Write an analysis about how a specific career (one that you are interested in learning more about) will impact your life/lifestyle.

Your date in the heading should be like this: 4 March 2022.
Use a creative title.
Job titles are not capitalized unless there is a proper noun such as Latin teacher.
Analyze why the career is a positive or negative for your lifestyle.
Use evidence for every body paragraph from a source.
Use three different types of sources.
Use five sources total.
Spell out numbers with fewer than four words.
Use signal phrases to introduce quotes, paraphrases, and summaries. The first time you use a source, give credentials for the source.
Do not use contractions.
Use 1st and 3rd person (not 2nd person you/your).
Use correct in-text citations.
Alphabetize your works cited entries.
Use our textbook and my comments to revise your works cited page.
Use this organization for your body paragraphs:
Topic sentence that states the one positive or negative.
Source material to support that pro or con.
Analysis of source material for your life.
Your Writing Assignment: Write an analysis about how a specific career (one that you are interested in learning more about) will impact your life/lifestyle. In writing your analysis, you will use research to find out more about the career, so you can decide what positives and negatives there are to this career. The purpose of this assignment is to help you learn about a career you are interested in as well as learn how to research and use sources appropriately in an essay.
The purpose of this assignment is to help you learn about a career you are interested in as well as learn how to research and use sources appropriately in an essay. These skills are important in both college writing and in real world jobs.

Required Pros/Cons: This analysis should include information on these areas: 1) how the job duties of that career impact you, 2) how the salary impacts you, and 3) how the job market for that career might or might not fit in your lifestyle. However, do not just limit your essay to those three items. Many job details you could analyze as positives or negatives might be specific to the career you choose. For example, if you choose police work, a negative for you might be the danger of the career or for power plant technicians, the shift work might be a negative.

Required Body Paragraph Format: Your topic sentence should state the one topic and if is a positive or negative for you. Then, you will provide evidence from source(s) to support your claim that this is true of that career. Finally, analyze in 1st person why this is a negative or positive for you giving specific examples to explain.

Documented Research Requirements: You are required to use five research sources on this essay (at least three different types of sources—i.e. a book, online sources, magazines, journals, newspaper articles, government documents, etc.). You can certainly use more than five sources if needed, however. I strongly recommend you use the government website (cite as a government document): . Any time you use information or ideas from sources, you must cite those sources. Otherwise it is plagiarism. NOTE WELL: I WILL CHECK ALL OF YOUR SOURCES FOR PLAGIARISM.

Signal Phrases/In-text Citations: You must use a signal phrase to introduce all quotes, paraphrases, and summaries in your essay, and then cite those sources in-text with a parenthetical citation using what is first in the works cited entry so readers can cross reference these. We will read and work on this in the next few weeks.

Works Cited: A Works Cited page is required for this assignment. This should be the last page of your paper. Do not use programs to help you cite your paper–do it yourself since most of the program are inaccurate, including the citations on web pages many times.

Format:
updated MLA format–see your Pocket Style Manual for details for page layout and all citations
3-4 pages typed (not including the works cited page); 3 full pages minimum
double-spaced
12 point Times New Roman font
1” margins
only allowed one long quote (a quote 5 lines or longer)
1st person (not 2nd person) and a formal voice

Uses these 5 sources I found:
1.)
2.)
3.)
4.) use this to do intent citations; (Ferguson’s Career Guidance Center)
HistoryReliable methods of putting a patient to sleep were first developed in the 1840s, when the discovery of ether anesthesia revolutionized surgery. Before that time, when surgery offered the only possible chance of saving a person’s life, all that the surgeon could do was give alcohol or opium to deaden the pain. Similarly, mandrake, hemp, and herbane may have been given orally, or by inhalation, during childbirth.

The first nurse anesthetist was Sister Mary Bernard, who practiced in Pennsylvania in the 1870s. The first school of nurse anesthetists was founded in 1909 at St. Vincent Hospital in Portland, Oregon. Since then, many schools have been established, and the nurse anesthesia specialty was formally created on June 17, 1931, when the American Association of Nurse Anesthetists held its first meeting.

