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Giving babies Tylenol may blunt vaccines' effect
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Just something to think about: From Yahoo News

Giving babies Tylenol to prevent fever when they get childhood vaccinations may backfire and make the shots a little less effective, surprising new research suggests.

It is the first major study to tie reduced immunity to the use of fever-lowering medicines. Although the effect was small and the vast majority of kids still got enough protection from vaccines, the results make "a compelling case" against routinely giving Tylenol right after vaccination, say doctors from the U.S. Centers for Disease Control and Prevention.
They wrote an editorial accompanying the study, published in Friday's issue of the British medical journal, Lancet.

The study only looked at preventive use of Tylenol — not whether it is OK to use after a fever develops.

Tylenol or its generic twin, acetaminophen, is widely recommended as a painkiller for babies. Many parents give it right before or after a shot to prevent fever and fussiness, and some doctors recommend this. The CDC's vaccine advisory panel says it is a reasonable thing to do for children at high risk of seizures, which can be triggered by fevers.

However, fever after a vaccine isn't necessarily bad — it's a natural part of the body's response. Curbing fever, especially the first time a baby gets a vaccine, also seems to curb the immune response and the amount of protective antibodies that are made, the new study found.

It was led by military and government scientists in the Czech Republic and was done at 10 medical centers in that Eastern European country. It involved 459 healthy infants, 9 to 16 weeks old, who were getting vaccines against polio, pneumonia, meningitis, whooping cough, tetanus, hepatitis and other childhood diseases.

Half were given three doses of Calpol, or paracetamol — a Tylenol-like brand sold in Europe — during the first day after vaccination. The others were given nothing besides the vaccines.

Babies given the painkiller were significantly less likely to develop a fever — 42 percent versus 66 percent of the others — and very few in either group developed a high one.

However, lower rates of protective antibody levels from several vaccines were seen in the group given the drug. Levels remained significantly lower in this group after booster vaccines, given when the babies were 12 to 15 months old.

Next, the researchers looked at 10 other vaccine studies and found some supporting evidence that using Tylenol to prevent fevers at the time of vaccination may curb immune system response rates. The same may not be true of using the drug to treat fevers after they develop.

The research was sponsored by Belgium-based GlaxoSmithKline Biologicals, which makes all the vaccines used in the study. Some authors have financial ties to the company, including owning stock in it, and Glaxo had a role in reporting the results.

Even with the fever-lowering drugs, more than 90 percent of children in the Czech study achieved protection from the various vaccines after the booster dose, so the effect of lower levels of antibodies on any individual might be small, Dr. Robert Chen and two other CDC doctors wrote in an editorial.

Yet the consistency of findings from other studies makes "a compelling case against" routine use of fever-lowering medicines during immunization, they write.

It's not known if Tylenol or other painkillers might reduce vaccine response in adults, but they are less likely to develop a fever after vaccination or to be so bothered by it, said Dr. John Treanor, a vaccine specialist at the University of Rochester Medical Center in Rochester, N.Y., who had no role in the study.

Tylenol is the only member of the family of over-the-counter pain relievers that is not a nonsteroidal anti-inflammatory drug, or NSAID.

"There's been speculation for a long time that the use of NSAIDs might have an effect" on antibody production after vaccination, but this is far from proved, Treanor said.

Given that so few children develop high fevers after vaccines, skipping the meds unless fever develops "may be the way to go," he said.

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FORUM: Nursing News

RN - Occupational Outlook 2008-09
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Occupational Outlook Handbook, 2008-09 Edition
U.S. Department of Labor | Bureau of Labor Statistics
Source: http://www.bls.gov/oco/print/ocos083.htm

Significant Points

Registered nurses constitute the largest health care occupation, with 2.5 million jobs.
About 59 percent of jobs are in hospitals.
The three major educational paths to registered nursing are a bachelor's degree, an associate degree, and a diploma from an approved nursing program.
Registered nurses are projected to generate about 587,000 new jobs over the 2006-16 period, one of the largest numbers among all occupations; overall job opportunities are expected to be excellent, but may vary by employment setting.

Training, Other Qualifications, and Advancement

The three major educational paths to registered nursing are a bachelor's degree, an associate degree, and a diploma from an approved nursing program. Nurses most commonly enter the occupation by completing an associate degree or bachelor's degree program. Individuals then must complete a national licensing examination in order to obtain a nursing license. Further training or education can qualify nurses to work in specialty areas, and may help improve advancement opportunities.

