.JPG)
When Charles Pyron's heart rhythm problem wasn't getting better, he turned to the heart specialists at UAB. UAB Cardiologist Vance Plumb, M.D., explains the benefits of treatment at UAB.
About Me
Saturday, May 24, 2008
ECG Video: Atrial Fibrillation
Atrial fibrillation is one of the most commonly encountered cardiac arrhythmias
ECG Video: Atrial Flutter
Atrial flutter is a common arrhythmia. Here is a video recording from the cardiac monitor...
ECG Video: Ventricular Tachycardia
Ventricular tachycardia can be with pulse or pulseless. Pulseless VT is a type of cardiac arrest
ECG Video: Paroxysmal supraventricular tachycardia
A common arrhythmia presenting with palpitation is young individuals
Friday, May 23, 2008
ECG Video: AV Block - Complete (Third Degree)
Complete dissociation between atrial and ventricular electrical activity.
ECG Video: Cardiac Asystole
Complete cardiac standstill. Once confirmed, considered as cardiac arrest
ECG Video: Pacemaker Rhythm
When a patient is receiving electrical stimulation from a pacemaker for cardiac activity, this is how it looks like...
More on: http://www.mediscuss.org/talk/forumdisplay.php?f=65
More on: http://www.mediscuss.org/talk/forumdisplay.php?f=65
The Pacemaker of the Heart
The Pacemaker of the Heart
The pacemaker of the heart, a tiny area of specialized nervous tissue in the right atrium, sets the heart beating about seventy times a minute. Without it the heart would beat only forty times per minute, which is too slow for the body's needs. The pacemaker, or sinuatrial node, regularly sends out nerve impulses which spread through the two atria, causing them to contract. From the atrioventricular node the contraction spreads down special conducting tissue, the bundle of His, causing the ventricles to contract and pump blood out of the heart.
The pacemaker of the heart, a tiny area of specialized nervous tissue in the right atrium, sets the heart beating about seventy times a minute. Without it the heart would beat only forty times per minute, which is too slow for the body's needs. The pacemaker, or sinuatrial node, regularly sends out nerve impulses which spread through the two atria, causing them to contract. From the atrioventricular node the contraction spreads down special conducting tissue, the bundle of His, causing the ventricles to contract and pump blood out of the heart.
ECG Video: Ventricular Fibrillation
A deadly arrhythmia, commonest cause of death of myocardial infarction.
Ventricular fibrillation
From Wikipedia, the free encyclopedia
http://en.wikipedia.org/wiki/Main_Page
Ventricular fibrillation (V-fib or VF) is a condition in which there is uncoordinated contraction of the cardiac muscle of the ventricles in the heart, making them tremble rather than contract properly. Ventricular fibrillation is a medical emergency. If the arrhythmia continues for more than a few seconds, blood circulation will cease, and death will occur in a matter of minutes.
Historical aspects
Lyman Brewer suggests that the first recorded account of ventricular fibrillation dates as far back as 1500 BC, and can be found in the Ebers papyrus of ancient Egypt. The extract recorded 3500 years ago may even date from as far back as 3500 BC. It states: "When the heart is diseased, its work is imperfectly performed: the vessels proceeding from the heart become inactive, so that you cannot feel them … if the heart trembles, has little power and sinks, the disease is advanced and death is near."
Whether this is a description of ventricular fibrillation is debatable (Brewer LA 1983). The next recorded description occurs 3000 years later and is recorded by Vesalius, who described the appearance of "worm-like" movements of the heart in animals prior to death.
The significance and clinical importance of these observations and descriptions possibly of ventricular fibrillation were not recognised until John Erichsen in 1842 described ventricular fibrillation following the ligation of a coronary artery (Erichsen JE 1842). Subsequent to this in 1850, fibrillation was described by Ludwig and Hoffa when they demonstrated the provocation of Ventricular fibrillation in an animal by applying a "faradic" current to the heart [1].
In 1874, Edmé Félix Alfred Vulpian coined the term mouvement fibrillaire, a term that he seems to have used to describe both atrial and ventricular fibrillation[2]. John A. MacWilliam, a physiologist who had trained under Ludwig and who subsequently became Professor of Physiology at the University of Aberdeen, gave an accurate description of the arrhythmia in 1887. This definition still holds today, and is interesting in the fact that his studies and description predate the use of electrocardiography. His description is as follows: "The ventricular muscle is thrown into a state of irregular arrhythmic contraction, whilst there is a great fall in the arterial blood pressure, the ventricles become dilated with blood as the rapid quivering movement of their walls is insufficient to expel their contents; the muscular action partakes of the nature of a rapid incoordinate twitching of the muscular tissue … The cardiac pump is thrown out of gear, and the last of its vital energy is dissipated in the violent and the prolonged turmoil of fruitless activity in the ventricular walls." MacWilliam spent many years working on ventricular fibrillation and was one of the first to show that ventricular fibrillation could be terminated by a series of induction shocks through the heart[3].
The first electrocardiogram recording of ventricular fibrillation was by August Hoffman in a paper published in 1912 [4]. At this time, two other researchers, Mines and Garrey, working separately, produced work demonstrating the phenomenon of circus movement and re-entry as possible substrates for the generation of arrhythmias. This work was also accompanied by Lewis, who performed further outstanding work into the concept of "circus movement."
Later milestones include the work by Kerr and Bender in 1922, who produced an electrocardiogram showing ventricular tachycardia evolving into ventricular fibrillation[5]. The re-entry mechanism was also advocated by DeBoer, who showed that ventricular fibrillation could be induced in late systole with a single shock to a frog heart[6]. The concept of "R on T ectopics" was further brought out by Katz in 1928[7]. This was called the “vulnerable period” by Wiggers and Wegria in 1940, who brought to attention the concept of the danger of premature ventricular beats occurring on a T wave.
Another definition of VF was produced by Wiggers in 1940. He described ventricular fibrillation as "an incoordinate type of contraction which, despite a high metabolic rate of the myocardium, produces no useful beats. As a result, the arterial pressure falls abruptly to very low levels, and death results within six to eight minutes from anemia of the brain and spinal cord"[8].
Spontaneous conversion of ventricular fibrillation to a more benign rhythm is rare in all but small animals. Defibrillation is the process that converts ventricular fibrillation to a more benign rhythm. This is usually by application of an electric shock to the myocardium and will be discussed later.
[edit] Mechanisms of ventricular fibrillation
Ventricular fibrillation has been described as "chaotic asynchronous fractionated activity of the heart" (Moe et al. 1964). A more complete definition is that ventricular fibrillation is a "turbulent, disorganised electrical activity of the heart in such a way that the recorded electrocardiographic deflections continuously change in shape, magnitude and direction"[9].
Ventricular fibrillation most commonly occurs within diseased hearts, and, in the vast majority of cases, is a manifestation of underlying ischaemic heart disease. Ventricular fibrillation is also seen in those with cardiomyopathy, myocarditis, and other heart pathologies. In addition, it is seen with electrolyte disturbances and overdoses of cardiotoxic drugs. It is also notable that ventricular fibrillation occurs where there is no discernible heart pathology or other evident cause, the so-called idiopathic ventricular fibrillation.
Idiopathic ventricular fibrillation occurs with a reputed incidence of approximately 1% of all cases of out-of-hospital arrest, as well as 3%-9% of the cases of ventricular fibrillation unrelated to myocardial infarction, and 14% of all ventricular fibrillation resuscitations in patients under the age of 40[10]. It follows then that, on the basis of the fact that ventricular fibrillation itself is common, idiopathic ventricular fibrillation accounts for an appreciable mortality. Recently-described syndromes such as the Brugada Syndrome may give clues to the underlying mechanism of ventricular arrhythmias. In the Brugada syndrome, changes may be found in the resting ECG with evidence of right bundle branch block (RBBB) and ST elevation in the chest leads V1-V3, with an underlying propensity to sudden cardiac death[11].
The relevance of this is that theories of the underlying pathophysiology and electrophysiology must account for the occurrence of fibrillation in the apparent "healthy" heart. It is evident that there are mechanisms at work that we do not fully appreciate and understand. Investigators are exploring new techniques of detecting and understanding the underlying mechanisms of sudden cardiac death in these patients without pathological evidence of underlying heart disease[12].
Familial conditions that predispose individuals to developing ventricular fibrillation and sudden cardiac death are often the result of gene mutations that affect cellular transmembrane ion channels. For example, in Brugada Syndrome, sodium channels are affected. In certain forms of long QT syndrome, the potassium inward rectifier channel is affected.
[edit] Consequences
Ventricular fibrillation is a cause of cardiac arrest and sudden cardiac death. The ventricular muscle twitches randomly, rather than contracting in unison, and so the ventricles fail to pump blood into the arteries and into systemic circulation.
Ventricular fibrillation is a sudden lethal arrhythmia responsible for many deaths in the Western world, mostly brought on by ischaemic heart disease. Despite much work, the underlying nature of fibrillation is not completely understood. Most episodes of fibrillation occur in diseased hearts, but others occur in so-called normal hearts. Much work still has to be done to elucidate the mechanisms of ventricular fibrillation.
[edit] Prevalence
Sudden cardiac arrest is the leading cause of death in the industrialised world. It exacts a significant mortality with approximately 70,000 to 90,000 sudden cardiac deaths each year in the United Kingdom, and survival rates are only 2%[13]. The majority of these deaths are due to ventricular fibrillation secondary to myocardial infarction, or "heart attack"[14]. During ventricular fibrillation, cardiac output drops to zero, and, unless remedied promptly, death usually ensues within minutes.
[edit] Treatment
The condition can often be reversed by the electric discharge of direct current from a defibrillator. If no defibrillator is available, a precordial thump can be delivered at the onset of VF to regain cardiac function. If there is no other option available this can be tried, however, research has shown that the precordial thump releases no more than 30 joules of energy. This is far less than the 300–360 J required to bring about normal sinus rhythm. Consequently, in the hospital setting, this treatment is not used. Antiarrhythmic agents like amiodarone or lidocaine can help, but, unlike atrial fibrillation, VF rarely reverses spontaneously in large adult mammals. Although a defibrillator is designed to correct the problem, and its effects can be dramatic, it is not always successful.
In patients at high risk of ventricular fibrillation, the use of an implantable cardioverter defibrillator has been shown to be beneficial.