Contemporary anesthesiology is far more complicated and much more effective than in the early days when an ether- or chloroform-soaked cloth or sponge was held up to the patient’s face. Today, a combination of several modern-day anesthetic agents is usually used to anesthetize the patient.

The Job
The American Association of Nurse Anesthetists notes that more than 49 million anesthetic procedures are carried out annually in U.S. medical facilities, and the majority of these are administered by nurse anesthetists. In some states, nurse anesthetists are the only anesthesia providers in nearly 100 percent of the rural hospitals.

Nurse anesthetists are clearly important members of health care teams across the country. Prior to surgery, a nurse anesthetist takes the patient’s history, evaluates his or her anesthesia needs, and forms a plan for the best possible management of the case (often in consultation with an anesthesiologist). The nurse anesthetist also explains the planned procedures to the patient and answers questions the patient might have. Prior to the operation, the nurse anesthetist administers an intravenous (IV) sedative to relax the patient. Then the nurse anesthetist administers a combination of drugs to establish and maintain the patient in a controlled state of unconsciousness, insensibility to pain, and muscular relaxation. Some general anesthetics are administered by inhalation through a mask and tube, and others are administered intravenously. Because the muscular relaxants prevent patients from breathing on their own, the nurse anesthetist has to provide artificial respiration through a tube inserted into the windpipe.

Throughout the surgery, the nurse anesthetist monitors the patient’s vital signs by watching the video and digital displays. The nurse anesthetist is also responsible for maintaining the patient’s blood, water, and salt levels as well as continually readjusting the flow of anesthetics and other medications to ensure optimal results. After surgery, nurse anesthetists monitor the patient’s return to consciousness and watch for complications. The nurse anesthetists must be skilled in the use of airways, ventilators, IVs, blood- and fluid-replacement techniques, and postoperative pain management.

Earnings
Nurse anesthetists are among the highest paid nursing specialists. Earnings vary based on type and size of employer, years of experience, and location, among other factors. According to the Department of Labor, nurse anesthetists earned a median salary of $174,790 in May 2019. The lowest paid 10 percent earned less than $82,460 and the top paid 10 percent earned in excess of $184,180 annually.

Nurse anesthetists who work for the federal government are paid according to a special pay scale. FederalPay.org reports that the median yearly salary for a nurse anesthetist is about $168,287. CRNAs working in the private sector frequently have higher earnings. For example, Salary.com reports that the average annual salaries for certified nurse anesthetists in 2020 ranged from $156,766 or less to $202,319 or more.

Fringe benefits are usually similar to other full-time health care workers and may include sick leave, vacation, health and life insurance, and tuition assistance.

Work Environment
Nurse anesthetists usually work in sterile, well-lighted operating facilities. They spend considerable time on their feet and may be required to stand for many hours at a time. Emergencies can produce a stressful and fast-paced environment. Many nurse anesthetists must be on call, usually on a rotation basis, to respond to emergency surgical situations.

Exploring This Job
Books, nursing association Web sites, and informational interviews with nurses will provide you with more information about nursing careers. Ask your careers services offices for help with setting up an informational interview with a nurse anesthetist, and be sure to prepare a list of question to bring to the interview. You can also learn more about nurse anesthetists by visiting the “Become a CRNA” page of the AANA Web site (.

Education and Training Requirements
High School

If you want to become a nurse anesthetist, you will first need to become a registered nurse. To prepare for this career, you should take high school mathematics and science courses, including biology, chemistry, and physics. Health courses will also be helpful. English and speech courses should not be neglected because you must be able to communicate well with patients.

