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LadysSolo 5,732 Views

Joined Dec 17, '06. Posts: 273 (71% Liked) Likes: 761

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  • 10:56 am

    Totally true. I am completely in the same boat after only six years. So unfortunate. The one thing I can't agree with in this article is the use of "lunch breaks". In six years I have had around 8 lunch breaks consisting of 30 minutes of uninterrupted time. Normally my breaks consist of shoving everything down my throat in three minutes or less because there is no time or help. You can bet your bottom dollar they sure do take that 30 minutes out of my paycheck though every work day automatically though. There is no gratitude. There is no respect. There is no support. We are alone and we need to rise up together if we ever want to see a positive change!

  • 5:08 am

    Quote from SaltySarcasticSally
    One of my positions had managers that used so many buzz words that honestly meetings got confusing because the nursing staff had no idea what they were trying to say.

    Some that I loathed the most:
    - "Everyone needs to get on the bus or your going to be left at the bus stop." (Maybe we want to be left at the bus stop....)
    - "We will circle around to that issue later offline." (Huh? Didn't know we were online but ok.)
    - "Jane Doe will take the lead on this subject." (Meanwhile, Jane looking bewildered, has no idea she is the leader on this subject.)
    - "We will revisit that issue later." (Mmm, ok, you don't care, got it.)
    - "We will run that idea up the flagpole." (No one literally has any idea what the hell that means but nod and smile to get this meeting over with))
    - "We are going to punt that to XYZ." (Cant we just not punt that and deal with it now boss?)

    That's only a few. Our favorite past time was compiling a list of the most ridiculous words and cackling over it regularly.
    Oh my god. Buzzword Bingo! You should have had cards made and bought prizes. Imagine during the meeting people keep jumping up and yelling Bingo! And then get to pick a prize. Meetings would be the same level of productive but a lot less excruciating.

  • 4:53 am

    Oh, yeah. All the time. I have a suspicion that memorizing scripts is what people are doing for two years in MSN Leadership.

    I do not know why, but the phrase "is there anything I can help you" said with the clearest meaning that things are what they are and nothing is going to be done about them pisses me right off. I got it, you can't divide as an yeast cell and send the second self to answer this call button. Life sucks sometimes. I know it, you know it. Then get off my neck and do not be yet another thing I have to pay attention to!

  • 4:51 am

    As a risk manager, I have the opportunity to do a lot of apologizing on behalf of the providers, staff and organization. I like to say that years of marriage have made me an expert in apologizing for things that aren't even my fault.

  • 4:51 am

    Thank you for your input. You are a valued member of the team!

  • 4:47 am

    First of all, scripting is highly insulting to the patient; it assumes that they don't notice hearing the exact same lines BID-TID. All of your staff need to agree that you will not insult pts' intelligence.

    1a) it is highly insulting to licensed professional staff. All of your staff need to agree that you will communicate as professionals -- and I don't mean professional ACTORS.

    Second, report in any fashion needs to take 30 minutes -- no more. All of your staff need to be VERY protective of that 30 minutes, and refuse to come in early or stay late for the sake of report.

    Third, interrupted sleep is a known major contributor to delurium (aka ICU psychosis, aka "brain failure" as a former educator called it.) All of your staff need to agree that pts will only be roused for an important medical reason. Frequent post-tPA neuro assessment is a valid medical reason; shift change is not.

    Fourth, sometimes it's just not appropriate. Some pts do not want their ROS to be discussed in front of family or roommates. All of your staff need to agree that you will provide *pt centered* care. Not idiotic management centered care.

  • 4:45 am

    I wonder what suit thought this up?

  • May 7

    Quote from ksisemo
    Last but not least, my school is in the top 3 for ACNP programs. I am trying not to give TMI, though not sure if it matters. So when you say you can't see a top program allowing this...they actually do.
    So I'm guessing your program is the MSN PreSpecialty Entry at Vanderbilt University? Three semesters for the RN (70 credits), followed by three semesters (75 credits) for the MSN ACNP - Hospitalist Track. An estimated cost of $197K. 700 clinical hours for the RN, 630 clinical hours for ACNP, 1,330 hours total. No RN experience required. And then you can prescribe, diagnose,and manage the care of acutely ill patients! Yay!!!

