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https://killexams.com/exam_list/AdobeKillexams : How Adobe’s chief product officer makes time for what’s importantNo result found, try new keyword!To make sure he tackles everything on his to-do lists, Adobe chief product officer Scott Belsky has come up with a rigid system.Mon, 28 Nov 2022 16:00:00 -0600text/htmlhttps://www.fastcompany.com/90813453/how-adobes-chief-product-officer-makes-time-for-whats-importantKillexams : 5 learner-centered education models to inspire reform
School models are, for the most part, outdated–and very overdue for replacement. When students reach high school, research shows that close to 66 percent of students are disengaged. But even students who do successfully navigate their schooling emerge with only a specific (and often narrow) skillset that may or may not match their strengths or interests.
Conventional schooling often leaves students disillusioned, questioning their intelligence and value as it is framed by a system that needs an overhaul.
Learner-centered education can play a critical role in reshaping education systems, offering a more holistic approach to meeting learners’ needs and helping students find fulfillment in their academic accomplishments.
K-12 Value Networks: The Hidden Forces That Help or Hinder Learner-Centered Education, a new report from the Clayton Christensen Institute and authored by CCI senior research fellow Thomas Arnett, offers insight into understanding why schools struggle to change their instructional models, along with tips to establish and support learner-centered education models.
Program leaders, sponsors, learners and their families, staff, community partners, and funders are all critical to the success of these learner-centered education models.
The report describes how five different learner-centered education models–The Met, Virtual Learning Academy Charter School, Iowa BIG, Village High School, and Embark Education–were able to launch and grow their models by assembling value networks congruent with their vision for learner-centered education.
1.The Met: The Metropolitan Regional Career and Technical Center, known as The Met, is a network of six small, public high schools located in Providence and Newport, Rhode Island. The hallmark of The Met’s learner-centered model is that its learners go out in their communities for two days out of the week to lead real-world projects as interns for partner organizations. For example, learners might work with a local bakery, a law firm, a tech company, or a recording studio.
When learners join the Met, they and their families work with an advisor to identify their strengths, needs, and interests, and then develop an individualized learning plan with an internship as its centerpiece. Learners are responsible for researching potential internship opportunities and communicating with partner sites to arrange their internships. Advisors coach them as they do their research and outreach to ensure that internships match their needs and interests.
2.Virtual Learning Academy Charter School: The Virtual Learning Academy Charter School (VLACS) is a statewide virtual school created in 2007 that serves K–12 learners throughout New Hampshire. The concept for the school came from the superintendent of the Exeter Region Cooperative School District, who saw an opportunity to take advantage of a new charter school law to apply for a statewide charter. Rather than create another conventional school, however, the superintendent recognized the distinctive value of using a virtual school model to offer a wide array of flexible, part-time and full-time learning options unavailable through brick-and-mortar campuses.
VLACS’s competency-based model is highly adaptable to learners’ needs and interests. It offers a range of options for learners to earn credits: through online courses, learner-designed projects, and out-of-school learning experiences such as internships and travel. Learners who take online courses move through those courses at their own pace and earn credit whenever they’re able to demonstrate mastery of designated competencies. For projects and other learning experiences, VLACS aligns these experiences with state learning standards and then measures learners’ mastery of standards using performance-based assessments.
Laura Ascione is the Editorial Director at eSchool Media. She is a graduate of the University of Maryland's prestigious Philip Merrill College of Journalism.
Tue, 29 Nov 2022 18:45:00 -0600Laura Ascioneen-UStext/htmlhttps://www.eschoolnews.com/2022/12/01/5-learner-centered-education-models/Killexams : How To Become A Nurse Practitioner: A Step-By-Step Guide
Editorial Note: We earn a commission from partner links on Forbes Advisor. Commissions do not affect our editors' opinions or evaluations.
If you want a rewarding career in the healthcare sector without spending a decade of your life training to become a doctor, you might consider working as a nurse practitioner (NP). These advanced practice nurses are primary care providers whose career path is significantly shorter and less expensive than that of a doctor.
Our guide explores how to become a nurse practitioner, including education, licensure and potential specialty areas.
What Does a Nurse Practitioner Do?
What is a nurse practitioner? NPs are advanced practice registered nurses (APRNs) who provide healthcare services to specific patient demographics.
Role and Responsibilities
NPs provide primary care to their patients. They analyze patients’ medical histories and order, conduct and assess diagnostic tests. They typically work with healthcare teams to create treatment plans and offer follow-up care.
Due to their advanced education and training, many NPs can work independently and write prescriptions. Nurse practitioners can also perform medical procedures like debridement, putting casts on injuries and intubation. Other NP responsibilities may include the following:
Managing overall patient care
Educating patients on how to prevent diseases and make positive choices for their health
Counseling
Work Environment
A nurse practitioner can work in any healthcare organization, including physician’s offices, hospitals, outpatient care centers, educational facilities and nursing homes.
Some NPs work in home health as well, providing treatment or follow-up care in patients’ homes. They may also participate in rural outreach programs, traveling and offering services in areas with limited access to healthcare.
Nurse practitioners often work in shifts in healthcare facilities where patients need round-the-clock care. In physician’s offices, NPs tend to work typical business hours.