Postsecondary Training

All applicants to nurse anesthetist programs must be registered nurses with a bachelor’s degree and have at least one year’s acute care nursing experience. The Council on Accreditation of Nurse Anesthesia Educational Programs accredits nurse anesthesia programs within the United States and Puerto Rico. A listing of these programs can be found on its Web site, . Admission is competitive, and programs last 24 to 36 months. All accredited programs offer at least a master’s degree, and some offer a post-master’s certificate or a doctorate. Students take extensive classes in pharmacology and the sciences. They also acquire hundreds of hours of anesthesia-related clinical experience in surgery and obstetrics.

Certification, Licensing, and Special Requirements
Certification or Licensing

All registered nurses must be licensed to practice in the United States. In addition, nurse anesthetists are required to pass a national certification exam given by the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA). All states recognize certified registered nurse anesthetist (CRNA) status. Certified nurse anesthetists are not required to work under the supervision of an anesthesiologist, although some licensing laws do stipulate that they must work with a physician.

CRNAs must be recertified every two years according to the criteria established by the NBCRNA. Part of this requirement includes earning 40 continuing education credits every two years. The American Society of PeriAnesthesia Nurses also offers a certification program.

Experience, Skills, and Personality Traits
Nurse anesthetists should have proven track records in administering anesthesia and monitoring the patient throughout the surgical procedure. They should be knowledgeable about follow-through protocols and strategies. Their backgrounds must include not only the required education and certification, but also training in patient assessment, experience in working as part of a health care team, and a solid history in preparing and administering specific types of anesthesia.

Since nurse anesthetists are tasked with checking the patient throughout the surgery, they must be skilled at reading output from operating room machines and monitoring body functions. They must be able to adjust the anesthetic, ensuring the patient’s comfort and safety.

Nurse anesthetists must have the ability to concentrate for long periods of time and remain focused on monitoring their patient during surgery. They must be able to analyze problems accurately and swiftly, make decisions quickly, and react appropriately. They must have the ability to remain calm during emergencies and be able to handle stressful situations. Nurse anesthetists also need to have efficient time management skills in order to work efficiently with surgeons and their operating schedules. In addition, nurse anesthetists should also possess good communication skills. Since they are with the patient prior to, during, and after surgery, they should be able to translate highly technical medical jargon for the patient and their families.

Employment Prospects
Employers

There are about 45,000 nurse anesthetists working in the United States. Many nurse anesthetists are employed by hospitals or outpatient surgery centers. Dentists, podiatrists, ophthalmologists, plastic surgeons, and pain management specialists also employ them. Others may be employed in a group or independent practice that provides services to hospitals and other health care centers on a contract basis. Some work for rural hospitals, the U.S. Public Health Service, the Department of Veterans Affairs, and the U.S. military. Health care institutions are eager to employ nurse anesthetists because of the high-quality, cost-effective anesthesia service that they provide to patients.

Starting Out

Nurse anesthetists may apply for employment directly to hospitals, outpatient surgery centers, and government agencies that hire nurses. Jobs can also be obtained through school career services offices, by signing up with employment agencies specializing in placement of nursing personnel, or through the state employment office. Other sources of jobs include nurses’ associations, professional journals, and newspaper want ads.

5.) use this to do intent citations: (gale in context)
Introduction Advanced practice nurses (APNs) are required to improve the quality of patient care and the health care systems of hospitals and regions. APNs are registered nurses who hold master’s degrees and have acquired the expert knowledge base, complex decision making skills, and clinical competencies necessary for expanded practice [1]. They are known by various titles such as clinical nurse specialists, nurse practitioners, nurse anesthetists, and nurse midwives.

Clinical nurse specialists, as expert clinical leaders, have obtained favorable outcomes in nursing interventions with patients in complicated situations and have demonstrated abilities in reducing medical costs [2-6]. In Japan, an APN who has a master’s degree is recognized as a Certified Nurse Specialist (CNS), a qualification that has been adopted based on the CNS designation in the United States.

Most CNSs work directly with patients or in a division of nursing education developing effective health care techniques based on clinical evidence, solving complex problems, and educating nurses [7-10]. In contrast, one-fifth of CNSs work as full-time nurse administrators such as head nurses, nursing vice-directors, or nursing directors. [11]

The role of nursing administrators, and especially head nurses, is overall administrative responsibility, which involves ensuring optimal quality nursing care in their units [12,13]. To improve the quality of care, head nurses set goals, monitor important outcomes, and evaluate initiatives.