[edit] Re-entry
The role of re-entry or circus motion was demonstrated separately by Mines and Garrey[15]. Mines created a ring of excitable tissue by cutting the atria out of the ray fish. Garrey cut out a similar ring from the turtle ventricle. They were both able to show that, if a ring of excitable tissue was stimulated at a single point, the subsequent waves of depolarisation would pass around the ring. The waves eventually meet and cancel each other out, but, if an area of transient block occurred with a refractory period that blocked one wavefront and subsequently allowed the other to proceed retrogradely over the other path, then a self-sustaining circus movement phenomenon would result. For this to happen, however, it is necessary that there be some form of non-uniformity. In practice, this may be an area of ischaemic or infarcted myocardium, or underlying scar tissue.
It is possible to think of the advancing wave of depolarisation as a dipole with a head and a tail. The length of the refractory period and the time taken for the dipole to travel a certain distance—the propagation velocity—will determine whether such a circumstance will arise for re-entry to occur. Factors that promote re-entry would include a slow-propagation velocity, a short refractory period with a sufficient size of ring of conduction tissue. These would enable a dipole to reach an area that had been refractory and is now able to be depolarised with continuation of the wavefront.
In clinical practice, therefore, factors that would lead to the right conditions to favour such re-entry mechanisms include increased heart size through hypertrophy or dilatation, drugs which alter the length of the refractory period and areas of cardiac disease. Therefore, the substrate of ventricular fibrillation is transient or permanent conduction block. Block due either to areas of damaged or refractory tissue leads to areas of myocardium for initiation and perpetuation of fibrillation through the phenomenon of re-entry.
[edit] Abnormal automaticity
Automaticity is a measure of the propensity of a fiber to initiate an impulse spontaneously. The product of a hypoxic myocardium can be hyperirritable myocardial cells. These may then act as pacemakers. The ventricles are then being stimulated by more than one pacemaker. This may well lead to the generation of a circus-entry arrhythmia. Scar and dying tissue is inexcitable, but around these areas usually lies a penumbra of hypoxic tissue that is excitable. Ventricular excitability may be the trigger to generate re-entry arrhythmias.
It is interesting to note that most cardiac zain with an associated increased propensity to arrhythmia development have an associated loss of membrane potential. That is, the maximum diastolic potential is less negative and therefore exists closer to the threshold potential. Cellular depolarisation can be due to a raised external concentration of potassium ions K+, a decreased intracellular concentration of sodium ions Na+, increased permeability to Na+, or a decreased permeability to K+. The ionic basis of automaticity is the net gain of an intracellular positive charge during diastole in the presence of a voltage-dependent channel activated by potentials negative to –50 to –60 mV.
Myocardial cells are exposed to different environments. Normal cells may be exposed to hyperkalaemia; abnormal cells may be perfused by normal environment. For example, with a healed myocardial infarction, abnormal cells can be exposed to an abnormal environment such as with a myocardial infarction with myocardial ischaemia. In conditions such as myocardial ischaemia, possible mechanism of arrhythmia generation include the resulting decreased internal K+ concentration, the increased external K+ concentration, norepinephrine release and acidosis[16].
[edit] Triggered activity
Triggered activity can occur due to the presence of afterdepolarisations. These are depolarising oscillations in the membrane voltage induced by preceding action potentials. These can occur before or after full repolarisation of the fiber and as such are termed either early (EADs) or delayed afterdepolarisations (DADs). All afterdepolarisations may not reach threshold potential, but, if they do, they can trigger another afterdepolarisation, and thus self-perpetuate.
[edit] Characteristics of the ventricular fibrillation waveform
Ventricular fibrillation can be described in terms of its electrocardiographic waveform appearance. All waveforms can be described in terms of certain features, such as amplitude and frequency. Researchers have looked at the frequency of the ventricular fibrillation waveform to see if it helps to elucidate the underlying mechanism of the arrhythmia or holds any clinically useful information. More recently, Gray has suggested an underlying mechanism for the frequency of the waveform that has puzzled investigators as possibly being a manifestation of the Doppler effect of rotors of fibrillation[17]. Analysis of the fibrillation waveform is performed using a mathematical technique known as Fourier analysis.
[edit] Power spectrum
The distribution of frequency and power of a waveform can be expressed as a power spectrum in which the contribution of different waveform frequencies to the waveform under analysis is measured. This can be expressed as either the dominant or peak frequency, i.e., the frequency with the greatest power or the median frequency, which divides the spectrum in two halves.
Frequency analysis has many other uses in medicine and in cardiology, including analysis of heart rate variability and assessment of cardiac function, as well as in imaging and acoustics
Ventricular fibrillation
From Wikipedia, the free encyclopedia
http://en.wikipedia.org/wiki/Main_Page
Ventricular fibrillation (V-fib or VF) is a condition in which there is uncoordinated contraction of the cardiac muscle of the ventricles in the heart, making them tremble rather than contract properly. Ventricular fibrillation is a medical emergency. If the arrhythmia continues for more than a few seconds, blood circulation will cease, and death will occur in a matter of minutes.
Historical aspects
Lyman Brewer suggests that the first recorded account of ventricular fibrillation dates as far back as 1500 BC, and can be found in the Ebers papyrus of ancient Egypt. The extract recorded 3500 years ago may even date from as far back as 3500 BC. It states: "When the heart is diseased, its work is imperfectly performed: the vessels proceeding from the heart become inactive, so that you cannot feel them … if the heart trembles, has little power and sinks, the disease is advanced and death is near."
Whether this is a description of ventricular fibrillation is debatable (Brewer LA 1983). The next recorded description occurs 3000 years later and is recorded by Vesalius, who described the appearance of "worm-like" movements of the heart in animals prior to death.
The significance and clinical importance of these observations and descriptions possibly of ventricular fibrillation were not recognised until John Erichsen in 1842 described ventricular fibrillation following the ligation of a coronary artery (Erichsen JE 1842). Subsequent to this in 1850, fibrillation was described by Ludwig and Hoffa when they demonstrated the provocation of Ventricular fibrillation in an animal by applying a "faradic" current to the heart [1].
In 1874, Edmé Félix Alfred Vulpian coined the term mouvement fibrillaire, a term that he seems to have used to describe both atrial and ventricular fibrillation[2]. John A. MacWilliam, a physiologist who had trained under Ludwig and who subsequently became Professor of Physiology at the University of Aberdeen, gave an accurate description of the arrhythmia in 1887. This definition still holds today, and is interesting in the fact that his studies and description predate the use of electrocardiography. His description is as follows: "The ventricular muscle is thrown into a state of irregular arrhythmic contraction, whilst there is a great fall in the arterial blood pressure, the ventricles become dilated with blood as the rapid quivering movement of their walls is insufficient to expel their contents; the muscular action partakes of the nature of a rapid incoordinate twitching of the muscular tissue … The cardiac pump is thrown out of gear, and the last of its vital energy is dissipated in the violent and the prolonged turmoil of fruitless activity in the ventricular walls." MacWilliam spent many years working on ventricular fibrillation and was one of the first to show that ventricular fibrillation could be terminated by a series of induction shocks through the heart[3].
The first electrocardiogram recording of ventricular fibrillation was by August Hoffman in a paper published in 1912 [4]. At this time, two other researchers, Mines and Garrey, working separately, produced work demonstrating the phenomenon of circus movement and re-entry as possible substrates for the generation of arrhythmias. This work was also accompanied by Lewis, who performed further outstanding work into the concept of "circus movement."
Later milestones include the work by Kerr and Bender in 1922, who produced an electrocardiogram showing ventricular tachycardia evolving into ventricular fibrillation[5]. The re-entry mechanism was also advocated by DeBoer, who showed that ventricular fibrillation could be induced in late systole with a single shock to a frog heart[6]. The concept of "R on T ectopics" was further brought out by Katz in 1928[7]. This was called the “vulnerable period” by Wiggers and Wegria in 1940, who brought to attention the concept of the danger of premature ventricular beats occurring on a T wave.
Another definition of VF was produced by Wiggers in 1940. He described ventricular fibrillation as "an incoordinate type of contraction which, despite a high metabolic rate of the myocardium, produces no useful beats. As a result, the arterial pressure falls abruptly to very low levels, and death results within six to eight minutes from anemia of the brain and spinal cord"[8].
Spontaneous conversion of ventricular fibrillation to a more benign rhythm is rare in all but small animals. Defibrillation is the process that converts ventricular fibrillation to a more benign rhythm. This is usually by application of an electric shock to the myocardium and will be discussed later.
[edit] Mechanisms of ventricular fibrillation
Ventricular fibrillation has been described as "chaotic asynchronous fractionated activity of the heart" (Moe et al. 1964). A more complete definition is that ventricular fibrillation is a "turbulent, disorganised electrical activity of the heart in such a way that the recorded electrocardiographic deflections continuously change in shape, magnitude and direction"[9].
Ventricular fibrillation most commonly occurs within diseased hearts, and, in the vast majority of cases, is a manifestation of underlying ischaemic heart disease. Ventricular fibrillation is also seen in those with cardiomyopathy, myocarditis, and other heart pathologies. In addition, it is seen with electrolyte disturbances and overdoses of cardiotoxic drugs. It is also notable that ventricular fibrillation occurs where there is no discernible heart pathology or other evident cause, the so-called idiopathic ventricular fibrillation.
Idiopathic ventricular fibrillation occurs with a reputed incidence of approximately 1% of all cases of out-of-hospital arrest, as well as 3%-9% of the cases of ventricular fibrillation unrelated to myocardial infarction, and 14% of all ventricular fibrillation resuscitations in patients under the age of 40[10]. It follows then that, on the basis of the fact that ventricular fibrillation itself is common, idiopathic ventricular fibrillation accounts for an appreciable mortality. Recently-described syndromes such as the Brugada Syndrome may give clues to the underlying mechanism of ventricular arrhythmias. In the Brugada syndrome, changes may be found in the resting ECG with evidence of right bundle branch block (RBBB) and ST elevation in the chest leads V1-V3, with an underlying propensity to sudden cardiac death[11].
The relevance of this is that theories of the underlying pathophysiology and electrophysiology must account for the occurrence of fibrillation in the apparent "healthy" heart. It is evident that there are mechanisms at work that we do not fully appreciate and understand. Investigators are exploring new techniques of detecting and understanding the underlying mechanisms of sudden cardiac death in these patients without pathological evidence of underlying heart disease[12].
Familial conditions that predispose individuals to developing ventricular fibrillation and sudden cardiac death are often the result of gene mutations that affect cellular transmembrane ion channels. For example, in Brugada Syndrome, sodium channels are affected. In certain forms of long QT syndrome, the potassium inward rectifier channel is affected.