Benefits of NPs
NPs do a lot to Strengthen the lives of community residents. By acting as counselors and educators, NPs guide patients to live healthier lives, thus reducing the cost of healthcare. According to the American Association of Nurse Practitioners (AANP), patients who see NPs as their primary healthcare providers tend to have lower medication costs, shorter hospital stints and fewer visits to the emergency room.
NPs also approach patient care more holistically. Asides from targeting the physical problem, NPs listen for signs of mental distress and guide patients through recovery. NPs’ approach to patient management improves patient satisfaction.
How to Become a Nurse Practitioner
Earn a BSN
A bachelor’s degree in nursing (BSN) is the preferred academic qualification to start a career as a registered nurse (RN). A bachelor’s degree is also required for admission to a graduate-level nursing program.
Full-time students typically take four years to complete a BSN degree. However, it’s a longer process for part-time students.
Obtain RN Licensure
Once you earn a BSN, the next step is becoming an RN. This process requires passing the National Council Licensure Examination for Registered Nurses (NCLEX-RN).
It’s quite common for aspiring nurse practitioners to work as RNs before moving forward in their careers. However, nursing experience is not required to proceed to the next stage.
Earn an MSN
A master of science in nursing (MSN) degree is the minimum academic qualification for NPs. An MSN program advances your clinical knowledge and patient management skills.
It’s best to choose your specialty area before enrolling in a master’s in nursing program so you can focus your studies accordingly.
Consider Earning a DNP
A doctor of nursing practice (DNP) program equips APRNs for leadership in clinical settings. A DNP degree is the highest academic qualification a nurse practitioner can possess.
Though this degree is not a prerequisite for working as an NP, those who want to increase their earning potential and have more influence over healthcare policies may consider earning one.
Pass a National Certification Exam
After graduation, you must sit for and pass a national board certification exam specific to your chosen focus area. In most states, NPs are not permitted to practice until they pass a certification exam.
There are numerous organizations that administer NP certification exams. The exam you take depends on your chosen specialty area.
Obtain APRN Licensure
In most states, APRNs—including NPs—are required to hold state licensure. Once you obtain NP certification, you may apply for licensure in the state where you plan to practice.
Types of Nurse Practitioners
Acute Care
Acute care NPs handle urgent medical crises and care for people with chronic illnesses. These providers may work in emergency departments, intensive care units, cardiology units, coronary care and surgical wards.
Adult
NPs in this specialty offer medical support to patients between late adolescence and full-fledged adulthood. These NPs mostly offer primary care, which involves administering physical exams, diagnosing illnesses, creating treatment plans and educating patients about their health conditions.
Family
A family nurse practitioner provides comprehensive healthcare to individuals and families. Their expertise is not restricted to any age group, which makes this specialty one of the most flexible for NPs. Family nurse practitioners mostly focus on preventive care, but they also treat common illnesses and monitor patients’ health over time.
Gerontology
Gerontology nurse practitioners care for older populations. They help manage chronic illnesses, stabilize patients during acute episodes, analyze health records and help patients make lifestyle changes as they grow older. NPs in this specialty can work in emergency rooms, hospitals, physician’s offices, hospice centers and retirement homes.
Neonatal
A neonatal nurse practitioner cares for sick and premature newborns. Their scope of practice spans various settings, including neonatal intensive care units, outpatient settings, private practices, hospitals and community clinics.
Oncology
NPs in this specialty treat and care for patients living with cancer. They collaborate with oncologists to develop treatment plans specific to each patient’s condition. These NPs order diagnostic tests, oversee infusion therapy, monitor patient recovery and refer patients to other specialists.
Pediatric
Pediatric nurse practitioners treat children and young adolescents in acute and primary care settings. They conduct checkups, offer immunizations, treat injuries and educate their patients on disease prevention.
Psychiatric
Psychiatric NPs work in the mental health field. They diagnose mental illnesses, develop treatment plans and monitor patients’ progress over time.
Women’s Health
This specialty involves the reproductive and sexual health of women of all ages. Women’s health NPs offer wellness advice to adolescent girls and older women approaching menopause. They also treat infections that are unique to women.
Sub-Specialty Areas
The specialties listed above are relatively broad focus areas. As an NP, you can narrow your focus even further to specific body parts and functions instead of population groups. Potential sub-specialties to consider include dermatology, immunology, hematology, neurology, urology, occupational health and gastroenterology.
AANPCB administers certification examinations for family, adult-gerontology and emergency nurse practitioners. Before you can apply for any certification, you must create an account on the board’s official site to become a member.
PNCB offers two certifications that validate NPs’ critical thinking skills and understanding of children’s health. Offerings include:
Acute care certified pediatric nurse practitioner (CPNP-AC)
Primary care certified nurse practitioner (CPNP-PC)
Job Outlook and Salary for Nurse Practitioners
How much does a nurse practitioner make? The U.S. Bureau of Labor Statistics (BLS) reports that the median annual wage for NPs is $120,680. However, NP salaries vary based on location and work environment.
The five top-paying U.S. states for nurse practitioners, and NPs’ average annual salaries in each state, are as follows.
California: $151,830
New Jersey: $137,010
New York: $133,940
Washington: $130,840
Massachusetts: $129,540
Recent data from AANP reports over 355,000 licensed NPs in the U.S., and according to the BLS, this number is expected to grow significantly.
