Enhancing Accurate Delirium Detection in Older Patients With Heart Failure: Integrating Education and an Electronic Health Record Tool for Nurses

Journal of Doctoral Nursing Practice · 2025-02-18

β-Adrenergic Agonist–Induced Lactic Acidosis: A Case Report

AACN Advanced Critical Care · 2024-08-30 · 2 citations

β-Adrenergic agonist medications such as albuterol are the mainstay for treatment of patients with acute asthma exacerbations. Patients who present to the emergency department with severe symptoms are often treated with multiple albuterol doses in sequence to maximize the impact of the medications, relax bronchoconstriction, and relieve their breathlessness. Patients who present with acute dyspnea have numerous potential causes of hyperlactatemia and acidosis including an uncommonly recognized outcome of albuterol administration. This clinical case report outlines a scenario where a patient who was treated for an acute asthma exacerbation had rising lactate levels despite improving clinically. Causes of elevated lactate levels are discussed, particularly related to β-adrenergic agonist use, and considerations for monitoring and withdrawal of albuterol administration are outlined.

Gastrointestinal Symptoms

2018-06-14 · 1 citations

Pursuing the Clinical Track Faculty Role: From Clinical Expert to Educator

AACN Advanced Critical Care · 2017-08-28 · 6 citations

Within the health care profession, expectations for nurses continue to grow and advanced practice nurses increasingly need doctorate degrees. With this growth in expectations, more advanced practice doctoral programs are being developed so nurses can achieve their goals. There has been growth in both research-focused (PhD) and practice-focused (DNP) doctoral nursing programs. However, as of 2014, enrollment in PhD nursing programs had increased over the previous year’s by only 3.2% compared to a 26% increase in DNP programs1: 276 nursing schools offer the DNP to more than 18 000 students.1 As a result, a larger proportion of nursing faculty have clinical doctorate degrees (DNP) rather than traditional research doctorates (PhD, DNSc).Because of more DNP students and the desire to merge clinical and academic skills, schools of nursing need appropriately prepared educators, with many nurses choosing to become clinical track faculty (CTF) members.2 In the United States, schools of nursing have used the CTF role for many years. Typically, CTFs are clinicians with specific areas of expertise who hold advanced practice positions in nursing (eg, nurse practitioners [NPs] or clinical nurse specialists), maintain clinical appointments, and participate in academia. This blended faculty role is effective because, as practitioners at the forefront of care delivery, CTFs understand clinical work and are able to provide mentorship and career advice to nursing students. A successful CTF is a combination of clinician, educator, and scholar who incorporates service activities into the role.Acute care nurse practitioners (ACNPs) who want to become CTF face unique challenges, including balancing complex clinical work, maintaining active certification, and engaging in the academic setting. Acute care nurse practitioners who are considering becoming CTF must take into account factors that will affect work in both the clinical and academic settings.Clinical track faculty members possess the skills and confidence to impact clinical practice. As leaders in the clinical setting, they are ideally situated to be stewards for the advanced practice registered nurse (APRN) profession, advocates for the nursing profession, and role models for future clinicians (colleagues and students). However, ACNPs face obstacles in establishing their role in acute and critical care venues. It can be challenging for ACNPs to become valuable, autonomous, and discrete members of the team.According to Bryson,3 the NP role transcends the traditional boundaries of nursing and medicine more than do other nursing roles. Physicians and administrators may tend to view NPs as “support staff”—evidenced by the seemingly lack of or less protected time for scholarly work given to NPs as compared to their physician counterparts. Moreover, some physicians expect NPs to function as assistants or scribes, whereas some staff nurses expect NPs to perform tasks that physicians would not be expected to perform. Additionally, there are some settings where NPs’ duties include those normally performed by staff nurses or technicians.Alternatively, some NPs are expected to function as physicians,3,4 and many ACNPs take on roles traditionally held by junior physicians.4 Casida and Pastor5 found that NPs working in MCS (mechanical circulatory support) juggle multiple roles, including diagnosing and managing MSC patients, performing advanced procedures, managing heart failure and transplant patients, and researching and performing quality improvement projects. The study notes that in order to fully implement their role, NPs must become part of the interprofessional team, establish respect, and make an impact on patient care and institutional priorities.5 Nurse practitioners must invest in the practice, have an ability to network with team members, and make a commitment to a role that often transcends a traditional workday approach. In addition, ACNPs often are involved in team building, patient and staff education, and research.There are concerns that nurses in advanced practice, when taking on more “medical” roles, may lose knowledge of vital areas of nursing such as holistic and compassionate approaches to care.6 Thus, ACNPs constantly must work to prove their worth, carve out their spot on the team, and gain the acceptance and respect of the medical staff while striving to maintain a strong nursing presence.The complex APRN position is continually being redefined, but APRNs need to stay true to the practice of nursing while serving as leaders and role models in the nursing profession. Although it can be challenging to combine clinical and academic roles, CTF members