[edit] Consequences
Ventricular fibrillation is a cause of cardiac arrest and sudden cardiac death. The ventricular muscle twitches randomly, rather than contracting in unison, and so the ventricles fail to pump blood into the arteries and into systemic circulation.
Ventricular fibrillation is a sudden lethal arrhythmia responsible for many deaths in the Western world, mostly brought on by ischaemic heart disease. Despite much work, the underlying nature of fibrillation is not completely understood. Most episodes of fibrillation occur in diseased hearts, but others occur in so-called normal hearts. Much work still has to be done to elucidate the mechanisms of ventricular fibrillation.
[edit] Prevalence
Sudden cardiac arrest is the leading cause of death in the industrialised world. It exacts a significant mortality with approximately 70,000 to 90,000 sudden cardiac deaths each year in the United Kingdom, and survival rates are only 2%[13]. The majority of these deaths are due to ventricular fibrillation secondary to myocardial infarction, or "heart attack"[14]. During ventricular fibrillation, cardiac output drops to zero, and, unless remedied promptly, death usually ensues within minutes.
[edit] Treatment
The condition can often be reversed by the electric discharge of direct current from a defibrillator. If no defibrillator is available, a precordial thump can be delivered at the onset of VF to regain cardiac function. If there is no other option available this can be tried, however, research has shown that the precordial thump releases no more than 30 joules of energy. This is far less than the 300–360 J required to bring about normal sinus rhythm. Consequently, in the hospital setting, this treatment is not used. Antiarrhythmic agents like amiodarone or lidocaine can help, but, unlike atrial fibrillation, VF rarely reverses spontaneously in large adult mammals. Although a defibrillator is designed to correct the problem, and its effects can be dramatic, it is not always successful.
In patients at high risk of ventricular fibrillation, the use of an implantable cardioverter defibrillator has been shown to be beneficial.
[edit] Re-entry
The role of re-entry or circus motion was demonstrated separately by Mines and Garrey[15]. Mines created a ring of excitable tissue by cutting the atria out of the ray fish. Garrey cut out a similar ring from the turtle ventricle. They were both able to show that, if a ring of excitable tissue was stimulated at a single point, the subsequent waves of depolarisation would pass around the ring. The waves eventually meet and cancel each other out, but, if an area of transient block occurred with a refractory period that blocked one wavefront and subsequently allowed the other to proceed retrogradely over the other path, then a self-sustaining circus movement phenomenon would result. For this to happen, however, it is necessary that there be some form of non-uniformity. In practice, this may be an area of ischaemic or infarcted myocardium, or underlying scar tissue.
It is possible to think of the advancing wave of depolarisation as a dipole with a head and a tail. The length of the refractory period and the time taken for the dipole to travel a certain distance—the propagation velocity—will determine whether such a circumstance will arise for re-entry to occur. Factors that promote re-entry would include a slow-propagation velocity, a short refractory period with a sufficient size of ring of conduction tissue. These would enable a dipole to reach an area that had been refractory and is now able to be depolarised with continuation of the wavefront.
In clinical practice, therefore, factors that would lead to the right conditions to favour such re-entry mechanisms include increased heart size through hypertrophy or dilatation, drugs which alter the length of the refractory period and areas of cardiac disease. Therefore, the substrate of ventricular fibrillation is transient or permanent conduction block. Block due either to areas of damaged or refractory tissue leads to areas of myocardium for initiation and perpetuation of fibrillation through the phenomenon of re-entry.
[edit] Abnormal automaticity
Automaticity is a measure of the propensity of a fiber to initiate an impulse spontaneously. The product of a hypoxic myocardium can be hyperirritable myocardial cells. These may then act as pacemakers. The ventricles are then being stimulated by more than one pacemaker. This may well lead to the generation of a circus-entry arrhythmia. Scar and dying tissue is inexcitable, but around these areas usually lies a penumbra of hypoxic tissue that is excitable. Ventricular excitability may be the trigger to generate re-entry arrhythmias.
It is interesting to note that most cardiac zain with an associated increased propensity to arrhythmia development have an associated loss of membrane potential. That is, the maximum diastolic potential is less negative and therefore exists closer to the threshold potential. Cellular depolarisation can be due to a raised external concentration of potassium ions K+, a decreased intracellular concentration of sodium ions Na+, increased permeability to Na+, or a decreased permeability to K+. The ionic basis of automaticity is the net gain of an intracellular positive charge during diastole in the presence of a voltage-dependent channel activated by potentials negative to –50 to –60 mV.
Myocardial cells are exposed to different environments. Normal cells may be exposed to hyperkalaemia; abnormal cells may be perfused by normal environment. For example, with a healed myocardial infarction, abnormal cells can be exposed to an abnormal environment such as with a myocardial infarction with myocardial ischaemia. In conditions such as myocardial ischaemia, possible mechanism of arrhythmia generation include the resulting decreased internal K+ concentration, the increased external K+ concentration, norepinephrine release and acidosis[16].
[edit] Triggered activity
Triggered activity can occur due to the presence of afterdepolarisations. These are depolarising oscillations in the membrane voltage induced by preceding action potentials. These can occur before or after full repolarisation of the fiber and as such are termed either early (EADs) or delayed afterdepolarisations (DADs). All afterdepolarisations may not reach threshold potential, but, if they do, they can trigger another afterdepolarisation, and thus self-perpetuate.
[edit] Characteristics of the ventricular fibrillation waveform
Ventricular fibrillation can be described in terms of its electrocardiographic waveform appearance. All waveforms can be described in terms of certain features, such as amplitude and frequency. Researchers have looked at the frequency of the ventricular fibrillation waveform to see if it helps to elucidate the underlying mechanism of the arrhythmia or holds any clinically useful information. More recently, Gray has suggested an underlying mechanism for the frequency of the waveform that has puzzled investigators as possibly being a manifestation of the Doppler effect of rotors of fibrillation[17]. Analysis of the fibrillation waveform is performed using a mathematical technique known as Fourier analysis.
[edit] Power spectrum
The distribution of frequency and power of a waveform can be expressed as a power spectrum in which the contribution of different waveform frequencies to the waveform under analysis is measured. This can be expressed as either the dominant or peak frequency, i.e., the frequency with the greatest power or the median frequency, which divides the spectrum in two halves.
Frequency analysis has many other uses in medicine and in cardiology, including analysis of heart rate variability and assessment of cardiac function, as well as in imaging and acoustics
Cardiac Arrhythmia
Animated video about Cardiac Arrhythmia brought to you by MedFlux www.medflux.110mb.com
How the Body Works : Inside the Heart
Inside the Heart
The heart is a muscular pumping organ which beats nonstop to circulate blood around the body. It functions as two halves, each consisting of a holding chamber, or atrium, and a pumping center, or ventricle. After circulating around the body, blood, now deoxygenated, returns to the right atrium through large veins, the superior vena cava and the inferior vena cava. When the atrium is full, blood is forced through the tricuspid valve into the right ventricle. It is then pumped to the lungs through the pulmonary valve into the pulmonary artery. The oxygenated blood returns via the pulmonary veins to the left atrium. After flowing through the mitral valve it is pumped out of the left ventricle into the aorta to return to the general circulation.
The heart is a muscular pumping organ which beats nonstop to circulate blood around the body. It functions as two halves, each consisting of a holding chamber, or atrium, and a pumping center, or ventricle. After circulating around the body, blood, now deoxygenated, returns to the right atrium through large veins, the superior vena cava and the inferior vena cava. When the atrium is full, blood is forced through the tricuspid valve into the right ventricle. It is then pumped to the lungs through the pulmonary valve into the pulmonary artery. The oxygenated blood returns via the pulmonary veins to the left atrium. After flowing through the mitral valve it is pumped out of the left ventricle into the aorta to return to the general circulation.
What causes a heart attack?
More at www.multi-ed.com
Health information explaining what causes a heart. Also see the following parts: "What is a heart attack?", "How is a heart attack diagnosed?" and "How is a heart attack treated?".
Health information explaining what causes a heart. Also see the following parts: "What is a heart attack?", "How is a heart attack diagnosed?" and "How is a heart attack treated?".
STD Prevention and Protection
Fifty percent of Americans will contract a sexually transmitted disease in their lifetimes. But you don't have to give up on great sex to have safe sex.
CHOKING CHILD VIDEO - First aid for a choking conscious child
Learn the First Aid Techniques For A Choking Child
How to Perform the Heimlich Maneuver
http://www.WatchMojo.com presents... The proper way to execute the Heimlich maneuver.
Heimlich maneuver
Perform Heimlich maneuver on differetn victims: an infant under age of one, an adult and an obese or pregnant adult
Baby Rescue - Choking - American Heart Association
American Heart Association Baby Rescue - Choking For mothers and fathers
How To Perform Baby CPR
How to save a babies life and perform CPR (Cardiac Massage)
Provided by the British Red Cross
Provided by the British Red Cross
CPR Instuctions For Infants
Learn the Proper CPR techniques for children.
Learn CPR is a free public service supported by the University of Washington School of Medicine. Learn the basics of CPR - cardiopulmonary resuscitation. Updated with new CPR Guidelines issued by the American Heart Association and published in Circulation, March 31, 2008.
http://depts.washington.edu/learncpr/index.html
Learn CPR is a free public service supported by the University of Washington School of Medicine. Learn the basics of CPR - cardiopulmonary resuscitation. Updated with new CPR Guidelines issued by the American Heart Association and published in Circulation, March 31, 2008.
http://depts.washington.edu/learncpr/index.html
ACLS 2005 - CPR and AED Demo
Reanimação cardiopulmonar com AED. Fonte: Advanced Cardiovarcular Life Support - Student CD
New CPR Guidelines
The American Heart Association changed CPR guidelines to make it less confusing. Here are the new guidelines. The "456 EMS Show for the Awake, Alert and Disoriented" is produced by Studio-A in the National EMS Academy. Studio-A is presented in a BLOG format with articles, case studies, videos and a weekly trivia question. Find Studio-A at www.yourstudioa.com.
HANDS-ONLY CPR FOR ADULTS
NJN News Healthwatch Report - CPR Guidelines
The American Heart Association now says that hands only CPR works just as well as standard CPR for cardiac arrest in adults.
The American Heart Association now says that hands only CPR works just as well as standard CPR for cardiac arrest in adults.
Learn CPR - You Can Do It!
CPR IN THREE SIMPLE STEPS
http://depts.washington.edu/learncpr/quickcpr.html
1. CALL
Check the victim for unresponsiveness. If there is no response, Call 911 and return to the victim. In most locations the emergency dispatcher can assist you with CPR instructions.