The BLS projects a 46% employment growth rate for NPs from 2021 to 2031. This growth rate is more than nine times faster than the projected job growth rate for all occupations nationwide.
Frequently Asked Questions (FAQs) About How to Become a Nurse Practitioner
How long does it take to become a nurse practitioner?
At a minimum, it takes six years to complete the bachelor’s and master’s degrees required to become an NP. Aspiring NPs who study part time or work as RNs before pursuing more advanced credentials may need more time.
Is becoming a nurse practitioner worth it?
For many, yes. The process of becoming a nurse practitioner can be daunting, but NPs earn high median annual wages ($120,680) and have an exceptionally strong job outlook.
Wed, 30 Nov 2022 18:23:00 -0600Nneoma Ucheen-UStext/htmlhttps://www.forbes.com/advisor/education/become-a-nurse-practitioner/Killexams : Best Adobe Acrobat alternatives of 2022: free and paid options
The best Adobe Acrobat alternatives offer advanced PDF editing capabilities that rival the best PDF editor.
Adobe Acrobat DC has long been the go-to PDF editing software - for the very good reason that Adobe invented the PDF format. The filetype allowed true document standardization. No matter what device you viewed the file, it would appear the same to all users.
Today, there are plenty of premium and free PDF editors offering many of the same useful tools and features you’ll find in Adobe’s premiere PDF editing tool, including eSign software and OCR software. So, you’re looking to Strengthen efficiency, productivity, and faster workflows without taking out a Creative Cloud subscription, finding the best alternatives to Adobe Acrobat is essential.
To help you identify the right tools, we’ve tested, reviewed, and rated the best Adobe Acrobat alternatives to see where the competition matches, thrashes, and misses Acrobat’s power.
Foxit PDF Editor is a stellar substitute for Adobe Acrobat. Like Adobe, Foxit has been offering PDF tools for decades, and users can take confidence from the many high-profile endorsements proudly listed on the Foxit site, with the likes of Amazon, Google, Dell, and Intel among them.
The company's best Adobe Acrobat alternative, Foxit PDF Editor, offers dozens of useful features. This includes watermarking, adding headers and footers, tailoring password permissions, creating templates, and converting other documents to PDFs. One neat feature is being able to drag files of other formats - such as converting Excel to PDF or using the PowerPoint to PDF converter.
In our Foxit PDF Editor review, we felt it might not offer enough value to casual users, but the multi-platform PDF editor app was great for businesses who regularly need to manipulate, edit, redact, annotate, and alter PDF documents.
Indeed, the redaction tools were a special highlight for us. We were impressed with how easily they worked, thoroughly scrubbing sensitive data from documents .The feature is a boon for compliant-conscious teams who understand the importance of adhering to global data laws.
Pricing for Foxit PDF Editor is flexible, with monthly and yearly subscriptions. If on-going payments are one of the reasons you’re looking for the best Adobe Acrobat alternatives, there’s the opportunity to pick up a perpetual license for a one-off purchase.
You’ll also find two upgraded versions of the PDF editing software - Pro and Pro + - which add additional features for power-users.
PDF24 Creator isn’t just one of the best Adobe Acrobat alternatives for Windows - it’s also our top pick for best free PDF editor overall.
Despite the no-cost approach, the tool - a PC-only desktop app that works offline and is ideal for low-spec PCs - is surprisingly feature-rich.
During our time with the software, we rated it as “one of the best examples of free tools that go above and beyond. It’s packed full of features, and comes with everything you might need to create and edit a PDF document.”
Tools for PDF creation, compressing, merging, and converting are all present and results are grand. Extras like OCR and eSign are well-implemented. The interface is clean and fresh and emphasizes productivity - you can quickly find what you need and what to do.
We even felt it bested Adobe in one area. Praising Acrobat for its inclusion of tools for almost use-cases, we noted, “the only exception is if you need something more advanced for filling out forms, in which case an editor like PDF24 Creator or PDFZilla could work better, despite looking a bit clunkier.”
PDF24 Creator is available free and unlimited. The experience might not quite match Adobe’s fluid workflow, but it’s a price you can’t beat.
Best Adobe Acrobat alternative for avoiding subscriptions
Specifications
Operating system:Windows
Pricing:Perpetual license
Reasons to buy
+
Seamless integrations
+
E-signature workflows
+
Great collaboration tools
Reasons to avoid
-
Support ticket system restricted to VIP/Premium
-
Windows-only
Nitro PDF Pro is probably the best Acrobat alternative for those who absolutely, positively want to avoid subscriptions at all costs. You won’t find any on-going payment plans with this PDF editor. Just a one-off perpetual license.
When we tried out the product, we found it featured an impressive toolkit that compares favorably with Adobe Acrobat. The interface and experience make using the software incredibly simple and easy - a factor the sometimes overwhelming Acrobat struggles to boast.
Other tools to let you make changes to existing PDF documents, and even create one from scratch. You have a lot of tools at your disposal, including various ways to make annotations, leaving instructions for colleagues to follow.
Editing the real content of an already existing PDF isn’t as seamless as we’d like it to be, and that’s probably the weakest tool in Nitro’s arsenal. Everything else is very well implemented, and we especially liked how the ability to convert files to and from PDFs is performed.
