively on a variety of medicallegal issues. For more information, please visit: www.buppert.com.
Question: Are NPs obligated to practice in the specialty in which they were educated? For example, a certified, licensed woman’s health NP (WHNP) is considering a position in a family practice where a licensed family practice healthcare provider (HCP) offers to train the WHNP in the provision of lifespan, family primary care. Is this a legal or advisable option? Carolyn Buppert, NP, JD: First, ask your state’s board of nursing advanced practice consultant this question, as the board is the agency which has the authority to make the necessary decisions on issues such as this one. If the board gives you an answer that could in any way be in‐terpreted as “no” to the first question (are you obligated to practice in the specialty in which you were educated) and “yes” to the second question (is this legal or advis‐able), then answer the following questions before work‐ing in a specialty other than the one for which you were educated: If a patient claimed to have suffered an injury under your care, can you justify your qualifications to render care to the patient? How would you prove your qualifications? If you are a WHNP and you are treating a woman with a gynecologic problem, and something goes wrong and you are sued, it will be easy to prove you were qualified to treat the patient; you will produce your academic transcript and a copy of your certification. However, if you are educated and certified as a WHNP but you are treating a man, or treating a woman for diabetes melli‐tus, you are going to be hard‐pressed to prove your qualifications. It is possible to do so, but difficult. Per‐haps you could keep detailed records of the on‐the‐job training you received, such as dates of sessions with the teaching HCP, documentation of hours spent with the HCP, names of books you read, numbers of patients you treated while supervised, and so on. Unless you are go‐ing to record all of your on‐the‐job training, and unless
Advice for NPs who are Considering Practice Outside of their Certification Specialty
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June 2013
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Recently Added Course
Nurse Practitioner Certification Exam Review
and Advanced Practice Update
December 911, 2013 Waikiki, O’ahu, Hawaii
Presented by Margaret A. Fitzgerald, DNP, FNPBC, NPC, FAANP, CSP, FAAN, DCC
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FHEA LiveOnline Continuing Education Presentations
Date/Time Cost Presenter Title
7/10/2013 8‐10 p.m. EST
$18
Margaret A. Fitzgerald,
DNP, FNP‐BC, NP‐C, FAANP, CSP, FAAN,
DCC
Hypertension in the Elderly: The latest treatment
recommendations
7/17/2013 8‐10 p.m. EST
$18
Margaret A. Fitzgerald,
DNP, FNP‐BC, NP‐C, FAANP, CSP, FAAN,
DCC
Acute Bacterial Rhinosinusitis: A focus on the latest treatment recommendations
8/7/2013 8‐10 p.m. EST
$18
Margaret A. Fitzgerald,
DNP, FNP‐BC, NP‐C, FAANP, CSP, FAAN,
DCC
Bacterial Pharyngitis, Conjunctivitis, Acute Otitis Media: A focus on the latest treatment
recommendations
8/13/2013 8‐10 p.m. EST
$18
Margaret A. Fitzgerald,
DNP, FNP‐BC, NP‐C, FAANP, CSP, FAAN,
DCC
Antimicrobial Update: A focus on the treatment recommendations
in sexually transmitted infection (STI)
8/14/2013 8‐10 p.m. EST
$18
Margaret A. Fitzgerald,
DNP, FNP‐BC, NP‐C, FAANP, CSP, FAAN,
DCC
Probiotic and Prebiotic Use in Clinical Practice: What we know, what we are learning
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Come see Fitzgerald Health in person! We will be exhibiting at the following locations:
Date Location
June 1923, 2013
American Association of Nurse Practitioners 28th National Conference Las Vegas, Nevada
July 2528, 2013
National Nurse Practitioner Symposium Copper Mountain, Colorado
Sept. 1314, 2013
Fitzgerald Health Education Associates, Inc. Pharmacology Update Prague, Czech Republic
Getting Ready for the NP Certification Exam
A FREE Live
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Join Dr. Margaret A. Fitzgerald for a free, 75-minute live online presentation on certification exam preparation and comparisons between the exams. Learn the best practices
for preparing for certification and what to expect on the exams with this webinar designed for NP students, recent
NP grads and practicing NPs who are not certified.