2. BLOW
Tilt the head back and listen for breathing. If not breathing normally, pinch nose and cover the mouth with yours and blow until you see the chest rise. Give 2 breaths. Each breath should take 1 second.
3. PUMP
If the victim is still not breathing normally, coughing or moving, begin chest compressions. Push down on the chest 11/2 to 2 inches 30 times right between the nipples. Pump at the rate of 100/minute, faster than once per second.
CONTINUE WITH 2 BREATHS AND 30 PUMPS UNTIL HELP ARRIVES
NOTE: This ratio is the same for one-person & two-person CPR. In two-person CPR the person pumping the chest stops while the other gives mouth-to-mouth breathing.
Adult CPR Video Demonstration
http://www.americanheart.org
2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
To help healthcare professionals, EMS and lay rescuers understand important changes to emergency cardiovascular care resulting from the 2005 American Heart Association Guidelines for CPR and ECC and how these changes will impact resuscitation, the association has produced three setting-specific webcasts.
http://www.americanheart.org/presenter.jhtml?identifier=3037720
Wednesday, May 7, 2008
I want to become a nurse. How do I get started?
ANA'S Definition of Nursing ( American Nurses Association))
http://nursingworld.org/MainMenuCategories/CertificationandAccreditation/AboutNursing.aspx
About Nursing
Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.
(Nursing's Social Policy Statement, Second Edition, 2003, p. 6 & Nursing: Scope and Standards of Practice, 2004, p. 7)
In the first half of 2006, over 65,000 persons were newly licensed as registered nurses, joining 2.9 million other RNs in the nation’s largest health care profession.
Each followed a distinct path of education to become a registered nurse and, after obtaining the RN license, increased his or her expertise as a direct health care provider in work settings ranging from acute care hospitals to home and community centers to corporate work sites.
From the basic education required of an RN to the advanced educational and clinical paths taken by more experienced nurses, the depth and breadth of the nursing profession is meeting different health care needs of the population.
What is nursing?
Florence Nightingale, in her Notes on Nursing: What It Is and What It Is Not, defined nursing as having “charge of the personal health of somebody … and what nursing has to do … is to put the patient in the best condition for nature to act upon him.” The philosophy has been restated and refined since 1859, but the essence is the same. In the words of nursing theorist Virginia Henderson, nurses help people, sick or well, to do those things needed for health or a peaceful death that people would do on their own if they had the strength, will, or knowledge. The most current definition that reflects the evolution of professional nursing is from the 2003 edition of ANA’s Nursing’s Social Policy Statement:
Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.
The human response…
What defines nursing and sets it apart from other health care professions, particularly medicine with which it has long been considered part and parcel? It is nurses’ focus – in theory and practice – on the response of the individual and the family to actual or potential health problems. Nurses are educated to be attuned to the whole person, not just the unique presenting health problem. While a medical diagnosis of an illness may be fairly circumscribed, the human response to a health problem may be much more fluid and variable and may have a great effect on the individual’s ability to overcome the initial medical problem. It is often said that physicians cure, and nurses care. In what some describe as a blend of physiology and psychology, nurses build on their understanding of the disease and illness process to promote the restoration and maintenance of health in their clients.
Nurses’ broad-based education and holistic focus positions them as the logical network of providers on which to build a true health care system for the future. An acknowledged realization that individuals have considerable responsibility for their personal health has driven an increasing recognition that there is a professional group, whose focus is education and practice, that can facilitate individuals efforts to reach their fullest health potential. This profession is that of registered nurses.
Nursing education
To achieve the RN title, an individual must graduate from a state-approved school of nursing—either a four-year university program, a two-year associate degree program, or a three-year diploma program—and pass a state RN licensing examination called the National Council Licensure Examination for Registered Nurses (NCLEX-RN).
BSN
The four-year university-based Bachelor of Science in Nursing (BSN) degree provides the nursing theory, sciences, humanities, and behavioral science preparation necessary for the full scope of professional nursing responsibilities, and provides the knowledge based necessary for advanced education in specialized clinical practice, research, or primary health care. In 2005, 573 U.S. colleges and universities offer the BSN or advanced nursing degree.
• First two years – Most programs concentrate studies on psychology, human growth and development, biology, microbiology, organic chemistry, nutrition, and anatomy and physiology.
• Final two years – This is when many programs begin the focused nursing curriculum including adult acute and chronic disease; maternal/child health; pediatrics; psychiatric/mental health nursing; and community health nursing. Also, nursing theory, bioethics, management, research and statistics, health assessment, pharmacology, pathophysiology, and electives in complex nursing processes are covered.
Most often, supervised clinical practice is obtained during the last two years in hospitals, nursing homes, and community settings.
ADN
A two-year program granting an Associate Degree in Nursing (ADN) prepares individuals for a defined technical scope of practice. Set in the framework of general education, the clinical and classroom components prepares ADN nurses for nursing roles that require nursing theory and technical proficiency. Many RNs whose first degree is an ADN return to school during their working life to earn a bachelor’s degree or higher. In 2006, many students find the ADN program to be longer than 2 years, often 3 years or more. In 2005, Associate Degree programs were 58.9% of all U.S. basic programs.
Diploma
Usually associated with a hospital, the Diploma in Nursing program combines classroom and clinical instruction, usually over three years. Although once a common educational route for RNs, diploma programs have diminished steadily—to 4 percent of all basic RN education programs in 2006—as nursing education has shifted from hospitals to academic institutions.
Education of RN Workforce, 2004
Diploma 17.5%
ADN 33.7%
BSN 34.2%
Masters or PhD 13%
Licensing
Upon graduation, an individual must pass the NCLEX-RN to obtain a license to practice registered nursing and use the RN title. State boards of nursing govern licensing requirements, set continuing education or competency requirements, and handle disciplinary actions against RNs. Once an RN, the nurse must practice following the requirements of the nurse practice act in the state in which they function as an RN.
So what is a licensed practical nurse?
A licensed practical nurse is not a registered nurse. Also called a licensed vocational nurse (LVN) in some states, an LPN has taken a 12- to 14-month post-high school educational course that focuses on basic nursing care. LPNs also must pass a licensing exam (the NCLEX-PN). In 2005, there were about 710,000 LPNs in the United States, with an average salary of $36,210. The membership of the American Nurses Association consists only of registered nurses (RNs).
Where do RNs work?
As members of the nation’s largest health care profession, registered nurses practice wherever people need nursing care, including such common sites as hospitals, homes, schools, workplaces, and community centers, and uncommon areas such as children’s camps, homeless shelters, and tourist sites. Over 2.4 million of the nation’s 2.9 million RNs were employed in 2004, about one-quarter of them on a part-time basis.
About 56 percent of nurses currently work in hospitals. Hospital unit settings include intensive care, operating/recovery room, stepdown, emergency room, labor and delivery, and outpatient units.
The median salary of a staff nurse working full-time in hospitals in 2005 was $56,880.
Other settings where registered nurses work include:
Community/public health 14.9%
Ambulatory care 11.5%
Nursing homes 6.3%
Nursing education 2.6%
Advanced practice registered nurses
Advanced practice registered nurse (APRN) is an umbrella term given to a registered nurse who has met advanced educational and clinical practice requirements, at a minimum of a Master’s level, beyond the basic nursing education and licensing required of all RNs and who provides at least some level of direct care to patient populations. Under this umbrella fit the principal types of APRNs (numbers of APRNs based on 2004 data):
• Nurse practitioner (NP) – Working in clinics, nursing homes, hospitals, or private offices, more than 141,000 nurse practitioners are qualified to provide a wide range of primary and preventive health care services, prescribe medication, and diagnose and treat common minor illnesses and injuries.
• Certified nurse-midwife (CNM) –Almost 14,000 CNMs provide well-woman gynecological and low-risk obstetrical care. In 2002, CNMs attended more than 300,000 of U.S. births that year, in hospitals, birth centers, and homes.
• Clinical nurse specialist (CNS) –Working in hospitals, clinics, nursing homes, private offices, and community-based settings, some 72,000 CNSs handle a wide range of physical and mental health problems, and also work in consultation, research, education, and administration.
• Certified registered nurse anesthetists (CRNA) – The oldest of the advanced nursing specialties, CRNAs administer more than 65 percent of anesthetics given to patients each year. There were about 32,000 CRNAs in practice in 2004.
A move in nursing is currently underway to shift the standard for qualification to be an APRN to that of a Doctorate in Nursing Practice (DNP) by 2015. While still providing the direct care to patient populations, the shift demonstrates the comparability of the APRN with other such advanced roles, ie Doctorate in Physical Therapy, Doctorate in Pharmacy.
There are other nursing roles that are usually filled by master’s prepared registered nurses as well, including nursing administration, nursing education, patient and staff education. Yet another master’s level role currently being introduced into educational programs is the Clinical Nurse Leader (CNL) role. This role expects to act as a system facilitator for nursing care delivery.
Clearly, there are many opportunities for those prepared as registered nurses to advance their education and careers in a way that interests the individual and utilizes their strengths and areas of expertise.
To a healthier future
There are well over 200,000 advanced practice nurses in the United States today, helping to bring needed primary health care services to the population and paving the way for increased use of such nurses in the future. In 2006, advanced practice nurses reported an average annual salary of $69,200.
Baccalaureate and advanced education prepares nurses for the independent clinical judgement necessary in an increasingly complex work environment. While in 1977, only 18 percent of RNs had a bachelor’s degree, by 2004, over 34 percent of nurses had at least a BSN, and in 2005 nearly 35 percent of all new nursing students were enrolled in four-year programs. More than 124,000 students—almost 11 percent of them men—were enrolled in BSN programs in 2005.
The nursing process: A common thread amongst all nurses…
The common thread uniting different types of nurses who work in varied areas is the nursing process—the essential core of practice for the registered nurse to deliver holistic, patient-focused care.
Assessment
An RN uses a systematic, dynamic way to collect and analyze data about a client, the first step in delivering nursing care. Assessment includes not only physiological data, but also psychological, sociocultural, spiritual, economic, and life-style factors as well. For example, a nurse’s assessment of a hospitalized patient in pain includes not only the physical causes and manifestations of pain, but the patient’s response—an inability to get out of bed, refusal to eat, withdrawal from family members, anger directed at hospital staff, fear, or request for more pain mediation.
Diagnosis
The nursing diagnosis is the nurse’s clinical judgment about the client’s response to actual or potential health conditions or needs. The diagnosis reflects not only that the patient is in pain, but that the pain has caused other problems such as anxiety, poor nutrition, and conflict within the family, or has the potential to cause complications—for example, respiratory infection is a potential hazard to an immobilized patient. The diagnosis is the basis for the nurse’s care plan.