Ultimately, we found this Adobe Acrobat alternative “a good PDF editing software package that allows you to make changes to documents, annotate them, and perform numerous alterations on them. It also comes with a good OCR, conversion tools.”
This PDF editing software is capable of running on a PC or a Mac, and costs $180 per license. Volume licensing for businesses is also available.
EaseUS PDF Editor is the ideal choice if you’re on a PC - it’s one of the best alternatives to Adobe Acrobat for Windows.
Unlike many of the best Acrobat alternatives, EaseUS has a free, but limited version available alongside the Pro version. This works great in a pinch, but it restricted in many ways - not least adding a watermark to your documents. The Pro version opens up the software, however.
In our review, we described EaseUS’ offering as “a powerful, PC-only PDF editing software tool that allows you to manipulate and alter documents with relative ease. It also comes with more standard features, such as a converter, and has good OCR capabilities.” Elsewhere, you’ll find outstanding PDF converter tools and eSignature tools.
The program is impressively kitted out for PDF editing, splitting pages into boxes that can be moved and resized. Content can also be changed, such as altering the font, color, and the text itself.
And it’s all housed within a refreshingly clean user interface. This makes navigating the tool an absolute breeze - not dissimilar to the excellent user experience offered in Adobe Acrobat, with its focus on maximizing productivity.
Costs for EaseUS PDF editor vary, with monthly and annual subscriptions and a one-time-buy ‘lifetime upgrade’ option. It’s ‘one license for one computer’. Bundles are available.
Best Acrobat alternative for Mac, iPad, and iPhone
Specifications
Operating system:Mac, iPad, iPhone
Pricing:Annual subscription / Perpetual license
Reasons to buy
+
Draw directly onto PDFs
+
iPhone and iPad versions
+
Free trial included
If you’re looking for the best Adobe Acrobat alternative for Mac, iPad, and iPhone, look no further than Readdle PDF Expert.
While modern Apple machines come preinstalled with the excellent Apple Preview - a tool we felt “should be able to cater to all but the most demanding PDF road warriors” - it’s more of a PDF reader and manipulator, rather than a full PDF editor, like Acrobat.
PDF Expert is much more fully featured, making it a much better alternative to Acrobat. Alongside image and text editing, Readdle’s product also comes kitted out with converter tools for Word, Excel, and PowerPoint, OCR and eSign tools.
When we tested out the software, we were impressed to find it “has lots of useful features for people who use PDF files on a regular basis. It has a very clean UI design and everything is neatly organized so you don’t need a lot of help in understanding how the software works when you use it for the first time.” We also loved how well PDF Expert synced documents on all Apple devices.
A wide range of editing tools include the ability to highlight parts of the PDF and add notes, redact sensitive information, extract or rearrange pages, and merge documents. Being able to draw directly onto the PDF is also useful for those who are using the software on iPad and have an Apple Pencil.
The sleek interface and a well-organized toolbar make it simple and intuitive for new users to accomplish everyday PDF editing tasks. In short, PDF Expert makes you feel like a PDF expert.
Pricing is via an annual subscription or a perpetual license - however, only the yearly fee offers use across iPhone, iPad, and Mac.
PDF Architect, from pdfforge, offers a range of PDF packages that rival Adobe Acrobat. The free plan includes basic PDF creation for Word, Excel, and PowerPoint docs, and the ability to merge, move, and delete pages and files.
More advanced features rest in the Standard, Professional, and Pro + OCR plans. These open up necessary editing, converting, collaboration tools, and more. When we took a look at PDF Architect, we awarded it 4 stars, calling it “a great choice for those who need a reliable, advanced PDF editor with lots of extra features and a stable, reliable interface.”
We appreciated the excellent interface, which will be familiar to anyone used to Microsoft Office software, and the extensive toolkit - praising the developers for “researching the market and identifying underserved niches.” Best of all, with minimal system requirements, PDF Architect is one of the best alternatives to Adobe Acrobat for low-end, low-spec computers.
However, there are limitations, even beyond the free version. eSignatures, for example, require a separate module in the PDF editor. For that reason, we recommend a free trial to get a feel for what you can and can’t do, to see if it fits your current workflow.
For those with a need to edit PDFs online and on a budget, Sejda offers a tool that might just be the best free Acrobat alternative online.
It’s available as a desktop version that saves files locally to your computer or an online version that uses cloud storage. But watch out for restrictions in the free version. You can only perform three tasks per day, you can only work on one document at a time, and file sizes cannot exceed 200 pages or 50MB.
One of Sejda’s real highlights is its security process. All files uploaded to the server are automatically deleted after two hours. Ideal, then, for businesses with a focus on data protection and compliance.
The tool isn’t without its faults, though. We found in-document text editing to be fairly basic, meaning you might encounter some issues replicating a typeface if the original PDF features a unique or unusual font. But as a useful Adobe Acrobat alternative for infrequent PDF editing, Sejda offers an excellent no-cost or low-cost option.
As we noted when we reviewed the software, it’s “a convincingly powerful PDF editor, but you'll need to pay if you need to use it a lot.”