An $18 value!!
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June 2013
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Natural Family Planning Natural Family Planning (NFP) methods, also known as Fertility Awareness, help women track their fertile and non‐fertile days. Women who have regular periods can predict ovulation by checking basal body temperature, cer‐vical mucus, and/or calendar calculation. The fertile win‐dow begins two days before ovulation and ends five days afterward. Couples who avoid intercourse (or use a barrier method) during the fertile window can prevent unin‐tended pregnancy. Success with NFP requires substantial effort from both sexual partners.
Studies of NFP methods show a wide range of efficacy: 95% to 99% for perfect use and 75% to 98% for typical use. These studies' quality is limited by recruitment and dropout problems. For example, a long‐term study of women using NFP in Germany revealed a 1.8% pregnancy rate and a 9.2% dropout rate over 13 menstrual cycles. A study of women using NFP for 1 year or less in developing countries (Bolivia, Peru, Guatemala, and the Philippines) revealed that 23% of participants had unprotected inter‐course on one or more of their fertile days.
NFP demands dedication from its users. Women with ir‐regular periods cannot use NFP. However, because NFP is the only group of methods considered acceptable by relig‐ions that oppose contraception, it remains an important option for many couples.
Please write to [email protected] with any questions, comments or additional resources to add to the list. Helpful Resources Natural Family Planning Fact Sheet
Subscribe Access past issues of the Contraceptive Pearls This article was reprinted with permission from the Reproductive Health Access Project (RHAP), Contraceptive Pearls.
D plays a role in the maintenance of normoglycemia by possibly minimizing the risk of type 2 diabetes mellitus development. Since vitamin D receptors (VDR) are expressed by most cells of the immune system, this micronutrient plays an important role as an immunomodulator. When vitamin D is avail‐able in physiologic amounts, this micronutrient acts as a renin production, therefore contributing to blood pressure control. Vitamin D Sources A combination of dietary intake of foods rich in vita‐min D in addition to regular periods of skin expo‐sure to the sun should provide the body with an ade‐quate supply of this important micronutrient. How‐ever, with the average lifestyle where little time is spent outdoors and diets are usually replete with highly processed foods, seldom is vitamin D intake and synthesis sufficient to avoid deficiency. Fatty fish and vitamin‐D enriched dairy products can sup‐ply a small amount of the estimated 3000 to 5000 IU/d of vitamin D per day the body needs. The aver‐age dietary intake nationwide is typically less than 5% of the body’s requirement. For example, one cup of fortified milk or yogurt provides a scant 100 IU of vitamin D. Four ounces of wild salmon contains about 400 IU per 4 ounce serving where the same amount of farmed salmon has significantly less. Skin exposure to the sun’s rays should supply ≥95% of the daily requirements by triggering the body’s natural ability to synthesize this micronutrient.
Risk Factors for Vitamin D Deficiency The ability of the body’s sun‐induced vitamin D syn‐thesis is determined by a number of factors includ‐ing the skin’s melanin pigmentation; a person with a darker skin tone will synthesize less vitamin D with sun exposure when compared to a person with lighter skin tone. The use of sunscreen, while helpful in minimizing the risk of certain skin cancers and other solar damage, likely increases the risk of vita‐
(Vitamin D: Continued from page 1)
(Vitamin D: Continued on page 8)
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min D deficiency, as application of sunscreen with a sun protection factor of 8 reduces the capacity of the skin to produce vitamin D as much as 95%. Obviously, individu‐als who spend little time outdoors have significant vita‐min D deficiency risk. The time of year and place of residence also influences sun‐induced vitamin D synthesis, with winter sun and northern latitudes providing the weakest effect. Even people who are regularly involved in outdoor activities that facilitate exposure to sunshine can have vitamin D deficiency if little skin is left sun exposed. Exposing the hands, face, arms, or lower legs to about 5‐15 minutes of sun at a strength found north of the 37th parallel (approximately at Richmond, Virginia on the east coast and San Francisco, California on the west coast) between the hours of 11 AM and 2 PM will likely provide an ade‐quate amount of vitamin D synthesis. This level of sun exposure is unlikely to induce sunburn or increase skin cancer risk. At the same time, in parts of the country with a cold winter even this degree of sun exposure is likely not reasonable.