Outcomes/Planning
Based on the assessment and diagnosis, the nurse sets measurable and achievable short- and long-range goals for this patient that might include moving from bed to chair at least three times per day; maintaining adequate nutrition by eating smaller, more frequent meals; resolving conflict through counseling, or managing pain through adequate medication. Assessment data, diagnosis, and goals are written in the patient’s care plan so that nurses as well as other health professionals caring for the patient have access to it.
Implementation
Nursing care is implemented according to the care plan, so continuity of care for the patient during hospitalization and in preparation for discharge needs to be assured. Care is documented in the patient’s record.
Evaluation
Both the patient’s status and the effectiveness of the nursing care must be continuously evaluated, and the care plan modified as needed.
I want to become a nurse. How do I get started?
For additional information about nursing as a profession, how to prepare for nursing school, what to expect in a nursing program, nursing specialties and what it’s like to be a nurse, check these additional resources:
The Johnson & Johnson Company site: www.discovernursing.com
The National Student Nurses Association: www.nsna.org (click on Career Center)
The Department of Labor-Bureau of Labor Statistics: http://stats.bls.gov/oco/ocos083.htm
To find out which schools offer nursing programs and get started in selecting a school, obtain a copy of “Peterson’s Guide to Nursing Programs”. It is an excellent resource to nursing schools in the U.S., and is organized both by geographic area and by type of program. It also includes information on each school. Buy it at www.amazon.com, or look for it in your local bookstore.
Peterson’s also has a website with an online database of nursing schools. See www.Petersons.com
Financial assistance to become a nurse
There are both public (federal and state) and private funds available for nursing school. As a nursing student, you are also eligible for the same financial support available to any student in an approved college or university.
Your first and most important stop in seeking information should be the financial aid office of your chosen school. College and university offices of financial aid have a great deal of information available to them on both national and state sources of aid, and they are there to help you sort through it.
There are many sources of federal support for which you may be eligible, including both loans and grants. Possibilities are extensive, so contact the Federal Student Aid Information Center directly. Call them at (800)-4FEDAID or online at http://studentaid.ed.gov or at www.fafsa.ed.gov
For state sources of funding, contact your state Department of Education for information.
There are also many private organizations and foundations which offer smaller grants and loans, often tailored to particular degrees or requirements. Check your local bookstore for publications on searching for scholarships and grants. You can also try an online database, such as www.fastweb.monster or www.scholarshipcoach.com; these can match your information to a financial aid database.
Remember that, in addition to looking for one large scholarship or loan to pay for your college program, you may also have success putting together a package of several smaller grants and loans. Researching and assembling a financial aid package for your education requires time, attention and work; but the rewards are many as it will enable you to reach your personal and professional goals.
The importance of belonging to your professional oganization
The American Nurses Association, along with over 80 specialty nursing organizations, serves a vital role in advancing the role of nursing and the health care. ANA works to develop policies, set standards, advocate in government and private settings, provide education, maintain the Code of Ethics for Nurses and shape the future of the profession. It is members that allow associations to accomplish what needs to be done. Member dues provide the necessary funding and member volunteers provide the guidance and expertise to move the profession forward. Members make the difference – in the nursing profession and the health care of the nation.
References
American Nurses Association. (2003) Nursing’s Social Policy Statement: Second Edition. Washington, D.C.: Nursesbooks.org.
American Nurses Association. (2004) Nursing Scope and Standards of Practice. Washington, D.C.: Nursesbooks.org,
Henderson, V. (1961). Basic Principles of Nursing Care. London: International Council of Nurses.
Mee, Cheryl. (2006). Nursing 2006 Salary Survey. Nursing 2006 36 (10): 46–51. (October.)
National League for Nursing. (2006). Nursing Data Review, Academic Year 2004-2005, Baccalaureate, Associate Degree, and Diploma Programs. New York, NY: Author.
Nightingale, F. (1859). Notes on Nursing: What It Is and What It Is Not. London: Harrison and Sons. (Facsimile edition, J.B. Lippincott Company. 1946.)
U.S. Department of Health and Human Services. Health Resources and Services Administration. (2005). The Registered Nurse Population. National Sample Survey of Registered Nurses March 2004, 2005. Rockville, M: DHHS/HRSA
U.S. Department of Labor. Bureau of Labor Statistics. (2005) Occupational Employment and Wages, May 2005. http://www.bls.gov
Copyright © 2007 by American Nurses Association. All right reserved.
Additional Website to link to:
The Johnson & Johnson Company site: www.discovernursing.com
The National Student Nurses Association: www.nsna.org (click on Career Center)
http://nursingworld.org/MainMenuCategories/CertificationandAccreditation/AboutNursing.aspx
About Nursing
Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.
(Nursing's Social Policy Statement, Second Edition, 2003, p. 6 & Nursing: Scope and Standards of Practice, 2004, p. 7)
In the first half of 2006, over 65,000 persons were newly licensed as registered nurses, joining 2.9 million other RNs in the nation’s largest health care profession.
Each followed a distinct path of education to become a registered nurse and, after obtaining the RN license, increased his or her expertise as a direct health care provider in work settings ranging from acute care hospitals to home and community centers to corporate work sites.
From the basic education required of an RN to the advanced educational and clinical paths taken by more experienced nurses, the depth and breadth of the nursing profession is meeting different health care needs of the population.
What is nursing?
Florence Nightingale, in her Notes on Nursing: What It Is and What It Is Not, defined nursing as having “charge of the personal health of somebody … and what nursing has to do … is to put the patient in the best condition for nature to act upon him.” The philosophy has been restated and refined since 1859, but the essence is the same. In the words of nursing theorist Virginia Henderson, nurses help people, sick or well, to do those things needed for health or a peaceful death that people would do on their own if they had the strength, will, or knowledge. The most current definition that reflects the evolution of professional nursing is from the 2003 edition of ANA’s Nursing’s Social Policy Statement:
Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.
The human response…
What defines nursing and sets it apart from other health care professions, particularly medicine with which it has long been considered part and parcel? It is nurses’ focus – in theory and practice – on the response of the individual and the family to actual or potential health problems. Nurses are educated to be attuned to the whole person, not just the unique presenting health problem. While a medical diagnosis of an illness may be fairly circumscribed, the human response to a health problem may be much more fluid and variable and may have a great effect on the individual’s ability to overcome the initial medical problem. It is often said that physicians cure, and nurses care. In what some describe as a blend of physiology and psychology, nurses build on their understanding of the disease and illness process to promote the restoration and maintenance of health in their clients.
Nurses’ broad-based education and holistic focus positions them as the logical network of providers on which to build a true health care system for the future. An acknowledged realization that individuals have considerable responsibility for their personal health has driven an increasing recognition that there is a professional group, whose focus is education and practice, that can facilitate individuals efforts to reach their fullest health potential. This profession is that of registered nurses.
Nursing education
To achieve the RN title, an individual must graduate from a state-approved school of nursing—either a four-year university program, a two-year associate degree program, or a three-year diploma program—and pass a state RN licensing examination called the National Council Licensure Examination for Registered Nurses (NCLEX-RN).
BSN
The four-year university-based Bachelor of Science in Nursing (BSN) degree provides the nursing theory, sciences, humanities, and behavioral science preparation necessary for the full scope of professional nursing responsibilities, and provides the knowledge based necessary for advanced education in specialized clinical practice, research, or primary health care. In 2005, 573 U.S. colleges and universities offer the BSN or advanced nursing degree.
• First two years – Most programs concentrate studies on psychology, human growth and development, biology, microbiology, organic chemistry, nutrition, and anatomy and physiology.
• Final two years – This is when many programs begin the focused nursing curriculum including adult acute and chronic disease; maternal/child health; pediatrics; psychiatric/mental health nursing; and community health nursing. Also, nursing theory, bioethics, management, research and statistics, health assessment, pharmacology, pathophysiology, and electives in complex nursing processes are covered.
Most often, supervised clinical practice is obtained during the last two years in hospitals, nursing homes, and community settings.
ADN
A two-year program granting an Associate Degree in Nursing (ADN) prepares individuals for a defined technical scope of practice. Set in the framework of general education, the clinical and classroom components prepares ADN nurses for nursing roles that require nursing theory and technical proficiency. Many RNs whose first degree is an ADN return to school during their working life to earn a bachelor’s degree or higher. In 2006, many students find the ADN program to be longer than 2 years, often 3 years or more. In 2005, Associate Degree programs were 58.9% of all U.S. basic programs.
Diploma
Usually associated with a hospital, the Diploma in Nursing program combines classroom and clinical instruction, usually over three years. Although once a common educational route for RNs, diploma programs have diminished steadily—to 4 percent of all basic RN education programs in 2006—as nursing education has shifted from hospitals to academic institutions.
Education of RN Workforce, 2004
Diploma 17.5%
ADN 33.7%
BSN 34.2%
Masters or PhD 13%
Licensing
Upon graduation, an individual must pass the NCLEX-RN to obtain a license to practice registered nursing and use the RN title. State boards of nursing govern licensing requirements, set continuing education or competency requirements, and handle disciplinary actions against RNs. Once an RN, the nurse must practice following the requirements of the nurse practice act in the state in which they function as an RN.
So what is a licensed practical nurse?
A licensed practical nurse is not a registered nurse. Also called a licensed vocational nurse (LVN) in some states, an LPN has taken a 12- to 14-month post-high school educational course that focuses on basic nursing care. LPNs also must pass a licensing exam (the NCLEX-PN). In 2005, there were about 710,000 LPNs in the United States, with an average salary of $36,210. The membership of the American Nurses Association consists only of registered nurses (RNs).
Where do RNs work?
As members of the nation’s largest health care profession, registered nurses practice wherever people need nursing care, including such common sites as hospitals, homes, schools, workplaces, and community centers, and uncommon areas such as children’s camps, homeless shelters, and tourist sites. Over 2.4 million of the nation’s 2.9 million RNs were employed in 2004, about one-quarter of them on a part-time basis.
About 56 percent of nurses currently work in hospitals. Hospital unit settings include intensive care, operating/recovery room, stepdown, emergency room, labor and delivery, and outpatient units.
The median salary of a staff nurse working full-time in hospitals in 2005 was $56,880.