are well aligned to function in the clinical and academic worlds. Clinical track faculty members possess skills and confidence to have meaningful impact in practice and are ideally situated to be leaders in the clinical setting.The priority of the CTF is to educate nursing students; however, CTFs are expected to engage in scholarly work and research or quality improvement initiatives. A central focus of nurses working in academia is the advancement of the nursing profession. Therefore, CTFs are expected to engage in scholarly work that includes conducting and disseminating research, publishing, and presenting at professional conferences.Although the CTF position is a known faculty role in research-intensive universities, many universities have issues regarding scholarship and expected outcome from CTF members.7 Tschannen and colleagues7 found that there is no standardized number of publications or scholarly presentations required for CTF members.7 Tschannen also found that CTFs at more highly academically ranked universities often were more prolific with research and scholarship7—resources, funding, clearer expectations, and, most importantly, mentoring may be the reasons.Because CTFs still have clinical roles, they may excel in research areas that include case studies and policy reviews. Key areas where CTF members are able to develop and expand their impact are through the standardization and reasonable expectations of the CTF role itself. Clinical track faculty members can also mentor in areas of scholarship. As Bruner et al8 note, faculty members want mentorship, especially in publishing and balancing professional work and life.With experience and doctoral training, CTFs can increase their authorship of scholarly articles in professional publications. Many CTFs engage in clinical research studies as part of their clinical role. Thus, CTFs can disseminate research findings and incorporate these findings into practice. Further, CTF members educate students about how to review, evaluate, and extrapolate results from research studies.Being an ACNP can be challenging and leave little time for scholarship; however, CTF members’ abilities to balance work-life responsibilities also translate into balancing their clinical and scholarly work. In order to become an autonomous and valued member of the clinical team, the ACNP may have to work outside the typical 9-to-5 workday. Additionally, patient care needs and expectations from administrators and physicians can encroach on an ACNP’s time for scholarly endeavors, which often are undertaken at home, on weekends, or during off-shifts. Although striving to maintain an active role in scholarly work can be stressful for CTFs, schools of nursing can build a supportive atmosphere by providing CTF members with support, mentoring, and time to engage in activities such as publishing, professional speaking, research, and other scholarly work.Educating future NPs and advancing the profession of nursing as well as the individual student’s career can be rewarding for CTFs. Although CTFs vary in their teaching methods, their overarching goals are the same: impart knowledge, foster the ability for students to think critically, and help students be more intentional with their work and succeed as APRNs. Clinical track faculty feel a great sense of reward when these goals are achieved.Graduate-level students often are highly motivated and passionate about advancing their nursing careers and have life experiences that enrich classroom discussions, which can make classroom teaching very satisfying. With each cohort admitted to an NP program, CTFs embark on an academic journey that lasts 2 to 5 years and can be followed by a relationship with students that lasts well past graduation. Once their former students become board certified, CTF gain new colleagues, preceptors, and even faculty peers—all of whom the CTF has at some point mentored. These relationships are often lasting and provide valuable networking and recruitment opportunities when former students are placed into other health care and academic institutions.Clinical track faculty members offer their perspective and assistance to help nursing students successfully complete their degrees. The teaching role of the CFT is multifaceted and includes precepting and mentoring, which require a mix of influence and perseverance. Nurse practitioner students often are tired and frustrated by the demands of the degree program and life stresses and may need support and perspective from faculty members. This in turn can be challenging to faculty members who also are trying to balance the demands of clinical practice with those of academia and their students.The CTF member’s teaching role is challenging and rewarding. Challenges include demanding students and clinical preceptors; personality conflicts with fellow students, faculty, or preceptors; clinical work situations that affect performance; preceptors with unrealistic expectations; and cultural and language barriers. The imbalance can become arduous, requiring increased time commitments, which can be challenging in light of clinical practice workload and personal commitments. Scheduling conflicts can become so demanding that other faculty members must step in to resolve them, and that can leave CTFs feeling inadequate.Another teaching demand for CTFs is assignment grading, which can be time intensive, especially when they must grade papers of new students who are still adjusting to the rigors of the NP program. Generally, grading demands lessen as students become more comfortable with documentation and the course workload.Being a CTF allows a nurse to continue clinical practice while bringing current and evolving standards of care and evidence-based practice to the classroom. It is through experience that CTFs are able to relay information in a way that makes it relatable, applicable, and easier for students to retain. Likewise, immersion in the academic world can enrich an ACNP’s clinical practice through varying perspectives, clinical