Pricing comes in the form of a weekly and monthly subscriptions for the web app, or an annual desktop and web app subscription. Team and volume licensing is available.
How to choose the best Adobe Acrobat alternative for you
Why you can trust TechRadar Our expert reviewers spend hours testing and comparing products and services so you can choose the best for you. Find out more about how we test.
When deciding which Adobe Acrobat alternative is best for you, you first need to consider how you will be working with PDF files.
Modern operating systems and browsers can open PDFs without additional software, meaning this is all you need if you only want to view the files.
You can make basic edits using a PDF reader, many of which are available as free versions.
If you need to make more in-depth edits, batch process files, or convert between file types, then a fully-fledged PDF editor is the best choice for you.
What is a PDF?
PDF is an acronym for Portable Document Format. The filetype was invented by Adobe and designed to look identical across different devices and screens - so, it retains consistency and maintains accuracy without formatting issues. However, because it’s standardized, it also means it can’t be edited without the use of a PDF editor like Adobe Acrobat.
What is Adobe Acrobat?
Adobe Acrobat is a PDF editor for Windows, Mac, Linux, iOS, and Android. Unlike PDF readers, lets users create, edit, and annotate PDF documents that can easily be shared and viewed by others. It’s often considered the industry standard in PDF editing software. Not only did the company design the PDF format, but also introduced a range of tools so businesses can easily build and modify documents
Why do I need an Adobe Acrobat alternative?
The best Adobe Acrobat alternatives deliver similarly effortless interfaces and experiences for PDF editing - without the need for a Creative Cloud subscription. Although Acrobat remains the obvious choice for editing PDFs, and is often considered the industry standard PDF editor, it might not fit your overall workflow, meet your needs, or your budget. This is especially true if you’re not a power-user; if you’re not a PDF power-user, alternatives may meet your needs better.
How we test the best Adobe Acrobat alternatives
To test the best Adobe Acrobat alternatives, we downloaded and installed each piece of software to give you a first-hand opinion.
Our research looked at operating system compatibility, system requirements, and real-world performance when working with large files.
We explored each program's features, noting any significant additions and omissions compared to Adobe Acrobat.
We also investigated the price, payment models, and free versions (where available) for each Adobe Acrobat alternative. Finally, we looked at the support services and documentation offered by each developer as we feel it's a key part of the overall user experience.
Fri, 02 Dec 2022 03:30:00 -0600Steve Clarkentext/htmlhttps://www.techradar.com/best/adobe-acrobat-alternativesKillexams : Nurse practitioner requirements are changing, allowing them to practice without physician supervision
California’s nursing agency has approved rules that will allow nurse practitioners to treat patients without physician supervision. It’s a move that aims to expand access to care in the Golden State at a time when workforce shortages plague just about every corner of health care.
The vote earlier this month is one of the last major steps necessary to fully implement a 2020 law that will allow nurse practitioners to practice more freely. Nurse practitioners, who have advanced degrees and training, currently must enter into a written agreement with a physician who oversees their work with patients.
Despite some earlier concerns about potential delays, nurse practitioners say they are now confident that applications to start the certification process will go live early in the new year as planned.
“Hopefully we don’t crash the website, but we are very excited,” said Cynthia Jovanov, president of the California Association of Nurse Practitioners. “This means that if I want to do a mobile clinic in Skid Row, I don’t have to be held hostage by paperwork to get a partnering physician who may not have the same desire.”
Nurse practitioners are a cost-effective way of bringing more primary care providers to communities that need them, particularly in rural areas, said Glenn Melnick, a health economist at the University of Southern California.
“And that can benefit the consumer as long as the quality of care is acceptable,” he said. Still, there are a limited number of them.
Nurse practitioners in California have been fighting to break free of physician oversight for years. The biggest pushback came from physicians. During legislative debate, the California Medical Association said nurse practitioners have less training than physicians, so allowing them to practice independently could lessen the quality of care and even pose a risk to patients.
Law is not 'carte blanche'
In 2020, Gov. Gavin Newsom signed into law Assembly Bill 890, which was authored by Assemblyman Jim Wood, a Santa Rosa Democrat. To go into full effect, the Board of Registered Nursing had to first iron out details, including how nurse practitioners would transition into their more independent role and what type of additional training or testing, if any, would be needed to obtain certification.
The law essentially created two new categories of nurse practitioners. Starting in January, nurse practitioners who have completed 4,600 hours or three years of full-time clinical practice in California can apply for the first category. This first step will allow them to work without contractual physician supervision, but only in certain facilities where at least one doctor or surgeon also practices. The idea is nurse practitioners would still be able to consult a doctor when needed.
“So that does not give them (nurse practitioners) the carte blanche that I think some people were fearful of,” said Loretta Melby, executive officer of the state’s Board of Registered Nursing. “And then, when they are there for three years in that group setting with a physician or surgeon, only then can they advance to the (second category).”
This second designation will allow nurse practitioners full practice authority, without any setting restrictions. And in theory, nurse practitioners would be able to open their own medical practice. Given the phased-in approach, eligible nurse practitioners will likely obtain full independence around January of 2026.
California’s requirements for nurse practitioners to transition into full independence will be among the most robust in the country, according to one analysis by the California Health Care Foundation.