Intensive care areas that are not managed by doctors specialized in intensive care (referred to as intensivists) are termed low intensity ICUs or open ICUs; particularly in these areas, facilitators are needed who have considerable clinical skills (e.g., deciding treatment policy, resolving various conflicts that arise during patient care). ICU head nurses often require not only management skills but also clinical skills to develop treatment policy and nursing care for patients with serious illnesses, cope with ethical problems, and convey the opinions of various clinical professionals as nursing advisors or caregivers. In some cases, these opinions and activities can change the treatment and nursing care a patient receives. Thus, a CNS acting in the head nurse’s role in critical care nursing may improve ICU patient outcomes by improving management’s role as head nurse and by directly enacting evidence-based care and treatment decision-making.

In nursing management science, there exists outcomes research regarding the working environment, patient safety, and leadership from the perspective of head nurses [14-18], but little work has focused on patient outcomes. Likewise, no work has been conducted on ICU patient outcomes in settings where a CNS is the head nurse. Therefore, this study evaluated the impact on patient outcomes of having a CNS as head nurse.

Method

Design

A retrospective cohort study was conducted among ICU patients in Japan over a five-year period. Data were collected from April 2014-March 2019. Results were compared between two groups: before and after a CNS was assigned as ICU head nurse.

Target ICU

The targeted ICU is a general ICU with 10 beds that accepts hospitalized patients whose condition has rapidly changed and tertiary emergency patients, who are predominately postoperative patients. The director of the ICU was a cardiovascular surgeon until March 2016, but from April 2017 intensivists in anesthesiology were the main ICU management personnel. A system in which doctors provide treatment without receiving advice regarding intensive care was changed to a system called elective care consultation [19], in which the attending physician consults with intensivists when needed [20].

CNS efforts

CNSs are required to perform six clinical roles: practice, coordination, ethical coordination, consultation, education, and research [10]. To form the basis of nursing practice to improve the quality of care in the ICU, practical nursing education was developed using guidelines and adult learning theory in accordance with treatment and nursing practices. Goals and progress on treatment, care, and rehabilitation are shared with physicians, intensivists, nurses, and other therapists, and are coordinated to improve treatment and care outcomes.

CNS-led multi-professional conferences were held for long-term ICU patients and cases with ethical issues: issues were noted, goals set, and future treatment and nursing in ICU was defined. When conflict that was difficult to solve occurred, the CNS encouraged consultation with the in-hospital ethics committee instead of seeking a solution on their own.

As a head nurse, before an elective care consultation for a complicated case or situation, the CNS discussed problems regarding the treatment plan and care based on patients’ backgrounds with the attending physician and staff nurses; the system was structured so that the intensivists could smoothly intervene. In addition, the ICU was effectively utilized. By referring to the medical judgment of intensivists, the necessity and extent of care were comprehensively examined, and patients who could leave ICU were identified. Other general management tasks of head nurses include setting ICU goals for nursing, managing staff, upgrading facilities, reducing medical costs, and decision making for the organization. In this way, the CNS fulfilled all of the roles of head nurse, and acted as a link between the attending physician, the intensivists in anesthesiology, the ICU nurses, and other medical staff.

Data collection

The data of patients admitted to the ICU of a Japanese hospital between April 2014 and 2018 were collected from electronic medical records and the ICU ledger, namely: disease, patient age, medical department, scheduled or emergency admission, associated surgery, days in ICU, severity of patient’s condition, degree of medical and nursing needs in ICU, use of ventilator, hours of ventilation, and outcomes.