Other settings where registered nurses work include:
Community/public health 14.9%
Ambulatory care 11.5%
Nursing homes 6.3%
Nursing education 2.6%
Advanced practice registered nurses
Advanced practice registered nurse (APRN) is an umbrella term given to a registered nurse who has met advanced educational and clinical practice requirements, at a minimum of a Master’s level, beyond the basic nursing education and licensing required of all RNs and who provides at least some level of direct care to patient populations. Under this umbrella fit the principal types of APRNs (numbers of APRNs based on 2004 data):
• Nurse practitioner (NP) – Working in clinics, nursing homes, hospitals, or private offices, more than 141,000 nurse practitioners are qualified to provide a wide range of primary and preventive health care services, prescribe medication, and diagnose and treat common minor illnesses and injuries.
• Certified nurse-midwife (CNM) –Almost 14,000 CNMs provide well-woman gynecological and low-risk obstetrical care. In 2002, CNMs attended more than 300,000 of U.S. births that year, in hospitals, birth centers, and homes.
• Clinical nurse specialist (CNS) –Working in hospitals, clinics, nursing homes, private offices, and community-based settings, some 72,000 CNSs handle a wide range of physical and mental health problems, and also work in consultation, research, education, and administration.
• Certified registered nurse anesthetists (CRNA) – The oldest of the advanced nursing specialties, CRNAs administer more than 65 percent of anesthetics given to patients each year. There were about 32,000 CRNAs in practice in 2004.
A move in nursing is currently underway to shift the standard for qualification to be an APRN to that of a Doctorate in Nursing Practice (DNP) by 2015. While still providing the direct care to patient populations, the shift demonstrates the comparability of the APRN with other such advanced roles, ie Doctorate in Physical Therapy, Doctorate in Pharmacy.
There are other nursing roles that are usually filled by master’s prepared registered nurses as well, including nursing administration, nursing education, patient and staff education. Yet another master’s level role currently being introduced into educational programs is the Clinical Nurse Leader (CNL) role. This role expects to act as a system facilitator for nursing care delivery.
Clearly, there are many opportunities for those prepared as registered nurses to advance their education and careers in a way that interests the individual and utilizes their strengths and areas of expertise.
To a healthier future
There are well over 200,000 advanced practice nurses in the United States today, helping to bring needed primary health care services to the population and paving the way for increased use of such nurses in the future. In 2006, advanced practice nurses reported an average annual salary of $69,200.
Baccalaureate and advanced education prepares nurses for the independent clinical judgement necessary in an increasingly complex work environment. While in 1977, only 18 percent of RNs had a bachelor’s degree, by 2004, over 34 percent of nurses had at least a BSN, and in 2005 nearly 35 percent of all new nursing students were enrolled in four-year programs. More than 124,000 students—almost 11 percent of them men—were enrolled in BSN programs in 2005.
The nursing process: A common thread amongst all nurses…
The common thread uniting different types of nurses who work in varied areas is the nursing process—the essential core of practice for the registered nurse to deliver holistic, patient-focused care.
Assessment
An RN uses a systematic, dynamic way to collect and analyze data about a client, the first step in delivering nursing care. Assessment includes not only physiological data, but also psychological, sociocultural, spiritual, economic, and life-style factors as well. For example, a nurse’s assessment of a hospitalized patient in pain includes not only the physical causes and manifestations of pain, but the patient’s response—an inability to get out of bed, refusal to eat, withdrawal from family members, anger directed at hospital staff, fear, or request for more pain mediation.
Diagnosis
The nursing diagnosis is the nurse’s clinical judgment about the client’s response to actual or potential health conditions or needs. The diagnosis reflects not only that the patient is in pain, but that the pain has caused other problems such as anxiety, poor nutrition, and conflict within the family, or has the potential to cause complications—for example, respiratory infection is a potential hazard to an immobilized patient. The diagnosis is the basis for the nurse’s care plan.
Outcomes/Planning
Based on the assessment and diagnosis, the nurse sets measurable and achievable short- and long-range goals for this patient that might include moving from bed to chair at least three times per day; maintaining adequate nutrition by eating smaller, more frequent meals; resolving conflict through counseling, or managing pain through adequate medication. Assessment data, diagnosis, and goals are written in the patient’s care plan so that nurses as well as other health professionals caring for the patient have access to it.
Implementation
Nursing care is implemented according to the care plan, so continuity of care for the patient during hospitalization and in preparation for discharge needs to be assured. Care is documented in the patient’s record.
Evaluation
Both the patient’s status and the effectiveness of the nursing care must be continuously evaluated, and the care plan modified as needed.
I want to become a nurse. How do I get started?
For additional information about nursing as a profession, how to prepare for nursing school, what to expect in a nursing program, nursing specialties and what it’s like to be a nurse, check these additional resources:
The Johnson & Johnson Company site: www.discovernursing.com
The National Student Nurses Association: www.nsna.org (click on Career Center)
The Department of Labor-Bureau of Labor Statistics: http://stats.bls.gov/oco/ocos083.htm
To find out which schools offer nursing programs and get started in selecting a school, obtain a copy of “Peterson’s Guide to Nursing Programs”. It is an excellent resource to nursing schools in the U.S., and is organized both by geographic area and by type of program. It also includes information on each school. Buy it at www.amazon.com, or look for it in your local bookstore.
Peterson’s also has a website with an online database of nursing schools. See www.Petersons.com
Financial assistance to become a nurse
There are both public (federal and state) and private funds available for nursing school. As a nursing student, you are also eligible for the same financial support available to any student in an approved college or university.
Your first and most important stop in seeking information should be the financial aid office of your chosen school. College and university offices of financial aid have a great deal of information available to them on both national and state sources of aid, and they are there to help you sort through it.
There are many sources of federal support for which you may be eligible, including both loans and grants. Possibilities are extensive, so contact the Federal Student Aid Information Center directly. Call them at (800)-4FEDAID or online at http://studentaid.ed.gov or at www.fafsa.ed.gov
For state sources of funding, contact your state Department of Education for information.
There are also many private organizations and foundations which offer smaller grants and loans, often tailored to particular degrees or requirements. Check your local bookstore for publications on searching for scholarships and grants. You can also try an online database, such as www.fastweb.monster or www.scholarshipcoach.com; these can match your information to a financial aid database.
Remember that, in addition to looking for one large scholarship or loan to pay for your college program, you may also have success putting together a package of several smaller grants and loans. Researching and assembling a financial aid package for your education requires time, attention and work; but the rewards are many as it will enable you to reach your personal and professional goals.
The importance of belonging to your professional oganization
The American Nurses Association, along with over 80 specialty nursing organizations, serves a vital role in advancing the role of nursing and the health care. ANA works to develop policies, set standards, advocate in government and private settings, provide education, maintain the Code of Ethics for Nurses and shape the future of the profession. It is members that allow associations to accomplish what needs to be done. Member dues provide the necessary funding and member volunteers provide the guidance and expertise to move the profession forward. Members make the difference – in the nursing profession and the health care of the nation.
References
American Nurses Association. (2003) Nursing’s Social Policy Statement: Second Edition. Washington, D.C.: Nursesbooks.org.
American Nurses Association. (2004) Nursing Scope and Standards of Practice. Washington, D.C.: Nursesbooks.org,
Henderson, V. (1961). Basic Principles of Nursing Care. London: International Council of Nurses.
Mee, Cheryl. (2006). Nursing 2006 Salary Survey. Nursing 2006 36 (10): 46–51. (October.)
National League for Nursing. (2006). Nursing Data Review, Academic Year 2004-2005, Baccalaureate, Associate Degree, and Diploma Programs. New York, NY: Author.
Nightingale, F. (1859). Notes on Nursing: What It Is and What It Is Not. London: Harrison and Sons. (Facsimile edition, J.B. Lippincott Company. 1946.)
U.S. Department of Health and Human Services. Health Resources and Services Administration. (2005). The Registered Nurse Population. National Sample Survey of Registered Nurses March 2004, 2005. Rockville, M: DHHS/HRSA
U.S. Department of Labor. Bureau of Labor Statistics. (2005) Occupational Employment and Wages, May 2005. http://www.bls.gov
Copyright © 2007 by American Nurses Association. All right reserved.
Additional Website to link to:
The Johnson & Johnson Company site: www.discovernursing.com
The National Student Nurses Association: www.nsna.org (click on Career Center)
Tuesday, May 6, 2008
A Primer For All That Wish To Work In The US
http://allnurses.com/forums/f75/start-here-primer-all-wish-work-us-160143.html
May 28, 2006, 08:36 PM
suzanne4
Super Moderator
Join Date: Dec 2003
Start here: A Primer For All That Wish To Work In The US permalink
--------------------------------------------------------------------------------
Please read this first before posting any questions on the forum, especially if you are new to us. I am going to try and answer the most common questions right here. I will be making editions here from time to time, so please check it for any updates.
I am also going to create a sticky with my name on it, if you have a question specifically for me, please place it there. I am unable to look at each individual thread on a daily basis, and this will keep me from missing what is addressed to me. We have managed to turn this into the best International Bulletin Board and lets continue to keep it going.
Please post any questions that deal with US immigration or working in the US, directly on this forum, not the country specific forums. It will make it easier for all to see, unless it is strictly related to the one country. And make my job easier.
I am going to unstick all of the other stickies and see how they are responded to in the future. Will make changes as needed.
Thanks in advance......
--------------------------
NCLEX-RN exam is required of all nurses, no matter where they trained to work in the US. It is a national exam, and the results are accepted in all fifty states, and never has to be taken again.
You must apply to a state for "License by Examination" and have your file approved before you will be permitted to sit for the exam. It requires an ATT (Authorization to Test) to have in your hand to take to the testing center. You will get this after you have been accepted by the state, and have paid the fee for the exam to Pearson-Vue. It is $200US if taken in the US, and $350US if taken out of the US.
There are a few states that require a local license, most do not. US Immigration does not require a local license in your home country.
CGFNS does require a local license to sit for the CGFNS exam.
The only thing that is needed for the GREEN CARD is a Visa Screen Certificate. This can be gotten by passing either the CGFNS exam or the NCLEX-RN exam, and the series of English exams, if you are not exempt from them. Requirement is based on where you did your initial nursing training, not where you have worked. Even if you are now in the US working on your MSN; but trained in another country for the BSN, you will still need to take the English exams.
Permanent residency, or green card, is what you will be getting. There are no temporary work visas being issued to nurses, and there have not been any for over two years. H1-B visas do not exist for nurses. If someone tells you otherwise, they are incorrect. Please list permanent residency on any application that asks for the type of visa, and include a copy of your passport with it.
