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apocatastasis 7,286 Views

Joined Feb 13, '08 - from 'Austin, TX'. apocatastasis is a APRN/ARNP, PMHNP. He has '4' year(s) of experience and specializes in 'Psychiatry, ICU, ER'. Posts: 213 (59% Liked) Likes: 540

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  • Mar 22

    I'm a new NP, received my Master's 3 months ago. I have no complaints about the clinical portion of my MSN program. But we would have been well-served with MORE than 700 clinical hours. I would love, and willingly pay for, a doctoral program that would provide me with additional didactic and clinical training in psychotherapy, neuroscience, and psychopharmacology. You know, USEFUL stuff that we're supposed to know.

    Would the DNP provide those experiences? Absolutely not, because this clinical/practice doctorate is neither clinical nor practical.

    I've looked at curricula from schools all across the U.S. I can't help but see the DNP, quite frankly, as an inferiority complex-driven grab for money and power that embodies everything that is WRONG with nursing education.

    Forgive me if I'm overly cynical, but these wounds are too fresh. I've already yawned my way through more hours of health policy, systems, and research than I care to count. I've already witnessed the most egregious and childish stereotyping of minorities in the name of a semester of "cultural competency." I've already written far too many forty page papers on the history of dryer lint and the ethical concerns surrounding Florence Nightingale's lighting farts on fire with a match, formatted in APA format and referenced.

    And they're telling me I have to do it AGAIN? NO. THANKS.

    When AACN gets its act together, it can find me over here... actually taking care of patients. (Now there's a concept they've never heard of.)

  • Feb 13

    I'm an NP student, with slightly over 2 years of experience, and I resent the OP's post.

    I say this as a ICU nurse who, with a measly YEAR of experience, had multiple opportunities to save the asses of SEVERAL "experienced" nurses both in ICU and in rapid responses on the floor.

    I can also say this as an ER nurse who has had to take on facets of care of critically ill patients for allegedly "experienced" ER nurses who, for instance, couldn't use the IN-LINE SUCTION on a VENT. Don't even get me started on how these "experienced" nurses don't know how to properly start or to titrate nitro drips, pressors, or propofol.

    I get the gist of your vent. A person is a fool if they say or think they know everything. This is independent of how much experience they have. Do not paint us all with such broad strokes.

  • Dec 24 '15

    As an ICU/ER nurse (and atheist), I don't think I should have to pick up the slack because of your religious beliefs. Sure, I'll check the blood with you, but YOU are responsible for YOUR patient: you spike the bag, you prime the line, you set the pump, and you monitor the patient.

    I've had patients that needed 5-10 blood products in one shift... you're going to interrupt me every time your patient needs FFP, PRBCs, albumin? Honey, I got patients too, and I don't always agree with patient/family attitudes or plan of care but I still do my job. Maybe this kind of nursing isn't for you.

  • Dec 15 '15

    For what it's worth as a psych NP student with 2 semesters to go (!)... we are regularly inundated with postings for psych NPs. They are all over the internet and all over the place. The last one I got was in Chicago, starting salary of six figures with 2.5 months per year of PTO (2-3 weeks sick and CME and the rest vacation). Full medical insurance paid. I know that at least a couple of psych NPs in private practice here in Texas make more than 200k a year, and 90k-130k starting seems to be the norm across the country, though inpatient/hospital type settings seem to pay less across the board.

    A common theme I'm seeing about NP salaries is you have to know how much money you are bringing in to a practice and argue your case for an appropriate salary. Healthcare is NOT any different from any other business, if you own a practice, build up a clientele and charge the going rate in your area. If you are employed by a practice, you HAVE to play hardball sometimes to get what you want, or, yeah, you will be paid $65k a year and you have nothing to blame but yourself. Why would an employer pay you 120k a year when you are ignorantly chugging along, thanking him for the 1,000 dollar raise to your 65k salary?

    Nurses in general seem not to be very astute at business so they slide along making crap wages. Sorry, but here in Austin, RN wages are TERRIBLE given the work conditions, who wants to do this for the rest of their lives?! If you look, you will find opportunities to make a decent wage, earn a good return on your money, and, most importantly, do what you love to do.

  • Dec 2 '15

    One of my co-workers ate the leftovers from the dirty, nasty patient meal trays from our dirty inner city hospital ICU crawling with MRSA and VRE and E. Coli ESBL and all kinds of other goodies. Day after day. SO gross.

  • Sep 7 '15

    I work primarily outpatient in community psychiatry, though I have also worked at a crisis facility and do some inpatient rounding PRN. There are a number of specialties in psych which are quite different from the kind of work I do (e.g. substance abuse, working with TBI or HIV patients, crisis work, mobile outreach or ACT teams, eating disorders, liaison work in hospitals [which is very interesting if inpatient and medical comorbidities are your thing]). Psych has much broader applications than most people realize, though you must always be mindful of your scope of practice.

    I currently work 8-5, M-F. I'm on call 4 days out of every 3 months unless I want to pick up more, and I am compensated well for it ($300 a night for F/Sat/Sun call and $125 a night for weekday).

    I do not do any counseling, but I DO do psychoeducation, try to throw in some basics of CBT, talk about engaging with group therapy, etc. Unfortunately, employer does not want me doing therapy, as that can be farmed out to the LPCs and LCSWs. I have a caseload of over 1,000 patients and have only 20 minute appointments, so I feel like a conveyer belt towards a prescription pad at times. However, you can still make a big difference even given 20 minutes... meds aren't miracles for most people, but I've seen some amazing changes which make the work seem very much worth it.