Measurements

The severity of each patient’s condition and the extent of his or her required medical and nursing care were determined. The former was assessed using a scale that measures the degree of dependence on medical care for patients admitted to the ICU created by the Ministry of Health, Labor and Welfare of Japan (S1 and S2 Tables). The higher the score, the greater the degree of dependence on treatment and nursing care (severity). The score is divided into item A and item B. Item A scores medical dependency out of a maximum of 15 points in terms of presence or absence of electrocardiogram monitor, infusion pump, syringe pump, A-line, central venous catheter, and respirator attachment; use of transfusion and blood products and Swan-ganz catheter; and special treatment (intra-aortic balloon pumping [IABP], Continuous hemodiafiltration [CHDF], percutaneous cardiopulmonary support [PCPS], intracranial pressure measurement [ICP measurement], ventricular assist device [VAD], and extracorporeal membrane oxygenation [ECMO]). Item B scores the degree of dependence on nursing care out of a maximum of 12 points, in terms of the items turn over (unable to, can with assistance, can), transfer (cannot, needs assistance or observation, can), oral care (cannot perform, can perform), food intake (cannot feed self, requires assistance, can feed self), remove clothes (cannot, requires assistance, can), understand instructions regarding medical treatment (cannot understand, can understand), and dangerous behavior (yes, no). Evaluation criteria for each item apply nationwide and are evaluated daily for patients admitted to the ICU.

ICU nurses were responsible for scoring patients on this scale after completing training on how to do so via e-learning. After completing the training, all the nurses passed a computer-based examination.

