Tag: practitioner

Reflective Practice in Social Work #social #worker, #social #work, #clinical, #medical, #social #services, #addiction,


Eye on Ethics

Reflective Practice in Social Work — The Ethical Dimension
By Frederic G. Reamer, PhD
April 2013

Recently, I received an urgent voicemail message from a hospital social worker: “Please get back to me as soon as possible. I have a meeting tomorrow morning with our head of human resources, and I’m very nervous about it.”

Later in the day, I connected with the social worker and learned the following: He had been employed by the hospital for seven years and had never been disciplined. His current predicament began when his immediate supervisor called him in to discuss concerns about possible boundary violations and an alleged inappropriate dual relationship with a hospital patient. The social worker explained to me that in his personal life he is actively involved in a community-based group of parents who adopted children from China. The group sponsors a wide range of activities to support and enhance the children’s ethnic identity. Through this involvement, the social worker said, he and his wife had become very friendly with several other adoptive parents.

About three weeks earlier, one of the parents who had become a good friend was admitted to the social worker’s hospital for treatment of a chronic, debilitating infection. The friend did not receive social work services. During the friend’s hospital stay, the social worker occasionally stopped by his room to say hello and inquire about the friend’s health. The patient’s attending physician had collaborated professionally with the social worker in other hospital cases and was well aware of the patient’s friendship with the social worker.

One afternoon during the patient’s hospital stay, the physician contacted the social worker and explained that the patient was distraught after having just learned that he was diagnosed with bone cancer. According to the social worker, the physician asked the social worker to visit the patient and offer emotional support. The social worker visited the patient in his room and spent about an hour helping his friend process the distressing medical news.

The social worker documented this patient encounter in the hospital chart. During a random quality-control review of social workers’ chart entries, the hospital’s social work supervisor read the note and became concerned because the social worker had not been assigned to provide social work services to this patient. The supervisor learned of the social worker and patient’s friendship and notified the director of human resources, who documented this “incident” in the social worker’s personnel record and asked to meet with the social worker.

The Nature of Reflective Practice
In 1983, the late scholar Donald Schon published his influential and groundbreaking book The Reflective Practitioner: How Professionals Think in Action . Schon’s thesis, based on his extensive empirical research, was that the most skilled and effective professionals have the ability to pay critical attention to the way they conduct their work at the same time that they do their work. Schon coined the terms “knowing-in-action” and “reflection-in-action,” which suggest that some professionals can take a step back and think hard about what they are doing while they are doing it. The concepts are akin to the widely used social work concept “use of self.”

Ordinarily the concepts of knowing-in-action and reflection-in-action are applied to practitioners’ cultivation and use of technical skill, whether in surgery, architecture, town planning, engineering, dentistry, or psychotherapy. In my view, and as the above case demonstrates, social workers would do well to extend the application of these compelling concepts to their identification and management of ethical issues in the profession. Ideally, effective practitioners would have the ability to recognize and address ethical issues and challenges as they arise in the immediate context of their work, not later when someone else points them out. Put another way, social workers would have a refined “ethics radar” that increases their ability to detect and respond to ethical issues.

Of course, the most important benefit is client protection. However, an important by-product is self-protection, that is, the increased likelihood that social workers will protect themselves from ethics-related complaints.

Implementing Reflective Ethics Practice
Certainly the hospital social worker who called me with panic in his voice would have benefited from reflective ethics practice and highly sensitive ethics radar. Had he reflected on the ethical dimensions of the boundary challenges that emerged when he interacted with his friend and hospital patient, it is likely that this well-meaning practitioner would have avoided his unpleasant encounter with the human resources department. The social worker’s decision to visit his friend was not the error; that was a humane and compassionate gesture. The error, rather, was not reflecting on his role in that moment and managing the boundaries carefully, including discussing them with his friend and his supervisor.

In my experience, ethics-related reflection-in-action entails three key elements.

Knowledge: Skillful management of many ethical dilemmas requires knowledge of core concepts and prevailing standards. Ethics concepts are addressed in professional literature and standards exist in several forms, including relevant codes of ethics, agency policies, statutes, and regulations. For example, the National Association of Social Workers’ Codeof Ethics includes explicit standards pertaining to boundaries, dual relationships, and conflicts of interest (especially section 1.06). It would have been best for the hospital-based social worker to consult relevant literature and standards with regard to conflicts that can arise when a social worker encounters a friend or social acquaintance in the work setting. The hospital’s personnel policies also prohibit dual relationships that involve conflicts of interest.

In some cases, although not all, statutes and regulations address ethical issues. In the United States, both federal and state laws address various ethical issues, such as confidentiality, privileged communication, informed consent, and social workers’ ethical conduct. Such laws would not have been particularly helpful in the hospital social worker’s case, but often they are helpful and critically important, for example, when social workers must decide whether to disclose confidential information without clients’ consent to protect a third party from harm or whether parental consent is necessary to provide services to minors who seek help with substance abuse but insist that this information be withheld from their parents.