scenarios, and practice techniques from students and other faculty members who work in different specialties. Moreover, teaching often inspires new questions that can lead to research and improved evidence-based practice. Although there are challenges with balancing the demands of the CTF role, the satisfaction of producing well-rounded clinicians and future colleagues—all while advancing the nursing profession—can make the role an enriching choice.Most CTF members participate in service activities that provide nursing expertise to community groups or to local, state, national, and international organizations. Service gives CTFs the chance not only to help the community but also to help the university achieve valuable outreach.9 Faculty members also can serve on unit, school, and university committees; participation in administrative tasks is crucial to an academic institution’s functioning. Mentoring junior faculty colleagues is a critical area of service for senior academic ranked CTFs.10 Additionally, CTF members at schools of nursing routinely participate in a practical service component in clinical settings. In these settings, the overlap of the CTF’s academic and clinical roles positively affect student and patient populations.Typically, university groups are organized and structured to unite colleagues who teach in similar content areas. Clinical track faculty members might join academic work groups that include governance, curriculum committees, or leadership (eg, executive committee). Depending on the institution, there may be other opportunities for faculty to offer service across the broader university community, often in interdisciplinary groups. Participation in academic service groups is seen as an essential aspect of service to the university community because participants pursue personal interests and represent perspectives of schools and colleagues.Most CTF members are involved in clinical organizations. By virtue of their academic and professional organizational roles, CTFs have access to a broader range of clinicians with similar interests and expertise. Thus, depending on the extent of their ongoing relationship with their clinical practice workplaces, CTFs can continue to advance goals and outcomes. Their experiences and relationships give CTF members the ability to bring new ideas and perspectives to the clinical practice to enhance patient outcomes and ultimately the university. Clinical service promotes and develops tangible results, such as best practice guidelines, clinical measures, care delivery and outcomes, organizational structure, and interdisciplinary collaboration that improves practice and patient management.Faculty involvement in professional organizations, participation on boards of scholarly and clinical journals, and leadership at relevant conferences are vital to the university community and instrumental in the advancement of one’s academic career. As experts in their field, and by virtue of their reach to other colleagues and organizations, CTFs are key in formulating strategies to promote positive outcomes in clinical practice on the regional, state, national, and international levels.Service for new CTF members often can begin at a variety of points. Although their academic role may be new, CTFs often have established clinical careers. Thus, CTFs may already be involved with professional organizations and are able to make an impact with these groups. Continuing the relationship with professional organizations can provide new clinical faculty members an appropriate starting point toward a service role that contributes to the development and goals of their professional organizations.New faculty members can enhance their involvement and networking in professional organizations by publishing and presenting research or offering subject-matter expertise. As the landscape of nursing continues to evolve, CTFs can become active in local, regional, state, and national conversations to promote the APRN discipline by example, advocacy, and practice development. Clinical track faculty can use their academic affiliations to promote their roles as faculty members, the missions of their universities, the goals of their professional organizations, and the experiences of students.Developing one’s teaching and academic skills to become a CTF member is a process that takes time, practice, experience, and mentorship. Several avenues exist through which an APRN can engage in academia—some do not require a formal academic rank (Figure 1). A clinician’s desire to promote the nursing profession and practice area should be at the forefront of any decision to get into academia. One of the best ways to begin is by precepting new staff colleagues. Guidance by an experienced and confident clinician is vital to new staff members—particularly new graduate APRNs. Furthermore, as staff members transition from RN to APRN roles, several unique issues arise; it is helpful to have a colleague who understands and can help navigate these issues. Precepting new staff and new APRNs is an excellent opportunity for the clinician potentially interested in an academic role.An APRN has various opportunities to gain teaching experience before formally joining an academic institution. For example, many university nursing programs, particularly those that align with the clinician’s expertise, welcome clinicians precepting students. With this first step into academia, clinicians develop teaching styles and learn about students’ needs. Advanced practice registered nurses who are confident in their own experience and are able to understand student issues might become better instructors. If the local university does not offer an advanced nursing graduate program, a clinician can supervise, precept, and provide clinical expertise and guidance to undergraduate students.Another avenue for an APRN to get into academia is through lecturing at a local university. Lecturing is a good way to enter into teaching, demonstrate interest to potential academic employers, and hone