All of the green cards for nurses are employer-based, which means that you must have an employer to start the process for you. You cannot apply to immigration for the green card on your own.
Once you have found an employer to do the petitioning for you, you will be given forms to complete. The one that you keep hearing about is the I-140, and this is what will need initial approval before you can go any further. Next, the visa bill will need to be paid, either by the employer, or you. DS-230 forms will come next, and will need to completed and returned. Your dependents must be listed here, or they will not be on your green card, and will need to go thru a separate process later on. And that can take about two years, so please make sure that everyone is on there.
If you have a baby, they can be added. But for others, there will be a wait involved. Once the DS-230 is received and verified, you will hear that your file is complete. Next step will the final step and that is the medical exam and the US Embassy interview. DS-230 is referred to as Packet 3, and the medical/interview is Packet 4. Length of time will be dependent on where you have to go to interview. the UK is currently about six weeks or so, Manila is on average about four to five months.
Anything that requires a notary, must be done at the US Embassy where you are. It does not need to be done in your home country, if you are not currently working there. If you are in the US, then a local notary is acceptable. There are some that have gotten by with local notaries in their home country, but many times they are not accepted and it is better to do things right the first time.
Reciprocity vs. Endorsement
The NCLEX exam has reciprocity, and is accepted in all fifty states. Once you pass it, you never have to take it again. Each state issues its own license, and you need to meet their requirements for it. Some have language requirements and some have additional courses required. Please check directly with the state that are seeking a license in.
Employment Contracts
These are binding legal documents and should be treated as such. If you were buying a home, you would not just sign it. Do the same with this. If it is not in the contract and written, it does not exist. Do not sign a letter of intent or employment, if you intend to look elsewhere and may break that contract. It makes it harder for others to get petitioned. Please be aware of this.
What to look for in a contract: Remember that you will be coming over to the US on a green card, all of you are college educated and with at least four year degrees. Do not sell yourself short.
You can request a specific state, or even city. If the agency doesn't have that one, then look other places. You can also do a direct hire with a hospital.
Make sure that length of orientation is included, this is extremely important. You should not be expected to be on your own in just a couple of days. Doesn't matter how much experience that you have in your country, things will be different in the US.
Never, ever sign a contract or letter of intent, etc., that has any blanks in it. It must be 100% complete; or your contract can be sold, and you are essentially sold to another company. Just like the slave contracts. And if you sign it, there is nothing that anyone can do to get you out of it. If something does not feel right to you about it, then do not sign it.
Canadian and Mexican RNs: You are covered under the NAFTA Free Trade Agreement and can be issued a TN Visa right at the border. You just need to present a Visa Screen Certificate and a job offer form an employer. This visa needs to be renewed every year. You can also go thru the same process as other foreign nurses to obtain the green card, if you wish. You mut actually hold a passport from that country, and not just have permanent residency there to qualify for this type of visa.
LPN/LVN:
This training is not accepted by US immigration for a green card. Statute states that the nurse must be a first level nurse in their country, and have RN after their name. There are no temporary work permits available for nurses.
The only way around the above is if you are married to a green card holder or an American, but you cannot get the green card on your own. It would have to be spousal only.
CGFNS:
Credentials Verification for NY is called the CVS. NY requires this, even if you are endorsing to there.
Regular Credentials Eval is called the CES.
Visa Screen Certificate is needed by all that are applying for a green card in their name.
Their website is www.cgfns.org
Most states are now requiring the CES, and not the CGFNS exam. And this can be for endorsement as well. Please check the specifics with the state that you are applying to. Check out the initial licensure, as well as endorsement requirements.
English exams:
You have choice of either the TOEFL series, which includes TOEFL, TWE, and TSE. This is offered thru ETS, Educational Testing Services, and their website is www.ETS.com or the IELTS, in the academic branch with the speaking section. This is available thru the British Council.
Consular Processing vs. Adjustment of Status (AOS)
Consular processing means that you follow the routine process and have all of your immigration details processed while you are still out of the US, and complete your interview at the US Embassy before you travel to the US.
AOS is done once you have been in the US for a period of 90 days, continuously. You are not permitted to leave during the processing time for any reason. It is actually in violation of US Immigration law to come to the US for the sole purpose of finding a job and staying however, it is done all of the time. But there are some things that you need to be aware of. You must make sure that you have about five months of funds available to you to live on while waiting. It is the 90 days before a petition can be submitted, plus about another 60 days before you are will receive the EAD, which permits you to work. Then you need to allow about one week for your SSN# to arrive after you apply for it. It is illegal to accept any type of work during this time, and if you are caught, you face deportation and not being permitted to return to the US for a period of at least ten years. EAD stands for Employment Authorization Document.
And if you are going to come to the US with the idea that you are going to stay, make sure that you already have approval to sit for the NCLEX exam before you arrive here. Do not come with the idea that you will start everything once you are here. You are not going to be able to get things done in most cases, and will have to leave. You never want to apply for an extension after those 180 days are up, unless you have a very good reason. It must be done well in advance, not just a few days before it expires.
Foreign nursing students in the US
You can attend school on any of the visas that permit you to be in the US legally. The tourist visa will not alow you to carry a full load of classes.
CPT is available for you during school to get experience working in a hospital. The OPT is available for up to one year when you graduate, but yo umust apply for it before you actually finish your classes, or it will not be available to you. There are restrictions for both.
The only visa that you can apply for when you graduate is the green card, or permanent residency. H1 visas are not available to nurses, and have not been for over two years.
--------------------------------------------------------------------------------
Last edited by suzanne4 : Jan 20, 2007 at 12:14 PM.
Jun 10, 2006, 02:52 PM
NRSKarenRN
Co-Administrator
Join Date: Oct 2000
Re: A Primer For All That Wish To Work In The US permalink
--------------------------------------------------------------------------------
Copying edited info from lawrence01 here as helpful:
Reliable information websites to assist in immigration/working in US
There are a lot of inaccurate informations out here in the Philippines, whether its on the 'net or worse, from hearsays. Please do not depend on just these hearsays, and rumors. We need to check out all the information being given out. If you are already on the 'net, there is no reason that you should get inaccurate informations. We just have to go to reliable websites and forums like this.
Here are some links to reliable websites that I think all nurses should know.
For ALL State BON (and their respective requirements) and everything about NCLEX:
www.ncsbn.org
Allnurses: US states board of nursing websites http://allnurses.com/forums/boards-of-nursing.php
For CES, CVS, CGFNS certifications and esp. VisaScreen Certification (everybody needs this): Go thru the whole website. Everything is in there.
www.cgfns.org
Immigration/legal websites:
(examples + informative, no endorsement by allnurses. Karen)
www.shusterman.com
www.murthy.com
For Official news realeases from USCIS pertinent to Schedule A nurses:
www.uscis.gov
Instructions for registration with Pearson-Vue:
www.pearsonvue.com and
www.ncsbn.org
Hospital websites for diff. States:
http://www.theagapecenter.com/Hospitals/
Nursing websites/e-magazines:
www.nursingspectrum.com
http://nursing.advanceweb.com/main.aspx
Texas service center processing dates for I-140 schedula A nurses:
https://egov.immigration.gov/cris/js...ceCenter=Texas
Nebraska service center processing dates for I-140 schedula A nurses:
https://egov.immigration.gov/cris/js...enter=Nebraska
Vermont service center processing dates for I-140 schedula A nurses:
https://egov.immigration.gov/cris/js...Center=Vermon t
Phillipines Local Licensing body:
www.prc.gov.ph
Of course, the Int'l and Filipino forums of www.allnurses.com
With all these reliable websites, there are no reasons that nurses would get lacking or inaccurate informations. We just have to do our own research and do what is best for ourselves and most importantly let's network and help each other out. If we know any info. (bad or good) pls. share it. It has to be as much as possible accurate or if you received info. but not sure if it's accurate or not, pls. share it and ask about it in forums like this so that those who have gone thru the process or are more experienced or an authority could give their inputs and suggestions.
Lastly, to those posting on public forums (such as www.allnurses.com ) be responsible, respectful and sensitive in your posts. These posts are monitored by not just RNs but everyone related in this industry (including prospective employers). We are all educated professionals here. Many may have differing opinions but we must always maintain respect with each other. We are the Captains of our own Ship and no one is forcing anyone to do something we don't want to.
------------
May 28, 2006, 08:36 PM
suzanne4
Super Moderator
Join Date: Dec 2003
Start here: A Primer For All That Wish To Work In The US permalink
--------------------------------------------------------------------------------
Please read this first before posting any questions on the forum, especially if you are new to us. I am going to try and answer the most common questions right here. I will be making editions here from time to time, so please check it for any updates.
I am also going to create a sticky with my name on it, if you have a question specifically for me, please place it there. I am unable to look at each individual thread on a daily basis, and this will keep me from missing what is addressed to me. We have managed to turn this into the best International Bulletin Board and lets continue to keep it going.
Please post any questions that deal with US immigration or working in the US, directly on this forum, not the country specific forums. It will make it easier for all to see, unless it is strictly related to the one country. And make my job easier.
I am going to unstick all of the other stickies and see how they are responded to in the future. Will make changes as needed.
Thanks in advance......
--------------------------
NCLEX-RN exam is required of all nurses, no matter where they trained to work in the US. It is a national exam, and the results are accepted in all fifty states, and never has to be taken again.
You must apply to a state for "License by Examination" and have your file approved before you will be permitted to sit for the exam. It requires an ATT (Authorization to Test) to have in your hand to take to the testing center. You will get this after you have been accepted by the state, and have paid the fee for the exam to Pearson-Vue. It is $200US if taken in the US, and $350US if taken out of the US.
There are a few states that require a local license, most do not. US Immigration does not require a local license in your home country.
CGFNS does require a local license to sit for the CGFNS exam.
The only thing that is needed for the GREEN CARD is a Visa Screen Certificate. This can be gotten by passing either the CGFNS exam or the NCLEX-RN exam, and the series of English exams, if you are not exempt from them. Requirement is based on where you did your initial nursing training, not where you have worked. Even if you are now in the US working on your MSN; but trained in another country for the BSN, you will still need to take the English exams.
Permanent residency, or green card, is what you will be getting. There are no temporary work visas being issued to nurses, and there have not been any for over two years. H1-B visas do not exist for nurses. If someone tells you otherwise, they are incorrect. Please list permanent residency on any application that asks for the type of visa, and include a copy of your passport with it.
All of the green cards for nurses are employer-based, which means that you must have an employer to start the process for you. You cannot apply to immigration for the green card on your own.