Nurse practitioners can perform physical exams, order lab tests, diagnose ailments and prescribe medication, but in California it had to be under the oversight of a doctor. Of the 31,000 nurse practitioners in California, an estimated 20,000 will be eligible to apply for expanded authority in 2023, according to the California Association of Nurse Practitioners.
Kenny Chen, a family nurse practitioner in South Central Los Angeles, exemplifies the type of clinicians researchers say California needs more of: He is interested in primary care; he speaks multiple languages, including Spanish and his native Mandarin; and he enjoys working with underserved populations.
Chen said that while he doesn’t expect major changes to his current role at Martin Luther King, Jr. Outpatient Center, the new law would allow his clinic to hire more nurse practitioners without having to meet physician-to-nurse practitioner ratios.
“It can be very difficult to recruit physicians to come work in South Central LA,” Chen said.
Giving nurse practitioners more authority, he said, can also attract more of them to California. All other western states, for example, already allow nurse practitioners greater independence. California’s restrictions could be a deterrence, he said.
Ahead of the vote, the California Medical Association sent a letter to the Board of Registered Nursing stating that the nursing board’s rules for nurse practitioners to transition into their independent roles lacked clarity and didn’t provide any more meaningful guidance than what was already stated in the text of the law.
Melby, the nursing board’s executive officer, said she has also heard concerns that the law would expand the scope of services that nurse practitioners can provide, but clarified that the law doesn’t actually change the type of work nurse practitioners will be doing.
“What was updated was the supervision requirement,” Melby said. “And so it’s not like the nurse practitioner is now going to have the freedom to go out and perform surgery; that has never been a nurse practitioner scope of practice.”
New rules may increase health care access
According to workforce researchers, allowing nurse practitioners more flexibility is a small but key piece of the puzzle in alleviating California’s provider shortage.
Even prior to the pandemic, California was experiencing a shortage of medical providers. A 2019 report by a commission of health care experts estimated that by 2030, the state would need an additional 4,100 primary care clinicians. About 7 million Californians already live in provider shortage areas with a need for primary, mental and dental care, according to the report.
Rural counties tend to have the greatest shortages — in counties like Glenn, Trinity, San Benito and Imperial, more than 80 percent of people live without sufficient access to care. And when patients do find care, they often rely on nurse practitioners. Some studies have shown that although physicians still make up the biggest proportion of primary care providers in rural areas, nurse practitioners are choosing to work in rural settings at a faster rate.
Alexa Curtis, a family and psychiatric mental health nurse practitioner at a substance use disorder facility in Nevada County, said the need in rural communities has driven most of her career. Curtis, who is also an associate dean at the School of Nursing at the University of San Francisco, plans to develop a rural street medicine program with a focus on unhoused people with mental health needs and substance use disorders.
Once she is granted greater authority, “I will be able to pursue that goal without the barrier and expense of needing to secure a physician supervisor,” she said.
But working with other types of providers, including physicians, will always be part of her practice. “It is how we are trained and how we function as nurse practitioners,” she said.
Earlier this year, Newsom also signed into law Senate Bill 1375, which authorizes nurse practitioners to provide reproductive care and first trimester abortions without doctor supervision.
These two wins were huge for nurse practitioners, said Jovanov, the president of the nurse practitioner lobby. “I can tell you that this will lead to many more bills for regulations that need to change. We’re on this momentum and that is really exciting.”
Sun, 27 Nov 2022 07:08:00 -0600entext/htmlhttps://www.bakersfield.com/news/nurse-practitioner-requirements-are-changing-allowing-them-to-practice-without-physician-supervision/article_e6b3b24c-6e81-11ed-a9bd-bf6f2e146710.htmlKillexams : 50,000 driving tests taken by learners who’ve failed five times alreadySome people may be better off not driving (Picture: Getty)
More than 50,000 driving tests a year are taken by people who have already failed at least five times, research shows.
The RAC Foundation said the figures suggest ‘driving might not be the thing for some people’.
Its analysis of Department for Transport data found 50,875 practical tests taken in Britain in the 12 months to March were candidates on their sixth attempt or greater.
Just 40% of these were passed. Learners aged 60 and above were behind the wheel for 290 of the tests. Their pass rate was 27% for men and 19% for women.
The average success rate for all tests is 49%.
DfT bosses recently said the frequency of examiners ‘physically’ intervening to avoid a dangerous incident has increased to one in eight tests.
Practical driving tests cost between £62 and £75 depending on when they are taken.
The total bill for repeated failures could run into thousands of pounds for learners who often pay for more lessons.
However, RAC Foundation director Steve Gooding said the number of failed tests may provide ‘reassurance’ to people who suspect it is too easy to get a licence.
‘For some learners that’s clearly far from the case,’ he said.
‘One loud and clear message this data reveals is that however hard some people find it to pass their test, becoming a qualified driver is so important to them that it is worth the money, time and energy involved in battling on to secure their licence.’
Mr Gooding believes the backlog of people wanting tests – caused by the pandemic – means some people may accept slots even if they’re not ready.
He added: ‘Of course, one other conclusion to be drawn from the figures is that driving might not be the thing for some people.’