Transparency: Reflective social workers who sense an ethical issue share their concern with supervisors, colleagues, and appropriate administrators. An effective way to protect clients and practitioners alike is to avoid any suggestion that the ethical issue is being handled “in the dark.” Such clarity demonstrates social workers’ good faith efforts to manage ethical dilemmas responsibly. When appropriate, clients should be included in the conversation.

Process: Although some ethical decisions are clear-cut, many are not. The hospital social worker who contacted me was unsure about the best way to manage his involvement with a good friend who had become a patient. Unfortunately, the social worker did not notify his supervisor about the dilemma or seek consultation. He documented his lengthy hospital-room encounter with the patient, but doing so in the client’s hospital chart created the impression that the social worker was functioning in his professional capacity, not as a friend. My hunch is that had the social worker notified his supervisor of his friendship with the patient and made clear that any contact with the patient occurred as a friend, the social worker may have avoided any adverse personnel issues. What I have learned is that many ethical decisions are not simple events; they require a considerable, often painstaking, process.

During the course of the profession’s history, social workers have refined the art of reflective practice. Historically, these skills have been applied primarily to clinical, policy, advocacy, and administrative functions. Clearly, reflective practice should extend to ethics as well.

— Frederic G. Reamer, PhD, is a professor in the graduate program of the School of Social Work, Rhode Island College. He is the author of many books and articles, and his research has addressed mental health, healthcare, criminal justice, and professional ethics.

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Nurse Practitioner vs #schooling #for #nurse #practitioner


Nurse Practitioner vs. Physician Assistant: Who Has the Better Salary?

So you want to become a nurse practitioner. or a physician assistant. The lines between these two professions are becoming increasingly blurred, however some differences do exist. How do you choose? I will begin to discuss the differences between these two professions in a series of blog posts. Lets start with the $$!

Advance for NP’s and PA’s published an excellent comparison of 2011 NP and PA salaries. The following is a review of their findings. From 2010 to 2011, both nurse practitioner and physician assistant salaries declined but at significantly varying degrees. Nurse practitioner salaries declined by just $187 while physician assistant salaries were reduced by $2,006. Career expert Renee Dahring believes this is because PA’s have been traditionally overrepresented in specialty fields. NP’s are beginning to enter specialty practice in higher numbers. The influx of nurse practitioners into this job market has resulted in depressed salaries for physician assistants.

Nurse Practitioner vs. Physician Assistant Salary Comparison

In 2011, the average full-time salary for nurse practitioners was $90,583 while the average salary for physician assistants was $94,870. The average hourly rate for nurse practitioners was $47.63/ hour versus $50.52/ hour for physician assistants.

Practice Setting Salary Comparison

The most important factor in determining nurse practitioner and physician assistant salaries is practice setting. Practice setting can account for an over $45,000/ year salary differential .

The takeaway? Both the nurse practitioner and physician assistant professions provide excellent salaries. Although physician assistant salaries are currently higher than those of nurse practitioners, physician assistant salaries are decreasing at a faster rate. I predict the salaries will continue to reflect each other more closely. Check out Advance for NP’s and PA’s for further salary comparison charts.

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Nurse Practitioner Programs in Pennsylvania: Facts – Figures #nurse #practitioner #schools #in #pa


Nurse Practitioner Programs in Pennsylvania: Facts Figures

The Health Resources and Services Administration keeps close track of what it refers to as Health Professional Shortage Areas (HPSAs), or counties that do not have enough health professionals to adequately serve their populations. There are numerous of these HPSAs across the state of Pennsylvania, and like many states in the U.S. there is a distinct need for nurse practitioners there.

The Pennsylvania State Board of Nursing handles all applications for nurse licensure in the state, including applications to be licensed as a:

  • Licensed Practical Nurse (LPN)
  • Registered Nurse (RN)
  • Advanced Practice Registered Nurse (APRN), including Nurse Practitioners
  • Advanced Practice Registered Nurse with Prescriptive Authority (APRN-Rx)
  • Dietitian-Nutritionist
  • Certified Nursing Assistant (CNA)

Nursing Licensure in Pennsylvania

Pennsylvania is not a member-state of the Nurse Licensure Compact. so nurses who are licensed in another state must reapply for local licensure if they wish to practice in Pennsylvania. The steps for application are outlined below, and more detailed instructions can be found at the website of the Pennsylvania Department of State.

  1. Complete the National Council Licensure Examination for RNs (NCLEX-RN), administered by the National Council of state boards of nursing (NCSBN).
  2. Submit all required paperwork, including transcripts from nursing college or training program and any previous licenses you have held.
  3. Submit to a criminal background check.
  4. Renew your license every two years using the application instructions available on the Pennsylvania Department of State’s website .
  5. Fulfill continuing education requirements every two years, and submit proof of this along with your renewal application.

Average Nursing Salaries in Pennsylvania

All salary data is as of May 2011.