Once you have found an employer to do the petitioning for you, you will be given forms to complete. The one that you keep hearing about is the I-140, and this is what will need initial approval before you can go any further. Next, the visa bill will need to be paid, either by the employer, or you. DS-230 forms will come next, and will need to completed and returned. Your dependents must be listed here, or they will not be on your green card, and will need to go thru a separate process later on. And that can take about two years, so please make sure that everyone is on there.
If you have a baby, they can be added. But for others, there will be a wait involved. Once the DS-230 is received and verified, you will hear that your file is complete. Next step will the final step and that is the medical exam and the US Embassy interview. DS-230 is referred to as Packet 3, and the medical/interview is Packet 4. Length of time will be dependent on where you have to go to interview. the UK is currently about six weeks or so, Manila is on average about four to five months.
Anything that requires a notary, must be done at the US Embassy where you are. It does not need to be done in your home country, if you are not currently working there. If you are in the US, then a local notary is acceptable. There are some that have gotten by with local notaries in their home country, but many times they are not accepted and it is better to do things right the first time.
Reciprocity vs. Endorsement
The NCLEX exam has reciprocity, and is accepted in all fifty states. Once you pass it, you never have to take it again. Each state issues its own license, and you need to meet their requirements for it. Some have language requirements and some have additional courses required. Please check directly with the state that are seeking a license in.
Employment Contracts
These are binding legal documents and should be treated as such. If you were buying a home, you would not just sign it. Do the same with this. If it is not in the contract and written, it does not exist. Do not sign a letter of intent or employment, if you intend to look elsewhere and may break that contract. It makes it harder for others to get petitioned. Please be aware of this.
What to look for in a contract: Remember that you will be coming over to the US on a green card, all of you are college educated and with at least four year degrees. Do not sell yourself short.
You can request a specific state, or even city. If the agency doesn't have that one, then look other places. You can also do a direct hire with a hospital.
Make sure that length of orientation is included, this is extremely important. You should not be expected to be on your own in just a couple of days. Doesn't matter how much experience that you have in your country, things will be different in the US.
Never, ever sign a contract or letter of intent, etc., that has any blanks in it. It must be 100% complete; or your contract can be sold, and you are essentially sold to another company. Just like the slave contracts. And if you sign it, there is nothing that anyone can do to get you out of it. If something does not feel right to you about it, then do not sign it.
Canadian and Mexican RNs: You are covered under the NAFTA Free Trade Agreement and can be issued a TN Visa right at the border. You just need to present a Visa Screen Certificate and a job offer form an employer. This visa needs to be renewed every year. You can also go thru the same process as other foreign nurses to obtain the green card, if you wish. You mut actually hold a passport from that country, and not just have permanent residency there to qualify for this type of visa.
LPN/LVN:
This training is not accepted by US immigration for a green card. Statute states that the nurse must be a first level nurse in their country, and have RN after their name. There are no temporary work permits available for nurses.
The only way around the above is if you are married to a green card holder or an American, but you cannot get the green card on your own. It would have to be spousal only.
CGFNS:
Credentials Verification for NY is called the CVS. NY requires this, even if you are endorsing to there.
Regular Credentials Eval is called the CES.
Visa Screen Certificate is needed by all that are applying for a green card in their name.
Their website is www.cgfns.org
Most states are now requiring the CES, and not the CGFNS exam. And this can be for endorsement as well. Please check the specifics with the state that you are applying to. Check out the initial licensure, as well as endorsement requirements.
English exams:
You have choice of either the TOEFL series, which includes TOEFL, TWE, and TSE. This is offered thru ETS, Educational Testing Services, and their website is www.ETS.com or the IELTS, in the academic branch with the speaking section. This is available thru the British Council.
Consular Processing vs. Adjustment of Status (AOS)
Consular processing means that you follow the routine process and have all of your immigration details processed while you are still out of the US, and complete your interview at the US Embassy before you travel to the US.
AOS is done once you have been in the US for a period of 90 days, continuously. You are not permitted to leave during the processing time for any reason. It is actually in violation of US Immigration law to come to the US for the sole purpose of finding a job and staying however, it is done all of the time. But there are some things that you need to be aware of. You must make sure that you have about five months of funds available to you to live on while waiting. It is the 90 days before a petition can be submitted, plus about another 60 days before you are will receive the EAD, which permits you to work. Then you need to allow about one week for your SSN# to arrive after you apply for it. It is illegal to accept any type of work during this time, and if you are caught, you face deportation and not being permitted to return to the US for a period of at least ten years. EAD stands for Employment Authorization Document.
And if you are going to come to the US with the idea that you are going to stay, make sure that you already have approval to sit for the NCLEX exam before you arrive here. Do not come with the idea that you will start everything once you are here. You are not going to be able to get things done in most cases, and will have to leave. You never want to apply for an extension after those 180 days are up, unless you have a very good reason. It must be done well in advance, not just a few days before it expires.
Foreign nursing students in the US
You can attend school on any of the visas that permit you to be in the US legally. The tourist visa will not alow you to carry a full load of classes.
CPT is available for you during school to get experience working in a hospital. The OPT is available for up to one year when you graduate, but yo umust apply for it before you actually finish your classes, or it will not be available to you. There are restrictions for both.
The only visa that you can apply for when you graduate is the green card, or permanent residency. H1 visas are not available to nurses, and have not been for over two years.
--------------------------------------------------------------------------------
Last edited by suzanne4 : Jan 20, 2007 at 12:14 PM.
Jun 10, 2006, 02:52 PM
NRSKarenRN
Co-Administrator
Join Date: Oct 2000
Re: A Primer For All That Wish To Work In The US permalink
--------------------------------------------------------------------------------
Copying edited info from lawrence01 here as helpful:
Reliable information websites to assist in immigration/working in US
There are a lot of inaccurate informations out here in the Philippines, whether its on the 'net or worse, from hearsays. Please do not depend on just these hearsays, and rumors. We need to check out all the information being given out. If you are already on the 'net, there is no reason that you should get inaccurate informations. We just have to go to reliable websites and forums like this.
Here are some links to reliable websites that I think all nurses should know.
For ALL State BON (and their respective requirements) and everything about NCLEX:
www.ncsbn.org
Allnurses: US states board of nursing websites http://allnurses.com/forums/boards-of-nursing.php
For CES, CVS, CGFNS certifications and esp. VisaScreen Certification (everybody needs this): Go thru the whole website. Everything is in there.
www.cgfns.org
Immigration/legal websites:
(examples + informative, no endorsement by allnurses. Karen)
www.shusterman.com
www.murthy.com
For Official news realeases from USCIS pertinent to Schedule A nurses:
www.uscis.gov
Instructions for registration with Pearson-Vue:
www.pearsonvue.com and
www.ncsbn.org
Hospital websites for diff. States:
http://www.theagapecenter.com/Hospitals/
Nursing websites/e-magazines:
www.nursingspectrum.com
http://nursing.advanceweb.com/main.aspx
Texas service center processing dates for I-140 schedula A nurses:
https://egov.immigration.gov/cris/js...ceCenter=Texas
Nebraska service center processing dates for I-140 schedula A nurses:
https://egov.immigration.gov/cris/js...enter=Nebraska
Vermont service center processing dates for I-140 schedula A nurses:
https://egov.immigration.gov/cris/js...Center=Vermon t
Phillipines Local Licensing body:
www.prc.gov.ph
Of course, the Int'l and Filipino forums of www.allnurses.com
With all these reliable websites, there are no reasons that nurses would get lacking or inaccurate informations. We just have to do our own research and do what is best for ourselves and most importantly let's network and help each other out. If we know any info. (bad or good) pls. share it. It has to be as much as possible accurate or if you received info. but not sure if it's accurate or not, pls. share it and ask about it in forums like this so that those who have gone thru the process or are more experienced or an authority could give their inputs and suggestions.
Lastly, to those posting on public forums (such as www.allnurses.com ) be responsible, respectful and sensitive in your posts. These posts are monitored by not just RNs but everyone related in this industry (including prospective employers). We are all educated professionals here. Many may have differing opinions but we must always maintain respect with each other. We are the Captains of our own Ship and no one is forcing anyone to do something we don't want to.
------------
National Nurse Campaign
With the nursing shortage getting so much national attention, several experienced nurses have united to form a campaign to bring nursing issues back to the fore at the state and federal government levels. Watch this recent news story to learn more.
Be A Nurse, you can make a difference!
Nursing Promotional Advertisement..Decker School of Nursing, Binghamton University.
International Nurses - From NCSBN
Nurse Licensure & Certification
Licensure is the process by which an agency of state government grants permission to an individual to engage in a given profession upon finding that the applicant has attained the essential degree of competency necessary to perform a unique scope of practice. Licensing requirements define what is necessary for the majority of individuals to be able to practice the profession safely and validate that the applicant has met those requirements. This regulatory method is used when regulated activities are complex, require specialized knowledge and skill and independent decision-making. The licensure process includes the predetermination of qualifications necessary to perform a legally defined scope of practice safely and an evaluation of licensure applications to determine that the qualifications are met. Licensure provides that a specified scope of practice may only be performed legally by licensed individuals. Licensure provides title protection for those roles. It also provides authority to take disciplinary action should the licensee violate provision of the law or rules in order to assure that the public health, safety and welfare will be reasonably well protected.
A Minimal Data Set for the Evaluation of International Nurses was developed and approved by the Delegate Assembly in August 2004. The minimal data set represents the minimal level of data needed by boards of nursing to make informed licensure decisions regarding international nurses.
https://www.ncsbn.org/171.htm
Licensure is the process by which an agency of state government grants permission to an individual to engage in a given profession upon finding that the applicant has attained the essential degree of competency necessary to perform a unique scope of practice. Licensing requirements define what is necessary for the majority of individuals to be able to practice the profession safely and validate that the applicant has met those requirements. This regulatory method is used when regulated activities are complex, require specialized knowledge and skill and independent decision-making. The licensure process includes the predetermination of qualifications necessary to perform a legally defined scope of practice safely and an evaluation of licensure applications to determine that the qualifications are met. Licensure provides that a specified scope of practice may only be performed legally by licensed individuals. Licensure provides title protection for those roles. It also provides authority to take disciplinary action should the licensee violate provision of the law or rules in order to assure that the public health, safety and welfare will be reasonably well protected.
A Minimal Data Set for the Evaluation of International Nurses was developed and approved by the Delegate Assembly in August 2004. The minimal data set represents the minimal level of data needed by boards of nursing to make informed licensure decisions regarding international nurses.
https://www.ncsbn.org/171.htm
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