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Psychcns 12,568 Views

Joined Feb 10, '06. Psychcns is a Psych APRN. She has '30' year(s) of experience and specializes in 'Psychiatric Nursing'. Posts: 874 (43% Liked) Likes: 831

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  • Dec 7

    Quote from Jules A
    Although I know I'm more productive in real life I also believe the things I write here cause people to think regardless of if they agree or disagree and I also learn about different perspectives from other posters.
    Indeed. Your writings and that of others gave me a new perspective and insight that has served me quite well. It made me hungry for more and for what I deserve, desire, and require.

  • Dec 6

    Preceptor training. We have looked at preceptor training as there is ample evidence from other disciplines that outcome quality is dependent on the effectiveness of the preceptor in their role; sadly many preceptors have never done any formal (or informal) training.
    Bedside nurses have gone through quite a bit of training in many places as preceptors. My job before this one was creating preceptor workshops and nurse residency courses and I trained nurses all over the country. It was fantastic. There will be a NP preceptor course created probably in the next year as grant funding is coming through. The CCNE has accredited many BSN programs, I think the NP one will follow the same teaching methods which is all based on adult learning principles. You are right, however, having a trained preceptor makes a big difference.

  • Dec 6

    lol we all know its just a money bang. schools and BON get rich and people get to wear their white coats proudly. Everybody wins except the students at the tail end of the NP gold rush, currently working NPs, and the patients.
    NP schools are a lot more than you are giving them credit for. There are variances in school quality, but your sweeping statements are factless. I have seen a lot more physicians in favor of NP's than the opposite and if NP's were killing people at alarming rates, we would hear about it. It makes me nervous when I read posts from medical students who have such disrespect for a discipline they will have to work so closely with. If you like medicine better, great, go like medicine, but many physicians also really like working with NP's and value their input and expertise.

  • Nov 16

    Because of this post. I'm sure majority of the nurses are renewing their malpractice insurance. =)

    The good news is... it sounds like the OP is now fully recovered! Thanks for sharing your story!

  • Nov 13

    Quote from casias12
    Since somewhere around 40% of our dollars go to immigrants, legal or otherwise, who have not paid in, I believe a part of the cost savings plan will start there.
    Don't mean to go off topic but please quote your sources especially since you invoked legal immigrants as well who are eligible for legal employment. The data shows that undocumented immigrants actually contribute to state and local taxes at an estimated $11.64 billion annually. I don't support illegal immigration either but I strive for facts.

  • Nov 12

    Quote from PsychGuy
    I am proud to support President Elect Trump, my Republican party, and I have never been so excited about politics.

    For those worried about the direction of healthcare, keep working. Do well, work hard, and you'll make money. We're losing money as a result of Obamacare. For my family of three, I pay $16,000/year in health insurance. I can afford it, but it's ABSURD. It's hard to gauge what a President can do with his first term, but I am definitely excited to find out.

    Obama never did anything positive, productive, and lasting. We now have a business leader who will take office, and I hope this leader will run this country as a business without worrying about individual feelings and entitlements. An array of men have Trump's ear, and these are knowledgeable men with Conservative world views which is just what we need after eight years of socialism.

    I no longer have a concern with global warming. I feel like it's happening, but there are far more pressing issues to concern ourselves with, and sans the transgender sharing regular bathroom thing, which I also believe is ridiculous, I support the Trump-Pence platform wholeheartedly despite knowing more nurses are liberals.
    Trump had a platform? Other than hate, of course. Because it seems to me that he ran on misogyny, racism, xenophobia and all forms of bullying and hatred.

  • Nov 11

    Quote from Psychcns
    This is a quote from OP above
    . I was spoken to the other day for asking the woman who handles our referrals if there was someone local who handled bariatric surgery requests (something I've only had a patient request once) because I should have known the answer.

    My response
    This is bullsh*t. Not only is it disrespectful to be told "you should have know the answer." It seems they are looking for a list of things to terminate you. How did it get to your boss that you asked The referral person a question about referrals.

    Have you sent sent out resumes. Any prospects? You cannot thrive in a non-supportive environment like this.
    Yeah. It's BS. One of their big criticisms is that the questions I ask are too simple for someone who has been there as long as I have and that I should know the answers. I was even told that it's not about my clinical judgement but I guess more along the lines of office policies and procedures? They've included the bariatric thing as well as some other administrative type questions about situations I seldom encounter.

    I've come to find out that several people have essentially been told to watch me and report back to my MD. Thus perhaps explaining why people have been acting odd around me. I can now better understand how they must feel. Can't be too comfortable having your boss ask you to spy on a co-worker with whom you prevously had a good relationship. Ugh. I'm trying to be cordial, but very distant. Doing most of my charting and phone calls now in one of the back rooms away from other staff. But it's very walking-on-eggshells and it sucks.