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Mon, 28 Nov 2022 02:02:00 -0600Joe Robertsentext/htmlhttps://metro.co.uk/2022/11/28/50000-driving-tests-taken-by-learners-who-have-failed-five-times-17837890/Killexams : The best used cars for learners under £5k
There are three prerequisites for the ideal learner car. First, unless the bank of mum and dad is flush, it must be cheap to buy. Cheap to run, too. And definitely cheap to insure.
Yet that doesn’t mean the car should be cheaply made, merely inexpensive. Even the cheapest models from budget brands are rigorously engineered, although some are better than others when it comes to factors such as safety.
Traditionally the best first cars have been ageing used models, available for £1,000 or often much less. But there’s a good chance you’ll be buying a heap of trouble with one of these, with skimped maintenance rife.
More latest models tend to be safer; most teenagers (and their parents) may feel more confident with something no more than 10 years old. What’s more, anybody still learning to drive would be better off doing so in a modern car, like the one they’re likely to drive in future.
Mon, 28 Nov 2022 22:00:00 -0600en-GBtext/htmlhttps://www.telegraph.co.uk/cars/features/best-used-cars-learners-5k/Killexams : Learners with at least five failures take more than 50,000 driving tests a year
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More than 50,000 driving tests a year are taken by learners who have already failed at least five times, according to new analysis.
Motoring research charity RAC Foundation said the figures suggest “driving might not be the thing for some people”.
Its analysis of Department for Transport (DfT) figures found 50,875 practical tests taken in Britain in the 12 months to the end of March were the candidates’ sixth attempt or greater.
Just 40% of the tests were passed, compared with an average success rate for all tests of 49%.
Learners aged 60 and above were behind the wheel for 290 of the tests taken by candidates with a minimum of five previous failures.
Their pass rate was 27% for men and 19% for women.
Of course, one other conclusion to be drawn from the figures is that driving might not be the thing for some people
Steve Gooding, RAC Foundation
The DfT recently said the frequency of examiners having to “physically intervene to avoid a dangerous incident” has increased to one in eight tests.
Practical driving tests cost between £62 and £75 depending on when they are taken.
The total bill for repeated failures could run into thousands of pounds for learners who pay for more lessons.
RAC Foundation director Steve Gooding said the number of failed tests may provide “reassurance” to people who suspect it is too easy to get a licence, as “for some learners that’s clearly far from the case”.
He went on: “One loud and clear message this data reveals is that however hard some people find it to pass their test, becoming a qualified driver is so important to them that it is worth the money, time and energy involved in battling on to secure their licence.”
Mr Gooding believes the backlog of people wanting tests – caused by the coronavirus pandemic – means some people could accept slots “whether they are ready or not, for fear of a long wait if they delay”.
He added: “Of course, one other conclusion to be drawn from the figures is that driving might not be the thing for some people.”
Sat, 26 Nov 2022 19:06:00 -0600entext/htmlhttps://www.independent.co.uk/news/uk/rac-foundation-dft-britain-department-for-transport-b2233782.htmlKillexams : We disagree with doctors’ lobby, care from nurse practitioners should be expanded
First, do no harm.
That’s the credo our docs all sign on to, right?
Actually, let’s first clear something up about that “docs” business. People with MDs, despite what some of them and all of their lobbies maintain, are not the only doctors in this world. And they are not the only top-level medical professionals, either.
Dentists, pharmacists, doctors of physical therapy, osteopaths, chiropractors and very, very much, nurses — have both the training and the hands-on experience to treat many of the ailments physicians do. We would lobby, in fact, for that word — physician — to be the one used for our MDs. Nothing against them — everything for them. They often are first among equals among the dedicated people who take care of our health.
But through their lobbying groups, they are also too often first to go after the ability of any other caregivers who they perceive to be muscling in on their territory, whether allowing some leeway and advances in practice by other medical professionals is good for the public health, or not.
That’s why we cringed once again when reading of the reaction the MD lobby has to the latest effort in California to help expand health care through other means, in this case by allowing the highly trained people known as nurse practitioners to better care for us: “Some physicians are concerned the rules will expand the scope of services nurse practitioners provide,” a report says.
Yes, docs. That’s precisely what some new state rules will do. And thanks be for that.
As CalMatters reported Nov. 16, “California’s nursing agency this week approved rules that will allow nurse practitioners to treat patients without physician supervision. It’s a move that aims to expand access to care in the Golden State at a time when workforce shortages plague just about every corner of health care.”
That’s right — there aren’t enough physicians in this state to adequately take care of all Californians, especially in rural areas. And yet the “doctor” lobby is more interested in protecting its members’ loosening monopoly on health care than it is in, well, providing real health care for all.
That’s sick.
The vote by the nursing board, CalMatters reports, is one of the last steps necessary to fully bring into practice a 2020 law that will allow nurse practitioners to practice more widely. “Nurse practitioners, who have advanced degrees and training, currently must enter into a written agreement with a physician who oversees their work with patients,” and too often that’s a hard paper to get signed.
“If I want to do a mobile clinic in Skid Row, I don’t have to be held hostage by paperwork to get a partnering physician who may not have the same desire,” says Cynthia Jovanov, president of the California Association of Nurse Practitioners.
When the 2020 bill was going through the Legislature, the California Medical Association was the biggest opponent, saying that since nurse practitioners have less training than physicians, letting them practice independently might lower the level of care and “even pose a risk to patients.”