Data analysis

The period covered was divided into two intervals: before the ICU head nurse was a CNS (April 2014-March 2017) and after the ICU head nurse held this qualification (April 2017-March 2019). Differences between groups were compared using Fisher’s exact test for categorical variables and the Mann-Whitney U test for continuous variables. The primary endpoint of this study was the ICU mortality rate, and the secondary endpoint was the number of ventilator-equipped patients in the ICU. Multiple logistic regression analysis was performed with dependent variables being the degree of severity and need for nursing care, and independent variables of presence of a CNS ICU head nurse, patient age, patient gender, and emergency versus planned admission to ICU. Significant differences were defined as p < .05. The free software Easy R (EZR) version 3.5.2 was used for analysis. Ethical considerations The approval of the IRB of the Tokyo Saiseikai Central Hospital was obtained before the study commenced (No. 30-88). As this study did not involve any intervention, collecting informed consent from patients was judged unnecessary. The data obtained were password-protected and stored by the researchers. In consideration of privacy, patient names were not collected. Results Characteristics of patients During the study period, data were collected from 3,652 people, with 1,988 in the first group ("before" group: ICU head nurse was not a CNS) and 1,664 in the second group ("after" group: ICU head nurse was a CNS). Patient characteristics are shown in Table 1. There was no difference between groups in age or gender. As intensivists began to take charge of ICU treatment management during the "after" period, a system was created that encouraged the surgical system to place high-risk patients into the ICU following an examination in anesthesiology at a preoperative consultation. Accordingly, postoperative ICU admissions increased in number. Additionally, ICU admissions increased for patients with gastrointestinal ( p < .001) and respiratory (p < .001) issues. In contrast, establishment of a 10-bed emergency center ICU in the hospital after reorganization of the ward reduced the number of patients admitted to the ICU with cardiovascular disease (p < .001) from internal medicine and from emergency services (p < .001). As the number of patients admitted to the hospital increased, the severity of medical and nursing needs A score increased significantly (p < .001), although the B score decreased (p < .001). In addition, there were decreases in ICU admission days (p < .001), ICU mortality (p = .03), patients with ventilator (p = .003), and ventilator days (p < .001) due to the increase in planned surgeries. The A score increased, even though the number of patients requiring ventilation and the number of ventilation days decreased. This was due to an increase in patients treated with devices other than ventilators. In contrast, the B score decreased because the number of patients classified as exhibiting dangerous behavior decreased because the nursing team tried not to restrain individuals in the "after" period. In addition, there was no significant difference in the number of nurses (before: 24 staff nurses per month, range: 22-26; after: 25 staff nurses per month, range: 20-27; p = .075 by Mann-Whitney U test) and years of clinical experience (before: 5.3 years, range: 0-15 years; after: 5.1 years range: 0-14 years; p = .075 by Mann-Whitney U test) between the two groups, and no major changes in the medical devices used in the ICU during the study period. Relationship between presence of CNS ICU head nurse and patient outcomes Table 2 shows the results of the multivariate logistic regression analysis of ICU mortality. The presence of a CNS as ICU head nurse was significantly associated with lower ICU mortality (OR: 0.52, 95% CI: 0.36-0.73, p < .001) and fewer ventilator-equipped patients in the ICU (OR: 0.20, 95% CI: 0.10-0.26, p < .001; Table 3). Table 3. Association between CNS/Head Nurse Staffing and patients with mechanical ventilation by multivariate logistic regression analysis. [see PDF for image] Discussion A CNS conducts daily activities with a background of specialized medical and nursing knowledge and experience. The CNS contributes to patient outcomes through identifying problems and providing high-level practice, and through decision support and team building for dealing with difficult problems and patients in complex situations [21]. CNSs support stakeholders (i.e., patients and all ICU-related personnel) in addressing clinical problems and managing the care and treatment of patients. Further, CNSs fill an educational role for other nurses, which improves the quality of nursing care. The head nurse manages ward policy, nursing staff, and finances to achieve ward goals so that the staff can engage in effective nursing practice. However, head nurses placed in a highly specialized ward may experience difficulties in setting outcomes and goals [13]. This is because treatments are complex and care has a therapeutic aspect that influences the outcome. In this study, a CNS acted as a head nurse; this individual communicated nursing policies while exchanging information with doctors, nursing staff, and other medical professionals, in order to improve the treatment received by patients. Notably, the presence of a CNS as head nurse was associated with a reduction in mortality among ICU patients and fewer patients requiring ventilators. Previous research has shown that ICU management led by intensive care physicians is associated with improvements in mortality and the duration of hospitalization in Japanese and international contexts [20,22]. Advanced practice nurses, including CNSs, have advanced nursing skills and clinical decision making experience in their area of expertise [23-25], which can facilitate positive outcomes by guiding the medical team to appropriate solutions [6,26-28], especially for patients with complex and difficult problems in the ICU and general wards. In low-intensity ICUs or open ICUs, in which intensive care physicians do not determine treatment for various reasons, collaboration between physicians and the CNS responsible for advanced nursing practice improves treatment outcomes. It is essential that the CNS head nurse considers treatment in consultation with a physician, and in difficult cases, with intensivists, nurses, and other medical staff. The role of the CNS as a head nurse contributes to patient outcomes by predicting patient situations based on evidence and coordinating the use of nursing staff and medical device resources. The results of this study support the efficacy of ICU management performed by a CNS in low intensity and open ICUs. The fusion of clinical and management skills in CNS-qualified head nurses may contribute to positive ICU patient outcomes. The main limitation of this study is that it was based in a single institution; thus, it is difficult to generalize these results to other institutions. Further, because many factors affect patients' outcomes in a complex and mutually influential manner, it cannot be definitively concluded that the presence of a CNS as ICU head nurse directly affected patient outcomes. In addition, the scale used in this study reflected the severity of the patients' conditions and the need for nursing care, but it is used only in Japan, and the correlation between severity as assessed by other methods, such as the APACHE severity of disease classification system and scales reflecting mortality, should be examined. Research has been accumulating on CNS nursing interventions and CNS practice frameworks. Scientific analysis of the patient outcomes achieved by each CNS in their role, with a view to advanced practice nursing, will expand the role of the CNS. Conclusion The presence of a CNS as ICU head nurse was associated with improved patient outcomes and fewer ventilated-equipped patients in the ICU. The fusion of advanced clinical skills and management skills may contribute to favorable patient outcomes in low intensity ICUs with a CNS as head nurse. In the future, additional qualitative and quantitative data should be collected to validate the utility and clinical value of CNS-qualified head nurses.

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