    I've updated my resume and begun applying online. It's tough since I live in a rural area and have a no-compete clause, but I'll be working on things more tenaciously this weekend so here's hoping something comes from it.

    Thanks again to everyone for all of your support and suggestions.

  • Nov 6

    Quote from Buyer beware
    OP,...I think it would good for your overall well being to discuss with the supervising M.D. just why, given the polar opposite reviews of your competency and patient interaction, what has precipitated this professional and emotional rug pulled out from under you.You see the "not a good fit" is a pitiful cliche excuse to get rid of you when I believe as a professional and colleague what you should expect is a heart to heart constructive discussion with your detractors that will empower you to be in the position to evaluate their statements to be valid or not.
    Thank you for your response. I did actually ask her a few meetings ago what was different - what had chanaged. And she essentially told me these issues had been there from the beginning. I then asked her why it was never brought to my attention so I could have known about them and addressed them. She muttered something about how nobody likes to bring up these things. It still doesn't make sense to me. I don't think I'm a hero and I don't think they thought that either, but leaving the place feeling like there really weren't any criticisms toward me and then coming back to this was very jarring.

    We've met something like 5 or 6 times since that first event and every time we now meet I feel a lot clamer. While I continue to try to be introspective and improve my practice, I deeply feel as though they are just trying to find fault when no fault is there. I was spoken to the other day for asking the woman who handles our referrals if there was someone local who handled bariatric surgery requests (something I've only had a patient request once) because I should have known the answer. That kind of stuff. With a little distance from it, I see the "not a good fit" statement as likely being what it is it. If they don't think it's a good fit, then I'd be stupid to try to force it. So, yeah. I continue to reflect on their criticisms and try and improve (I don't want to sabatoge myself) while I look elsewhere. Thanks again.

  • Nov 5

    I thought about this overnight and wanted to come back to this because as anyone can guess I've gone thru a suit that was settled on my behalf that involved a pt injury.

    It was devastating to me personally but much less so professionally (surprisingly). I was a brand new APRN and thru a series of errors involving several people there was a mistake made, a pt was injured and lawsuit filed and ultimately settled for what I consider to be a large amt of money but which the attorneys all considered to be fairly low (in the neighborhood of your amt).

    It took 7 years for it to make its way thru the court system - all the while it rested right there in my mind day after day. Couldn't discuss it with anyone, yet everyone knew. Oh my other colleagues were all sympathetic but in their own minds thinking..."hmmm..that could never happen to me, I'm too cautious."

    Well - that's what I thought too...oh how the mighty will fall.

    I do sincerely know what you are going thru - its a horrid experience - one of the worst of my life (not the worst) but definitely the worst in my professional life.

    Please do consider counseling - the stress and the time that the stress continues can wear on you.

    For me, once the suit was settled, I truly breathed a sigh of relief only to find out that now the settlement info goes to the BON - yikes!

    Then...a hearing was scheduled. I had an administrative law attorney write a letter about the steps I had taken in the ensuing 7 years to remediate my deficiencies including additional CME and formal education as well as letters of recommendation and I was very fortunate not to receive disciplinary action.

    This all concluded over 3 years ago and even though the initial incident was over 10 years ago, I still remember it clearly.

    Please reach out! Take care.

  • Oct 30

    Quote from SnowShoeRN
    Thank you. It's all been verbal. At least they've said "We've gotten some complaints, we've heard about this, we've heard about that..." We've had 3 meetings. I received "minutes" from the first one - a synopsis of what was discussed that I signed and gave back to them. The first meeting was innocuous enough. The things they said were surprising, but relatively gentle, and I took it as a call to be more introspective and focus on my practice more thoroughly. But since then, they've backpedaled a lot with some of the things they've said and can't offer reasoning or rationale behind some of the other things. And their criticisms are getting harsher and largely unfounded.

    I constantly want to improve my practice and my relationships with my co-workers, but - yeah - it's really fishy. I asked someone at the practice, who I really trust, if she had heard anything and she said no and that she was incredibly surprised and really admired me and the way I practice.

    So...yeah. I think they just want to get rid of me. Thanks again.

    Largely unfounded? But some allegations are true? Correct these at once.

    Look for other work, don't just wait to be fired. Yes, you could collect Unemployment but might have to give it back if the former employer contests it and wins.

    Although - getting fired isn't necessarily the worst thing. Can you collect Disability? It's hard, although not impossible, to get Social Sec Dis, but do you have short-term and/or long-term disability insurance through a private insurer? If you're old enough, you could start collecting Social Security. I'm thinking you are pretty young, though.

    Don't believe your coworker didn't know about your troubles or would tell you the truth if she did. She's got her own life, her own troubles, would likely catch the devil if she were to actually back you up. Don't expect your "friends" at work to come to your aid. It's not fair to them. You are on your own.