Everyone has less training than someone else. Your GP doesn’t have, or claim to have, advanced cardiac-care training. That’s why she’s your general practitioner.
And the new law, authored by Assemblymember Jim Wood, D-Santa Rosa, is not exactly opening up some kind of anarchy in the state’s health care climate. It says that beginning next month, nurse practitioners who have completed 4,600 hours or three years of full-time clinical practice in California can apply for an initial category of practice in their field independent from a physician. In that first category, the nurses’ work must be in a facility where there are physicians to consult with when the nurses have questions.
After another period of intense training and practice, by 2026, some nurse practitioners will be able to apply for a second category of care allowing them to work with less supervision.
Come on, “docs.” Drop your historical opposition to such progress. First, do no harm.
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Fri, 02 Dec 2022 04:23:00 -0600The Editorial Boarden-UStext/htmlhttps://www.dailynews.com/2022/12/02/physicians-first-please-do-us-no-harm/Killexams : Positive reinforcement can spur physicians and health practitioners to promote tobacco cessation
University of Maryland Medical System researchers studied the effects of positive reinforcement to encourage physicians and health practitioners to promote referral to tobacco Quitline resources. The researchers observed an uptick in referrals after physicians and health practitioners received letters and certificates acknowledging their referral efforts in January 2022, indicating that positive feedback and acknowledgment may Strengthen tobacco cessation e-referral rates.
The authors assert that providing physicians and health care providers with access to accurate EHR data can also be a valuable tool in improving clinical outcomes in vulnerable populations and that recognition of physicians' and practitioners' efforts can potentially be expanded beyond tobacco cessation to address other areas of practice.
Tobacco use is one of the most preventable causes of morbidity and mortality in the United States. In our project, positive reinforcement for tobacco cessation referrals was accomplished by recognizing physicians/practitioners across the University of Maryland Medical System (UMMS) for their commitment to tobacco cessation.
The tobacco e-referral outreach and education initiative includes the entirety of the UMMS, which spans 12 hospitals and more than 150 ambulatory clinics in 11 counties and Baltimore City.
There are more than 4,600 affiliated physicians providing primary and specialty care who can utilize the tobacco cessation e-referral within the Epic electronic health record (EHR) to refer patients who use tobacco to the Maryland Quitline, or to the on-campus Tobacco Health Practice.
Outreach and education are conducted across UMMS to physicians/practitioners to promote the use of a tobacco cessation e-referral to the Maryland Quitline or to the Tobacco Health Practice for patients who use tobacco products. Referrals to the Maryland Quitline have been demonstrated to reach the most vulnerable segments of our population. Over 500 physicians/practitioners and staff were educated across 40 presentations on how to use the e-referrals.
Educational subjects include tobacco epidemiology, types of tobacco products including e-cigarettes/vape devices, tobacco cessation pharmacotherapeutics, tobacco treatment options, and EHR workflows. Education occurred via grand rounds, departmental meetings, webinars, pre-recorded presentations, Epic tip sheets, and one-on-one academic detailing.
Data from the Epic EHR were reviewed to identify the number of tobacco cessation e-referrals to the Maryland Quitline by physicians/practitioners across the UMMS in 2021. Physicians/practitioners who e-referred 10 or more patients in a 12-month period were considered "Tobacco Cessation Champions," and those who e-referred less than 10 patients were considered "Tobacco Cessation Advocates."
Each physician/practitioner received a letter and certificate via e-mail celebrating their work and inspiring them to encourage their colleagues to e-refer their patients for tobacco cessation. Letters and certificates were tailored to Champions and Advocates, respectively. In 2021, 264 physicians/practitioners e-referred patients to the Maryland Quitline.
These physicians/practitioners received a letter and certificate in January 2022. There were 203 e-referrals submitted to the Maryland Quitline in the 4th quarter of 2021 and 269 e-referrals submitted to the Maryland Quitline in the 1st quarter of 2022. There were also 443 referrals to the Tobacco Health Practice in 2021. The sustainability of this effort is supported by having developed a scalable EHR workflow and training material existing in perpetuity.
Positive reinforcement and acknowledgment of physicians'/practitioners' work to Strengthen their patients' health may help increase tobacco cessation e-referrals. Physicians/practitioners self reported enthusiasm at being acknowledged for their effort. Access to accurate EHR data can be a valuable tool in quality improvement to Strengthen clinical outcomes in vulnerable populations.
Recognition of physician/practitioner efforts can potentially be expanded beyond tobacco cessation to address other areas of practice. Future iterations of this effort should consider the proportion of patients who smoke and patients who do not require referral for treatment. Utilizing the rate of eligible smokers who need and are referred for treatment may produce a more accurate representation of physician/practitioner treatment efforts.
The research was published in The Annals of Family Medicine.
More information: Niharika Khanna et al, Tobacco Cessation Champions: Recognizing Physicians Who Ask, Advise, and Refer, The Annals of Family Medicine (2022). DOI: 10.1370/afm.2891
Citation: Positive reinforcement can spur physicians and health practitioners to promote tobacco cessation (2022, November 29) retrieved 9 December 2022 from https://medicalxpress.com/news/2022-11-positive-spur-physicians-health-practitioners.html
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