LACE and the APRN Consensus Model: Implications for Advancing Nursing Practice.

Understanding the historical context and contemporary trends in advanced practice registered nurse (APRN) education and regulation is pivotal for effective professional advocacy. Until the release of the APRN Consensus Model in 2008, a uniform model for APRN regulation was lacking. Adopting the model's recommendations has implications for APRNs beyond licensure and regulation, including full practice authority, license portability, and patient access to APRN-led care. A comprehensive understanding of APRN education and regulation empowers nurses, APRNs, and stakeholders to drive the profession forward through informed advocacy.

Supporting Emergency Care Delivery Through Updated Emergency Nurse Practitioner Competencies.

As multidisciplinary emergency care becomes increasingly complex, all team members must be aware of their respective roles and responsibilities. In the emergency department, nurse practitioners are integral members of the team. They possess a wide range of clinical and leadership competencies that allow them to perform specific and differentiated tasks within the emergency department. A well-defined competency not only contributes to the promotion of a positive work culture but also clarifies performance expectations, identifies skill gaps, and supports team development. Furthermore, it allows the nurse practitioner to adapt to changing conditions while maintaining patient safety. The competencies of emergency nurse practitioners have evolved over the past 2 decades. The authors discuss the importance of establishing clear expectations for emergency nurse practitioner practice in this article and the alignment of competencies with organizational culture and objectives.

Analysis of nurse practitioner practice in US emergency departments: Evidence supporting educational preparation, credentialing, scope of practice, and outcomes.

ABSTRACT: The nurse practitioner (NP) role within emergency care has grown in recent years and now there are an estimated 25,000 NPs employed in diverse emergency care settings. Despite this significant growth and expansion of the NP within emergency care areas, challenges exist. In addition to the pervasive confusion regarding the NP role in emergency care, data and statistics detailing characteristics and outcomes of NP practice in emergency care are either lacking or misrepresented. This article explores barriers and provides current and accurate information describing the current educational preparation, credentialing, scope of practice, and outcomes among NPs in US emergency departments. The totality of available evidence reviewed supports safe, timely, efficient, and patient-centered care provided by NPs in emergency care.

Consideration of the emergency nurse practitioner as a population within the APRN Consensus Model: A SWOT analysis.

ABSTRACT: After adoption of the 2008 Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation, evolution of the nurse practitioner (NP) role and emergency NP (ENP) specialty has outpaced regulatory standards. Lack of uniformity among regulators, health insurance providers, and employers in acknowledging the ENP specialty has created barriers to practice and access to care. This article serves to identify potential outcomes if the ENP specialty was transitioned to a population within the Consensus Model of Regulation. A strengths, weaknesses, opportunities, and threats (SWOT) analysis methodology was used to assess ENP specialty current state, specifically focusing on the licensure, accreditation, certification, and education model for APRN regulation. The data were collected from peer-reviewed literature, clinical subject-matter experts, and academic and advanced practice executive leaders. Variances in ENP licensure, recognition, and acknowledgment among State Boards of Nursing leave the ENP specialty in a precarious position. For each of the strengths and opportunities that could exist in recognizing the ENP at the population level of the Consensus Model, there are abundant weaknesses and threats. Although full acknowledgment of the ENP specialty is lacking, regulatory implications are highly variable, and employers' understanding of the APRN educational model is limited, our findings reveal that the ENP specialty is an evolving role that deserves regulatory legitimization. Although ideal placement for the ENP within the Consensus Model remains to be determined, challenges and opportunities exist with both specialty and population options.

Electrocardiogram Changes Associated With a Case of COVID-19 Infection: A Pathophysiological Perspective.

SARS-CoV-2 is the virus that causes COVID-19 and COVID pneumonia and is known to cause cardiovascular abnormalities with electrocardiogram (ECG) disturbances in affected patients. A 47-year-old male patient presented to the emergency department (ED) for the management of COVID-like symptoms. Initial diagnostics included an ECG, which showed significant rhythm changes. Progression of COVID-19 disease compounds myocardial injury with corresponding new-onset ECG anomalies such as QT-segment changes, bundle branch blocks, ST-segment disturbances, and other rhythm abnormalities. This case presentation illustrates ECG changes associated with cardiovascular disease progression.

Acid Reflux or Posterior Myocardial Infarction: One ECG Away From a Missed Diagnosis.

Health care professionals and hospitals have made tremendous advances in detecting, diagnosing, and treating posterior myocardial infarction over many decades. Electrocardiogram (ECG) alone is used to make a timely diagnosis of ST-segment elevation myocardial infarction in the emergency department. The typical signs of myocardial infarction, left-sided chest discomfort with radiation to the jaw or left arm, rule out a wide range of patient presentations with ST-segment elevation myocardial infarction. This variation in clinical symptoms is exacerbated by the fact that most ECG monitors lack algorithms that account for posterior myocardial infarction interpretation. Therefore, health care practitioners must exercise caution when dismissing nondiagnostic and faint ECG abnormalities as normal or unimportant.

Electrocardiographic Findings Associated With Neurological Pathology and Other T-Wave Catastrophes.

An 87-year-old female patient presented with altered mental status. During the routine workup for altered mental status, an electrocardiogram (ECG) was obtained. The ECG showed T-wave morphology known to be consistent with myocardial infarction. Although the ECG is a crucial diagnostic tool to recognize myocardial ischemia and infarction promptly, it must be understood that T-wave abnormalities can represent noncardiac pathology. A case presentation illustrates a unique ECG change whose presence is associated with catastrophic central nervous system diseases that cause increased intracranial pressure.

Emergency Care Considerations for the Transgender Patient: Complications of Gender-Affirming Treatments.

The transgender population presents a unique challenge for the emergency nurse. There are types of surgeries, medications, complications, and differences in laboratory testing that are unique to transgender people. In addition, emergency nurses are increasingly encountering more transgender patients in the emergency department for care, referrals, and education. Yet, many emergency nurses lack the formal training to care for transgender patients and their families. A complete understanding of the terminology, gender-transforming surgeries, hormonal suppression and augmentation of sexual characteristics, adverse effects, complications of surgeries, and ongoing health risks owing to the altered hormonal milieu and potential risk for acquiring sexually transmitted diseases is important to provide the necessary emergency care for this emerging population.

Allopurinol-Induced Drug Reaction With Eosinophilia and Systemic Symptoms: A Case Report.

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an uncommon yet serious adverse cutaneous drug reaction that results from a hypersensitivity reaction. Drug reaction with eosinophilia and systemic symptoms is often misdiagnosed because of vague and confounding signs and symptoms. The most common clinical manifestations of DRESS are shared with many other diseases and include rash, lymphadenopathy, and fever. Because the syndrome can be difficult to diagnose, patients are often in the late stages of the disease process before treatment is initiated. The mainstay of treatment is stopping the culprit medication. Drug reaction with eosinophilia and systemic symptoms is associated with a high mortality rate, most often from liver failure and failure to diagnose. Emergency providers should be able to recognize the clinical manifestations of DRESS, know what diagnostic studies are indicated, and be familiar with the appropriate treatment.