    It would be nice to know what actually happened
    to cause you to be viewed in the current light instead as the water walker you were at first. Were you hurt on the job? Can you still do the job?

    Staying there will likely become more and more upsetting and anxiety-producing as they continue to ride you and behave like the evil demons they sound like. Try to look at the matter from their perspective, though.

    Start looking right away for another job. Get your doctor and a couple of other workers to give you written letters of recommendation with live signatures on letterhead stationery. Of course, they could always say you faked them, but might be willing to help you.

    Best wishes. Probably good to act sooner rather than later.

  • Oct 30

    I've seen both models (NP's hired under nursing services and under physician services). I see pros and cons in both models.

    Large academic medical centers sometimes hire NP's under nursing either directly under the CNO or under an advanced practice nurse manager (typically someone belonging to one of 4 APN professions: NP, CNS, CNM, or CRNA). I've not seen an NP hired under nursing be managed by a non-APN but I'm sure it exists. This model helps "beef up" the actual number of advanced practice nurses in the total roster of nursing employees (which looks good on paper for institutions who are trying to maintain Magnet certification).

    In facilities where nurses are represented by a union, NP's sometimes become automatically represented and can have the benefit of collective bargaining (higher wages than non-advanced practice nurses, protection from long work hours). The downside is that the NP would have to make certain the source of where their salary is taken from - if your cost center is nursing, that can make billing under your name impossible because your salary is not under the physician part of Medicare billing.

    On the other hand, working under physician services also has its perks. For one, you could be eligible for a host of physician only accommodations such as physician parking, "physician dining" areas in hospitals. Sometimes benefits for physicians are different than regular staff so you also may be eligible for this higher level of benefits. The downside would be that salary can vary to being low-balled (as physicians would do if they can get away with it). You would need to be good at negotiating a fair wage and proving your ability to ramp up revenue with your RVU's.

    Personally, being under either model is not a deal breaker for me as I would look at the total compensation, the opportunity for growth, the overall culture of support and ongoing learning, etc. Nasty politics can exist in both.

  • Oct 30

    The facility in which my company placed me is weird. I'm credentialed by medicine, but I'm considered part of the nursing department. Makes for some interesting conversations. And I refuse to be dictated to by someone with an associate's degree. Collaborate yes. Dictated to, no.

    No provider should be under the direction of nursing. At this point, I'm a nurse but I also cross the line into medicine. All of my work is done as a medical provider. Ergo, I should be governed by medicine.

    That said, I'm still proud to be a nurse practitioner...

  • Oct 28

    It seems as if you are asking the question because you truly feel that you are one step away from termination. Since that seems to be your gut feeling, it might be better to resign instead of waiting for the shoe to drop. Or, go ahead and have the conversation, make an agreed upon exit plan, and look for a new position in earnest. Best wishes.

  • Oct 27

    Quote from llg
    I've worked in a couple of NICU's where the NNP's were "co-managed" by the physicians and nursing departments. Since the NNP's are practicing advanced-practice nursing (not medicine) when they work, they are part of the nursing division. Administrative matters (annual education, parking, scheduling, etc. is managed by the nursing division). However, their direct patient care is supervised by the physicians.

    I guess it comes down to what you consider an NP to be:
    1. An advanced nurse?
    2. A junior physician?

    Those who consider them to be advanced nurses want them to be a part of the nursing profession and organizational department. The aspects of their care that require physician supervision can always be "added on" as needed. Those who truly feel that NP's have left the nursing profession when they acquire those "advanced nursing practice skills" may not see themselves as nurses anymore. If you don't see yourself as a nurse any more, you should call yourself and advanced practice nurse.

    You can't have it both ways. If you see yourself as still a nurse, then being a part of the nursing division should not be a problem unless and unqualified nurse manager is trying to tell you how to manage the patients (which should not be happening.) But there are many ways to stay a nurse and be a part of the nursing department while still having the clinical portion of your practice supervised by a physician. However, if you feel you are no longer a nurse anymore, you should not call yourself an "advanced practice nurse" or "Nurse Practitioner" to begin with.
    This has a great point I have not reflected on much, I am a advanced practice nurse hence I suppose?? I practice nursing.... yet in reality we are in the same healthcare role as our colleagues DO's, MD's and PA's. We are share expertise and consult our expert colleagues when appropriate, and they us depending on specialty. It is a curious twist to consider who manages me, and I do not much care as long as they are professional and provide me the ability to provide the best care at the most efficient cost to my/our patients. I have seen some horrid physician/ARNP managers and superb RN managers. I do not want to get to caught up in the letters behind a name, just as my patients do not get caught up with the letters behind our name, but rather consider the product and outcome perhaps?

  • Oct 27

    Thanks for the info - do you function as an APRN? If so how does that work with NNPs?

    Or do you do some other type of role?