    For those you who say, "How is this different from PA school, they go in without prior experience?" let me explain. The OP will complete 1,330 hours, but only 630 hours are at the advanced practice level. The other 700 are just for the RN license, which is about average for a basic nursing education. And we all know how prepared new grad RNs are for practice following graduation.
    PA schools have over 2,000 clinical hours, all at the advanced practice level (in addition to a more rigorous medical education).

  • May 7

    Bnw6385 do you realize you are contradicting yourself all over the place? You say that the work of the bedside nurses is "much appreciated" by you and then turn around and say that but for your presence those same nurses would be killing patients "on the regular" and that you are "constantly keeping RN s from hurting patients". What exactly ARE you "appreciating"? If you think the NP and nursing roles are "totally different" and "barely even nursing anymore" that the "thought processes are entirely reversed" and the the "knowledge base is miles beyond RN teaching" then why do you think there should be a requirement for an RN to have "at least one year in an ED or ICU" because, according to you, even the CCRNs are one millisecond away from killing patients if you weren't there to intervene. On one hand you sneer at RNs then on the other you say RN experience should be an absolute requirement for entry into NP practice. It makes no sense and honestly isn't reflecting well on you. But I don't think you give a crap about that so...

  • May 7

    Quote from bnw6385
    Somewhat off topic, but someone has to say it. To the bedside RNs here, your work is much appreciated. I got out of that as soon as I could. I have been a critical care NP for 3 years now and an ACNP for nearly 6 years total. New grad NPs should be watched pretty closely, agreed. However, that is up to the NP, PA, M.D., or DO, the NP is collaborating with. It is your job to clarify orsers. There may even be things you can teach an NP because no one knows everything. All that being said, the things I habe seen and been asked by critical care nurses are truly horrifying and downright dangerous. These were the same CCRNs walking around acting like their you know what was top notch. When corrected, they got defensive as opposed to learning from errors, even though it was done respectfully. Granted, the floor nurses are leaps and bounds scarier and likely kill people on the regular, but for RNs to come in the NP section and act like they know it all and how to do our jobs better than many of us is...frustrating...to put it lightly. The job is totally different, barely even nursing anymore. The thought processes are entirely reversed. The knowledge base is miles beyond RN teaching. Sure, it takes APPs time to get there, but until you're there, the RNs like the one who called the OP a sellout (paraphrasing) just need to keep quiet.
    I'm sure your attitude at work is extremely respectful to those CCRNs you've corrected and to the floor nurses who are likely to "kill people on the regular." Of course it was. Why, you sound like an paragon of tact and respect.

    NOT.

  • May 7

    Quote from bnw6385
    It is easy to be respectful and professional in the workplace, Jules. I have no problem doing so. I am not surprised at the reaction here, though. It is funny, however, that you would react this way, but when RNs are insulting all of our colleagues and speaking as to how fantastic they are, you seem to find no problem with it. I was speaking to the FACT that I have constantly had to keep RNs from seriously hurting patients, and when covering floors, feel like half my job is keeping those nurses from killing their patients. I educate and correct, with respect, but it does not mean that I do not remember what happened. Unfortunately, I entirely understand where RNs would and do lose autonomy. Since becoming an NP, I have been thoroughly disappointed at the lack of critical thinking skills. When those calls are not being directed my way, but going to physician who are seeing that on a more massive scale, it hurts the nursing profession as a whole and is utterly embarrassing. It then is no wonder they seek to limit NPs. Call me what you like, but I will not sugar coat this outside the workplace to make people feel better. Call me a coward for doing it here. That is okay, as well. I have a thick skin. I also habe the guys to call things as I see them...at least in an arena where I won't be fired.
    My experience has been different and I am forever thankful for both my years as a floor RN and the nurses who now care for my patients 24/7. Although being a NP in psych is different in the tasks I perform my mindset and thought process are exactly the same. I always considered s/s of their diagnosis and what medications I'd like to see ordered or which of the available meds I would need to select for prn administration based on their presentation.

    I think it is beyond smug that people think they can step into this specialty without solid experience and identify the subtleties if they haven't ever seen and compared multiple presentations of psychosis vs delirium vs SUD vs personality disorder vs trauma vs TBI etc.