The mean annual wage for RNs in the state of Pennsylvania is $67,140, which is below the national mean, but at least in the same ballpark. The state’s metropolitan areas show a wide range of wages for nurses, possibly due to major differences in population density and relative income in the different regions.

The table below compares the mean annual salaries for RNs in Pennsylvania against those in the metropolitan areas of the state, and against the U.S. as a whole. All data has been provided by The Bureau of Labor Statistics .

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Cost of Nurse Anesthetist School – School by Cost #twu #nurse #practitioner


The Cost of Nurse Anesthetist School

What is the cost of nurse anesthetist school?

Nurse Anesthetist Programs can range from Tuition Freeup to $178,000.

It’s important to note that for CRNA schools that charge out of state tuition. the CRNA program will be listed twice ; first for the in state tuition cost and then for the out of state tuition cost.

Cost of Nurse Anesthetist School

Nurse anesthetist programs are listed by Total Cost of the entire program rather than tuition cost by semester or quarter. Total cost listed is a calculation of tuition + fees and expenses incurred over the entire duration of the program. It is based on information available on each school s website.

The calculation of fees and expenses: Often includes AANA membership fees, certification fees, and clinical fees.

It always includes the cost of textbooks and supplies. When schools do not offer an estimate of this cost, I assume a cost of $2,000 for text books, as this is fairly average.

It never includes housing, travel or basic living expenses, as those vary a great deal from student to student and that data is not always available on program websites. It also does not include the cost of a computer/ laptop or smartphone (which are often either required or recommended).

Though the calculation of nurse anesthetist programs tuition and fees gives you a great idea of how much it will cost you to complete your degree, it does not include every expense you will incur while in one of these nurse anesthetist programs.

Also, beware that cost of nurse anesthetist school is usually NOT an indicator of the quality of education offered. Rather, it reflects where each school gets their primary funding.

There are many instances where the cheapest schools perform far superior to the more expensive schools.

Some students come out two-three years later completely debt free, while others begin their careers as CRNAs strapped with crippling student loan debt.

and some who pay top dollar for their education end up not feeling prepared for their new career, while others who pay the lowest price (or get through tuition free) are the most confident.

Most people make assumptions about school cost that are simply unfounded.

If you want to find a low cost of nurse anesthetist school, paired with excellence in education, you ll want to search the CRNA School Spreadsheet. You ll find your perfect school in minutes, rather than wasting days or months, and still not getting it right.


Cost of Nurse Anesthetist School $0-20k

FREE TUITION + full time salary in exchange for an active duty service commitment of 5 years U.S. Army Graduate Program in Nursing Anesthesia. Texas

$2,100 PER MONTH STIPEND + LOAN REPAYMENT UP TO 50,000 for joining the Army Reserves. Also, compare Army Reserves vs. Active Duty


Cost of Nurse Anesthetist School $20k-30k

$24,818 In State Tuition University of Akron College of Nursing. Ohio Please note: This total does not include the 23 core graduate courses that can be taken in any order. Please see the tuition link to determine what your additional cost will be.


Cost of Nurse Anesthetist School $30k-40k

$35,789 In State Tuition State University New York (SUNY) Downstate Medical Center. New York. Program is voluntarily closing 5/31/2016.

$37,413 Out of State Tuition University of Akron College of Nursing. Ohio Please note: This total does not include the 23 core graduate courses that can be taken in any order. Please see the tuition link to determine what your additional cost will be.


Cost of Nurse Anesthetist School $40k-50k

$40,379 In State Tuition University of North Dakota. North Dakota

$41,376 Out of State Tuition Virginia Commonwealth University: Post-Master s DNAP, Virginia

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SCHOOL OF NURSING – Early Admission Option for Bachelor of Science in Nursing –


Submit Online EAO Application Here

Bachelor of Science in Nursing – Early Admission Option for High School Students

The Bachelor of Science in Nursing – Early Admission option degree program at Wichita State University is a benefit given to high school students who start their college career here at Wichita State. This program guarantees up to 30 eligible students a place in our nursing program, contingent upon fulfilling certain requirements.

Key Program Features

  • Be admitted sooner. High school students can find out in their senior year if they re admitted into the WSU undergraduate nursing program.
  • Guaranteed admittance. Early Admission students are guaranteed admission into the program contingent upon fulfilling certain requirements.
  • Enjoy more benefits. Early Admission students enjoy the benefits of WSU resources and College of Health Professions student organizations.
  • Receive personalized assistance. Early Admission students are assigned a designated adviser, who assists them in achieving their educational goals.

Program Facts

Program Entry Point

2-2.5 years prerequisites; 2 years professional program

Study Plan Requirements

Maintain full-time enrollment at WSU during fall and spring semesters, take all coursework upon Freshman entry at WSU

July 1 August 5 (example, July 1, 2016 – August 5, 2017)

July 1 summer prior to starting your Senior year in high school

August 5 prior to Freshman entry to WSU; admission is on a first come, first served basis

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