Education and training. There are three major educational paths to registered nursing—a bachelor's of science degree in nursing (BSN), an associate degree in nursing (ADN), and a diploma. BSN programs, offered by colleges and universities, take about 4 years to complete. In 2006, 709 nursing programs offered degrees at the bachelor's level. ADN programs, offered by community and junior colleges, take about 2 to 3 years to complete. About 850 RN programs granted associate degrees. Diploma programs, administered in hospitals, last about 3 years. Only about 70 programs offered diplomas. Generally, licensed graduates of any of the three types of educational programs qualify for entry-level positions.

Many RNs with an ADN or diploma later enter bachelor's programs to prepare for a broader scope of nursing practice. Often, they can find an entry-level position and then take advantage of tuition reimbursement benefits to work toward a BSN by completing an RN-to-BSN program. In 2006, there were 629 RN-to-BSN programs in the United States. Accelerated master's degree in nursing (MSN) programs also are available by combining 1 year of an accelerated BSN program with 2 years of graduate study. In 2006, there were 149 RN-to-MSN programs.

Accelerated BSN programs also are available for individuals who have a bachelor's or higher degree in another field and who are interested in moving into nursing. In 2006, 197 of these programs were available. Accelerated BSN programs last 12 to 18 months and provide the fastest route to a BSN for individuals who already hold a degree. MSN programs also are available for individuals who hold a bachelor's or higher degree in another field.

Individuals considering nursing should carefully weigh the advantages and disadvantages of enrolling in a BSN or MSN program because, if they do, their advancement opportunities usually are broader. In fact, some career paths are open only to nurses with a bachelor's or master's degree. A bachelor's degree often is necessary for administrative positions and is a prerequisite for admission to graduate nursing programs in research, consulting, and teaching, and all four advanced practice nursing specialties—clinical nurse specialists, nurse anesthetists, nurse-midwives, and nurse practitioners. Individuals who complete a bachelor's receive more training in areas such as communication, leadership, and critical thinking, all of which are becoming more important as nursing care becomes more complex. Additionally, bachelor's degree programs offer more clinical experience in nonhospital settings. Education beyond a bachelor's degree can also help students looking to enter certain fields or increase advancement opportunities. In 2006, 448 nursing schools offered master's degrees, 108 offered doctoral degrees, and 58 offered accelerated BSN-to-doctoral programs.

All four advanced practice nursing specialties require at least a master's degree. Most programs include about 2 years of full-time study and require a BSN degree for entry; some programs require at least 1 to 2 years of clinical experience as an RN for admission. In 2006, there were 342 master's and post-master's programs offered for nurse practitioners, 230 master's and post-master's programs for clinical nurse specialists, 106 programs for nurse anesthetists, and 39 programs for nurse-midwives.

All nursing education programs include classroom instruction and supervised clinical experience in hospitals and other health care facilities. Students take courses in anatomy, physiology, microbiology, chemistry, nutrition, psychology and other behavioral sciences, and nursing. Coursework also includes the liberal arts for ADN and BSN students.

Supervised clinical experience is provided in hospital departments such as pediatrics, psychiatry, maternity, and surgery. A growing number of programs include clinical experience in nursing care facilities, public health departments, home health agencies, and ambulatory clinics.

Licensure and certification. In all States, the District of Columbia, and U.S. territories, students must graduate from an approved nursing program and pass a national licensing examination, known as the NCLEX-RN, in order to obtain a nursing license. Nurses may be licensed in more than one State, either by examination or by the endorsement of a license issued by another State. The Nurse Licensure Compact Agreement allows a nurse who is licensed and permanently resides in one of the member States to practice in the other member States without obtaining additional licensure. In 2006, 20 states were members of the Compact, while 2 more were pending membership. All States require periodic renewal of licenses, which may require continuing education.

Certification is common, and sometimes required, for the four advanced practice nursing specialties—clinical nurse specialists, nurse anesthetists, nurse-midwives, and nurse practitioners. Upon completion of their educational programs, most advanced practice nurses become nationally certified in their area of specialty. Certification also is available in specialty areas for all nurses. In some States, certification in a specialty is required in order to practice that specialty.

Foreign-educated and foreign-born nurses wishing to work in the United States must obtain a work visa. To obtain the visa, nurses must undergo a federal screening program to ensure that their education and licensure are comparable to that of a U.S. educated nurse, that they have proficiency in written and spoken English, and that they have passed either the Commission on Graduates of Foreign Nursing Schools (CGFNS) Qualifying Examination or the NCLEX-RN. CGFNS administers the VisaScreen Program. (The Commission is an immigration-neutral, nonprofit organization that is recognized internationally as an authority on credentials evaluation in the health care field.) Nurses educated in Australia, Canada (except Quebec), Ireland, New Zealand, and the United Kingdom, or foreign-born nurses who were educated in the United States, are exempt from the language proficiency testing. In addition to these national requirements, foreign-born nurses must obtain state licensure in order to practice in the United States. Each State has its own requirements for licensure.