    As for my beloved RNs, they keep me abreast of what is actually happening, the many things I might not detect in the mere 15 minutes I spend face to face with my patients. They alert me to errors or omissions I might have made. They continually make me look good by ensuring everyone is alive each morning. I'm not saying there isn't the occasional mistake, as well all have made, or silly after hours call but I'd much rather they feel comfortable to contact me with anything than to let one major sign go unreported. I attempt to let them know how thankful I am for their vigilance and treat them to goodies regularly as a small gesture of my appreciation.

    You make an interesting point about our reputation and my loyalty. I consider my psych nurses to be more my colleagues than the newly minted NPs with zero experience who were not properly prepared by our quickie NP education to practice competently after becoming certified. In my opinion they are the ones who are embarrassing us to physicians not RNs and LPNs.

  • May 5

    An elderly female who was having a difficult time getting off the bedside commode, even with assistance. She passed gas loudly and exclaimed, "Good grief, I can't even get up when I am jet-propelled!"

  • May 4

    I think of it like a teachable moment- is there swelling? Is there bruising? Trouble with ROM? If the answer is no then ice isn't necessary. Helps them learn the difference between discomfort and injuries. I remind them how amazing their body is at healing itself but reassure them that if it still hurts in 45 min then we can reassess. Never see them again 😊 More often than not they just needed someone to reassure them they're fine.

  • May 2

    Quote from ksisemo
    So if a tree falls in the forest, and no one is around to hear it...

    Let me ask you this: is there not a point at which a practicing with NP with no prior RN work can feel that they, too, are experienced? Let's say you have an NP with 10 years of experience, all as an NP; and another NP with 10 years of experience; 5 as an RN and 5 as an NP: do you believe that the former is less competent than the latter? Or actually, is it vice versa? Or are they equal? At what point does the lack of RN experience no longer matter? Or will you guys argue that it will ALWAYS matter?

    I don't believe you can fairly say that having RN experience will always matter. In the beginning, certainly. Over time, these things must level out. Perhaps if you are an RN that happened to gain experience in a variety of settings, and now as an NP you will use that background in a single specialized area, then the advantage may always exist. But what if your RN experience was limited to OP clinics and your NP specialty requires critical care skills? Your NP experience will be the more important of the two.

    I honestly think this is a gap that may be able to be closed in a relatively short period of time. Even those programs that require experience before going on to advanced degrees (MSNs and CRNA programs) only need a year or two.

    I am playing devil's advocate, because I still believe experience is better. Which is why I think I will work after getting my RN, and do the MSN portion part-time. The program does not let me take time off in-between, though. I have to plow through.
    You don't know what you don't know. Experience matters. The gap may be closed in a decade, but how much harm will you do to your patients in the mean time? You don't know what you don't know.

    You're an articulate writer, and possibly quite intelligent. But you don't know what you don't know and you don't get that.

  • May 2

    Quote from ksisemo
    You're right, I've never been an RN in the ICU. But I HAVE been lucky enough to shadow an ACNP in the ICU, who was also on the Rapid Response team for the hospital. So saying I've never "stepped foot" in a critical care until is inaccurate. Don't get me wrong, I know shadowing gives no actual experience.

    I can't quite figure out why people are ignoring my comments about working during my MSN year. I'm saying that I'm now considering working during that portion, so that I CAN gain at least some experience.

    People are also making the assumption that I want a job in a critical care right when I come out of school. This is faulty. I would like to be trained in this area, but I don't necessarily feel the need to work there. ACNPs are employed in a variety of settings, not just ICUs.

    Last but not least, my school is in the top 3 for ACNP programs. I am trying not to give TMI, though not sure if it matters. So when you say you can't see a top program allowing this...they actually do.

    If you came here looking for consensus that what you're doing is a good idea, you didn't get it. Yes, you did get some folks saying that they did it and they're doing great. I'm wondering what their colleagues think about how "great" they're doing. I'm not saying it's impossible to take the short cut and still (eventually) become a competent NP. I'm just saying it's unlikely in the extreme that it will happen without a few patients along the way coming to harm; even to great harm. You still want to take the short cut. I'm am profoundly grateful that I won't be working with you when you graduate from your "top school." My department (in a large, famous teaching hospital) makes it a policy not to hire NPs who took your short cut after some truly horrifying experiences with NPs who did.


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