The use of certain medications, including phenytoin (Dilantin), phenobarbital and St. John’s Wort, is poten‐tially vitamin D depleting. As a result, patients on these medications require two to five times the recommended daily amount of vitamin D. Vitamin D deficiency is also common in the presence of hepatic or renal disease as well as post gastric bypass. Additional risk factors for vitamin D deficiency include obesity, age ≥ 65 years, or ≤25 years and fat malabsorption.
Vitamin D deficiency: A common problem Vitamin D deficiency is a common problem. For example, studies note that up to 36% of healthy adults aged 18‐29 in Boston are vitamin D deficient by winter’s end and 27% of otherwise healthy Asian children in the United Kingdom are vitamin D deficient. An additional study revealed vitamin D deficiency in 57% of patients on a hospital medical ward and in 93% patients with non‐specific musculoskeletal pain at a Minneapolis pain clinic. Of 824 elderly people (>70 years of age) from 11
(Vitamin D: Continued from page 8)
(Vitamin D: Continued on page 9)
Attending the 2013
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AANP Exhibit Hall Island Booth 1072
Meet Our Faculty Margaret A. Fitzgerald, DNP, FNP‐BC, NP‐C,
FAANP, CSP, FAAN, DCC Susan Feeney, MS, FNP‐BC, NP‐C
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FAANP Sally K. Miller, PhD, ACNP‐BC, ANP‐BC, FNP‐BC,
GNP‐BC, CNE, FAANP Monica N. Tombasco, MS, MSNA, FNP‐BC, CRNA
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At FHEA, we sometimes receive complaints or concerns from customers who have purchased FHEA products or Dr. Fitzgerald’s book, now in its 3rd edition, from other online vendors and secondhand sellers. Of course, that’s what free enterprise is all about but it also means buyer
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European countries, 36% of men and 47% of women had wintertime vitamin D levels in the severe defi‐ciency range. Recent research demonstrated a 10% rise in body mass index (BMI) was linked to a 4% drop in concentrations of vitamin D. Considering this, vita‐min D deficiency is a common problem in a variety of populations. Clinical effects of vitamin D deficiency: A musculoskeletal focus
In infants and children, severe vitamin D deficiency results in the failure of growing bone to mineralize; the resulting condition is rickets. In contrast, adult bones are no longer growing but are in a state of constant cell renewal and therefore susceptible to problems related to vitamin D deficiency including persistent, nonspe‐cific musculoskeletal pain. To appreciate this, consider some of the clinical effects of vitamin D deficiency. Without sufficient amounts of vitamin D, intestinal cal‐cium absorption is inadequate. The resulting calcium deficiency prompts an increase in production and se‐cretion of parathyroid hormone (PTH). PTH acts at the level of the kidney by facilitating an increase in tubular calcium reabsorption and stimulating renal production of 1, 25‐dihydroxyvitamin D, the hormonally active form of vitamin D. With a continued deficiency, unusu‐ally high levels of PTU allow osteoclast activation so that bone can serve as a calcium source. In addition, the continued presence of high levels of circulating PTH causes phosphate to be wasted via the kidney. The calcium phosphate product in the circulation decreases and becomes inadequate to mineralize the bone prop‐erly, potentially leading to osteopenia and osteoporo‐sis. At the same time, osteoblasts deposit a rubbery collagen matrix layer on the skeleton. This surface can‐not provide sufficient structural support; the clinical effect is osteomalacia. This abnormal collagen matrix can absorb fluids and expand. With expansion, pres‐sure builds under the richly innervated periosteal cov‐ering. This process likely, at least in part, explains the origin of the constant, dull bone ache often reported in patients with osteomalacia. In these patients, minimal pressure applied with a fingertip on the sternum, ante‐
rior tibia, radius or ulna elicits a painful response. Since vitamin D deficiency symptoms overlap considerably with those of fibromyalgia, one condition is often mis‐taken for the other. Vitamin D deficiency has also been long recognized as a cause of muscle weakness and muscle aches and pain in all ages. Aside from osteomalacia and localized bone pain, antigravity muscle weakness, difficulty rising from a chair or walking, and pseudofractures is also noted in the person with vitamin D deficiency. These findings resolve with appropriate treatment. Vitamin D defi‐ciency also contributes to the development of hypocalce‐mia and hypophosphatemia. In this situation, unless the vitamin D deficiency is addressed, replacing calcium or phosphate alone does not restore the body to homeostasis.