Other qualifications. Nurses should be caring, sympathetic, responsible, and detail oriented. They must be able to direct or supervise others, correctly assess patients' conditions, and determine when consultation is required. They need emotional stability to cope with human suffering, emergencies, and other stresses.

Advancement. Some RNs start their careers as licensed practical nurses or nursing aides, and then go back to school to receive their RN degree. Most RNs begin as staff nurses in hospitals, and with experience and good performance often move to other settings or are promoted to more responsible positions. In management, nurses can advance from assistant unit manger or head nurse to more senior-level administrative roles of assistant director, director, vice president, or chief nurse. Increasingly, management-level nursing positions require a graduate or an advanced degree in nursing or health services administration. Administrative positions require leadership, communication and negotiation skills, and good judgment.

Some nurses move into the business side of health care. Their nursing expertise and experience on a health care team equip them to manage ambulatory, acute, home-based, and chronic care. Employers—including hospitals, insurance companies, pharmaceutical manufacturers, and managed care organizations, among others—need RNs for health planning and development, marketing, consulting, policy development, and quality assurance. Other nurses work as college and university faculty or conduct research.

Employment

As the largest health care occupation, registered nurses held about 2.5 million jobs in 2006. Hospitals employed the majority of RNs, with 59 percent of jobs. Other industries also employed large shares of workers. About 8 percent of jobs were in offices of physicians, 5 percent in home health care services, 5 percent in nursing care facilities, 4 percent in employment services, and 3 percent in outpatient care centers. The remainder worked mostly in government agencies, social assistance agencies, and educational services. About 21 percent of RNs worked part time.

Job Outlook
Overall job opportunities for registered nurses are expected to be excellent, but may vary by employment and geographic setting. Employment of RNs is expected to grow much faster than the average for all occupations through 2016 and, because the occupation is very large, many new jobs will result. In fact, registered nurses are projected to generate 587,000 new jobs, among the largest number of new jobs for any occupation. Additionally, hundreds of thousands of job openings will result from the need to replace experienced nurses who leave the occupation.

Employment change. Employment of registered nurses is expected to grow 23 percent from 2006 to 2016, much faster than the average for all occupations. Growth will be driven by technological advances in patient care, which permit a greater number of health problems to be treated, and by an increasing emphasis on preventive care. In addition, the number of older people, who are much more likely than younger people to need nursing care, is projected to grow rapidly.
However, employment of RNs will not grow at the same rate in every industry. The projected growth rates for RNs in the industries with the highest employment of these workers are:

Offices of physicians39%Home health care services39Outpatient care centers, except mental health and substance abuse34Employment services27General medical and surgical hospitals, public and private22Nursing care facilities20

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FORUM: Nursing News

Random thought about nurses and marriage
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ANCC Launches a New Certification
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ANCC Launches a New Certification: Clinical Nurse Specialist Core

$100 Early Bird Rebate if you test by December 31, 2009!
The American Nurses Credentialing Center (ANCC) is looking for qualified nurses to sit for the new ANCC Clinical Nurse Specialist Core (CNS Core) examination between the dates of September 1, 2009 and December 31, 2009. Candidates who sit for the CNS Core exam during this period will receive a $100 rebate off of their application fee! Clinical nurse specialists in any field are welcome to apply. This certification is especially attractive to CNSs who specialize in a field that does not have its own national certification. (e.g. emergency, burn, perinatal, women's health, urology, neurology, cardio-pulmonary, etc.)

This rebate is in addition to any other discounts you are eligible for as a result of your membership in American Nurses Association or National Association of Clinical Nurse Specialists. All rebates will be refunded based on the original form of payment. Candidates must first apply and be determined eligible by ANCC to sit for the CNS Core exam, then must test by December 31, 2009 to qualify for the $100 rebate. Please turn in your application by November 1, 2009 to assure you can test by December 31, 2009.

Am I Eligible to Sit for This Exam?
Nurses who hold a master's, doctoral degree, or a post-graduate certificate from a clinical nurse specialist program may be eligible to sit for ANCC's CNS Core certification examination. Candidates who pass this exam will earn the credential CNS-BC. For information on specific eligibility requirements, study aids, or to downloading an application, please visit ANCC's website at: www.nursecredentialing.org/NurseSpecialties/CNSCoreExam.aspx

When Will I Receive My Exam Results?
You can expect to receive your score results by February 28, 2010.

Questions?
For additional information, please visit our website at www.nursecredentialing.org or call us at 1.800.284.2378

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FORUM: Nursing News

ANCC or AANP Certification
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