a teaching style. Clinicians may find lecturing opportunities at the programs from which they graduated or at a local university that offers nursing curricula. This step into lecturing allows clinicians to build confidence teaching materials with which they are familiar (eg, their clinical practice).There are several issues that need to be considered by an APRN moving into the formal academic setting, especially into the CTF role. Although the requirements for this role (eg, academic preparation, capability) vary from one institution to another, understanding the different academic ranks is helpful.For a CTF member, the progression through a school’s affiliated academic ranks is generally in the following order: (1) clinical instructor, (2) clinical assistant professor, (3) clinical associate professor, and (4) full clinical professor. Clinical lecturers in schools of nursing lecture in the classroom or precept students in the clinical setting. Although they are not always formally considered faculty, they have an affiliation with the academic institution where they are working. Many nursing schools offer adjunct or part-time faculty positions for instruction in the classroom or clinical settings. Generally, this type of position is offered to those who have a primary clinical appointment outside the school and have experience and skills that meet the teaching needs of the program.11 Faculty in nursing programs should have “graduate-level academic preparation and advanced expertise in the areas of content they teach,”12 although this again can vary from one academic program to another.The scholarship component of academic nursing may be challenging for new CTFs. Publishing clinical studies or presenting evaluations about specific clinical problems are good places to start because these types of publications can easily align with a CTF’s clinical experience and expertise. Moreover, CTFs should align scholarship with the development of their own focus of study and interest. Often these elements come from work in the clinical setting and can provide a bridge between the clinical and academic roles, reinforcing the CTF’s impact in both. Continued efforts to produce scholarly output can help clinicians establish their subject-matter expertise, potentially building opportunities within the academic and clinical institutions. Additionally, building scholarly expertise in a particular area or topic provides sustainability throughout the CTF’s academic career.The academic components of faculty responsibilities such as teaching, scholarship, and service vary by institution and academic rank; however, how the clinical practice and academic institutions support CTF members is an essential component for establishing an academic career (Figure 2).Clinical track faculty typically have a clinical practice appointment; the percentage of time spent at the clinic versus the university must be negotiated. For example, acute care CTFs would need to negotiate and balance matters such as shifts, overtime, holidays, and on-call coverage with their academic responsibilities. How CTF members balance the clinical and academic aspects of the role will affect both settings.Working part time as a clinician is something to be considered when taking the step into academia. It may be difficult for APRNs to find new clinical settings that accommodate the needs and schedules of CTF members. Thus, it may be more practical for APRNs to make arrangements with their current clinical setting rather than trying to find new ones. The amount of clinical effort and subsequent impact on the academic work and clinical load should be part of a discussion between the CTF member and their clinic.Salary and growth opportunities also are factors that CTF members must take into consideration. The overall salary earned from the academic institution and clinical site should be to the of a acute care APRN in the clinical Moreover, CTFs need to their expectations for academic appointment and academic institutions require faculty to have doctoral degrees in order to advance in academic whereas may the amount of support an academic is to offer is an consideration. These factors include for and from the clinical world to the academic world in nursing can be a rewarding and nursing programs are CTF positions that require the experience and expertise of practice and academia. This blended role the clinical expertise of the practitioner with the academic setting, in CTFs providing clinical practice while nursing students to develop their own practice. The CTF position commitment and understanding of the practical issues the process of moving from clinical practice to professional mentorship. A CTF also must understand an of the many aspects of the CTF role is essential for clinicians who are considering a into the academic setting. With and new clinical faculty members can continue to provide the best care to and to the discipline of nursing while the advancement of future

Palliative Care Nursing

2015-06-01 · 9 citations

Acute bronchitis

The Nurse Practitioner · 2013-09-14 · 4 citations

In Brief Acute bronchitis affects millions of individuals, significantly impacting patient health and the healthcare industry. Understanding evaluation and treatment guidelines for acute bronchitis allows the nurse practitioner to practice comprehensive care for patients. This article reviews evidence-based practices when caring for the patient with acute bronchitis, promoting optimization of healthy outcomes. Acute bronchitis affects millions of individuals, significantly impacting patient health and the healthcare industry. Understanding evaluation and treatment guidelines for acute bronchitis allows the nurse practitioner to practice comprehensive care for patients. This article reviews evidence-based practices when caring for the patient with acute bronchitis to promote healthy outcomes.

Acute Infectious Diarrhea

AJN American Journal of Nursing · 2012-07-26 · 2 citations

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