(Vitamin D: Continued from page 8)
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A survey conducted by Jackson Healthcare last year revealed that job satisfaction among NPs and PAs remains high, in spite of the demands placed on the professions by the implementa‐tion of the Affordable Healthcare Act (AHA). The aging baby boomer generation now re‐quires increased access to quality healthcare, while instances of chronic disease are increas‐ing, contributing to the shortage in primary care providers. The online survey gathered information from 395 practicing NPs and PAs. Of the respon‐dents, 74% reported being satisfied or very sat‐isfied with their current positions. The survey found that the top factors contributing to over‐all job satisfaction for NPs and PAs are work environment, patient interaction and the ability to make a difference, salary and benefits, auton‐omy and variety, and challenging cases and the ability to grow. The things that NPs and PAs expressed dissatisfaction with included su‐pervisor/management, not feeling valued, sal‐ary, support staff, and physician attitudes. On average, NPs and PAs reported seeing 16‐18 patients per day. However, this number is in‐creasing and advance practice providers are being asked to take on more responsibility. Of those surveyed, 30% reported an increase in the amount of overtime hours, while 59% said that overtime hours have remained the same. Half of the respondents reported an increase in their patient load over the past year, while 49% of their duties increased during that time. The survey also asked the respondents to identify
the top three qualities they look for in a work environment. The study found life balance, pay, and control over work schedule were the most important. The most common work places, according to respondents of the sur‐vey, are in office‐based settings, clinics or practices, hospitals, government institutions, outpatient surgery centers, mental health facilities or nursing homes, with PAs more often located in hospitals and NPs in office settings or clinics. In addition to the AHA, the number of retiring NPs and PAs continues to keep the professions in demand. Of the survey respon‐dents, 60% of NPs and 47% of PAs plan to retire within the next 15 years, while 47% of NPs surveyed believe that the role of the NP will be at risk in the future. The most com‐mon concerns reported were physician back‐lash, increased medical malpractice liability, and an increase in workload. Among PAs, 32% believe that future risks to their pro‐fession include the need for physician over‐sight and increased medical liability. References: Jackson Healthcare. Advanced Practice Trends 2012‐2013: An Attitude and Outlook on Nurse Practitioners and Physician Assistants. http://www.jacksonhealthcare.com/media/182734/advancedpracticetrendsre‐port_ebook0313_lr.pdf. Accessed May 14, 2013.
Survey Reveals NP and PA Satisfaction
by Charlene Cashman, staff writer
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Click Here for More Information
FHEA 25th Anniversary Resort Destinations
Learn about the latest in drug therapy with Dr. Margaret A. Fitzgerald as she
presents the FHEA Pharmacology Update in desirable resort settings.
Topics Include: Drug Update: New products, new indications, new warnings Pharmacogenomics: Exploring genetic variations in drug metabolism
Antimicrobial Update: A focus on treatment recommendations in urinary tract infections (UTI)
Prescribing in the Presence of Impaired Renal Function Depression: A primary care approach to assessment and intervention
As Seen on TV: What's in the OTC and herbal products your patients are taking?
Boscolo Prague Hotel Prague, Czech Republic September 1314, 2013
Itinerary Includes Three Sightseeing Tours: Sept. 16th — 3 hour guided walking tour of the Old Town. $24 USD pp.
Sept. 17th — 5‐6 hour guided Karlstejn Castle tour. $50 USD pp.
Sept. 18th — 3 hour guided walking tour of Hradcany Town. $40 USD pp.
The Coonamessett Inn Falmouth, Cape Cod, Massachusetts July 2324, 2013
“Skin of Color” by FHEA Faculty
Victor Czerkasij, MA, MS, FNP-BC Published in The Nurse Practitioner
To learn more from Victor, visit our online store to view upcoming LIVEonline presen‐tations:
FHEA Associate Lec‐turer, Victor Czerkasij, MA, MS, FNP‐BC, holds the May 2013 issue of The Nurse Practitioner, which features his article "Skin of Color" on the cover.
Best Practices in Skin Cancer 6/17/2013
Upon completion, participants will be able to:
Present the incidence and epidemiology of cutaneous malignancies.
Identify clinical characteris‐tics and treatment of skin cancer.
Learn to counsel patients for skin cancer prevention.
Issues of Darkly Pigmented Skin
6/18/2013
Introduce the history of skin color in the specialty of dermatology.
Indentify common cutaneous and pigmentary disorders and infections.
Present key differences of treatment from tradi‐tional management choices.
Recognize skin cancer in ethnic (ES) or skin of color (SOC).
The Changing Face of Acne and Rosacea
6/19/2013
Identify the pathophysiology of acne and rosacea.
Describe the best approaches for treatment. Recog‐nize new indications and cautions for established products.
Visit our web store for more information, or to register.
Fitzgerald Health Education Associates, Inc. • NP Certification Exam Preparation & Continuing Education • (978)794-8366 • www.fhea.com
3
June 2013
Fitzgerald Health Education Associates, Inc. • NP Certification Exam Preparation & Continuing Education (978) 794-8366 • www.fhea.com 12
Click here for more information about these and other courses
Fitzgerald Health Education Associates, Inc.
85 Flagship Dr. North Andover, MA
01845‐6154 Phone: (978) 794‐8366 Fax: (978) 794‐2455 Email: [email protected]
Interested in advertising in this newsletter? Email: [email protected] Editorial Staff Publisher Margaret A. Fitzgerald, DNP, FNP‐BC, NP‐C, FAANP, CSP, FAAN, DCC Managing Editor Marc Comstock Editor Jasmin Pastrana Assistant Editor June Kuznicki Staff Writers Charlene Cashman Noelle Proulx‐DeCain Technical Assistant Bernice Flete Contributors: Carolyn Buppert, NP, JD Open Forum FHEA welcomes articles, news, com‐ments, and ideas from its readers! Please e‐mail: [email protected]. If you would like to contact customer service please e‐mail: [email protected]. We have sent this e‐mail newsletter in the hope that you will find it useful. If you prefer not to receive future issues, please e‐mail: [email protected]. Please include "Stop" as the subject of your email and your full name and the e‐mail address where you receive the newsletter in the body. If you received a copy of this newsletter from a friend, you can subscribe by sending an e‐mail to: [email protected]. Be sure to include your full name, mailing address, and daytime phone number so that we can confirm and authenticate your subscription.
Clinical Pharmacology for NPs and Advanced Practice Clinicians
Presented by: Margaret A. Fitzgerald, DNP, FNP‐BC, NP‐C, FAANP, CSP, FAAN, DCC Sally K. Miller, PhD, ACNP‐BC, ANP‐BC, FNP‐BC, GNP‐BC, CNE, FAANP
Earn 45 Contact Hours!
This course addresses the growing need for a thorough course in the principles of pharmacotherapeutics. Be‐cause states’ requirements vary, it is important that you contact your state board of nursing for details regarding educational requirements for prescriptive authority. This course is also available online. (Contact hours differ
from the live course.)
Advanced Pathophysiology for NPs and Advanced Practice Clinicians
Presented by: Margaret A. Fitzgerald, DNP, FNP‐BC, NP‐C, FAANP, CSP, FAAN, DCC Sally K. Miller, PhD, ACNP‐BC, ANP‐BC, FNP‐BC, GNP‐BC, CNE, FAANP
Earn 45 Contact Hours!
This course is review and updated bi‐annually to ensure up‐to‐date content. It is presented by highly acclaimed clinician‐educators who currently maintain clinical prac‐tice. Fitzgerald Health brings the highest quality patho‐physiology program to our customers. We believe our approach provides an advanced pathophysiology course
that will meet your needs whether you are new to the profession or brushing up your pathophysiology. This course is also available online. (Contact hours differ from the live course.)
This course is scheduled live annually and is always available online. Contact hours for the online course differ from the live course.
This course is scheduled live annually and is always available online. Contact hours for the online course differ from the live course.