    As far as what I see patient-wise, it depends. I've worked at a few different facilities; at my current position, I have mostly stable patients... however, I am occasionally floated to cover for other prescribers, and the NPs who work at our crisis facility and on mobile crisis team frequently have medically and psychiatrically ill patients. When I was in Seattle, I worked with forensic and supportive housing clients who were about as medically and psychiatrically ill as they come. All this business about NPs don't take sick patients, the MDs take those-- very much NOT true in psych. If anything, I had patients who were quite a bit more ill than what most of the MD colleagues had.

    As for the money, a lot of it is how shrewd a businessperson you are. I can't speak for other specialties, but I personally would not take a job as a psych NP in a major market for less than $90k a year. You have to negotiate with employers and insurance companies. A lot of nurses and NPs are not good at this, which is probably part of the reason our wages are generally lower than they should be.

  • Aug 15 '15

    I'm not entirely sure WHY whenever marijuana is mentioned, a certain segment of the population cries "patient safety." News flash: alcohol is legal and we're not all coming to work impaired. Stop using "patient safety" as a way to object to something that YOU don't like.

  • Aug 5 '15

    I'm a new NP, received my Master's 3 months ago. I have no complaints about the clinical portion of my MSN program. But we would have been well-served with MORE than 700 clinical hours. I would love, and willingly pay for, a doctoral program that would provide me with additional didactic and clinical training in psychotherapy, neuroscience, and psychopharmacology. You know, USEFUL stuff that we're supposed to know.

    Would the DNP provide those experiences? Absolutely not, because this clinical/practice doctorate is neither clinical nor practical.

    I've looked at curricula from schools all across the U.S. I can't help but see the DNP, quite frankly, as an inferiority complex-driven grab for money and power that embodies everything that is WRONG with nursing education.

    Forgive me if I'm overly cynical, but these wounds are too fresh. I've already yawned my way through more hours of health policy, systems, and research than I care to count. I've already witnessed the most egregious and childish stereotyping of minorities in the name of a semester of "cultural competency." I've already written far too many forty page papers on the history of dryer lint and the ethical concerns surrounding Florence Nightingale's lighting farts on fire with a match, formatted in APA format and referenced.

    And they're telling me I have to do it AGAIN? NO. THANKS.

    When AACN gets its act together, it can find me over here... actually taking care of patients. (Now there's a concept they've never heard of.)

  • Jul 15 '15

    I'm a new NP, received my Master's 3 months ago. I have no complaints about the clinical portion of my MSN program. But we would have been well-served with MORE than 700 clinical hours. I would love, and willingly pay for, a doctoral program that would provide me with additional didactic and clinical training in psychotherapy, neuroscience, and psychopharmacology. You know, USEFUL stuff that we're supposed to know.

    Would the DNP provide those experiences? Absolutely not, because this clinical/practice doctorate is neither clinical nor practical.

    I've looked at curricula from schools all across the U.S. I can't help but see the DNP, quite frankly, as an inferiority complex-driven grab for money and power that embodies everything that is WRONG with nursing education.

    Forgive me if I'm overly cynical, but these wounds are too fresh. I've already yawned my way through more hours of health policy, systems, and research than I care to count. I've already witnessed the most egregious and childish stereotyping of minorities in the name of a semester of "cultural competency." I've already written far too many forty page papers on the history of dryer lint and the ethical concerns surrounding Florence Nightingale's lighting farts on fire with a match, formatted in APA format and referenced.

    And they're telling me I have to do it AGAIN? NO. THANKS.

    When AACN gets its act together, it can find me over here... actually taking care of patients. (Now there's a concept they've never heard of.)

  • Jun 14 '15

    What's the difference between the PhD and DNP? They aren't the same?

    And why is it so complicated? An MD is either an MD or DO, not this and this and this.....why isn't nursing the same?
    An MD is not, technically, a doctoral degree. It is a professional degree, as is the DNP. The JD, obtained by lawyers, is a Juris Doctor... again, it is a professional degree and not a doctorate. It is equivalent to a bachelor's degree in other countries (e.g. in the UK it is equivalent to the MBBS). Residency is graduate MD education. There are MDs and JDs who go back for further doctoral-level training and are MD PhDs and JD PhDs, respectively. Nursing wants to adopt this model.

    This is incorrect. Only 500 hours after completion of the master's degree? Not according to Baylor's curiculum for their FNP
    The University of Washington, as one instance, requires 1,000 hours for the DNP degree. However, I can apply my 700 Master's-level clinical hours towards my DNP. So, a DNP (in addition to the ridiculous coursework) would require only 300 clinical hours, which is slightly more than what I was doing every semester for my last two semesters of grad school. (And would probably add little to nothing to my clinical knowledge unless I were able to pick my clinical site and focus.)

    In any case, it certainly does not compare to physician training, though I wish it did in some respects.

  • May 8 '15

    So I had a situation the other day when I came on shift and took a patient from an RN, and she goes, "This patient has DKA, started the insulin drip, K was 6.3 so we gave Kayexalate..." I stopped her and was like, Kayexalate what the hell?! She said, "Well, the potassium was 6.3 and the doctor ordered it, so I gave it."

    When I worked ICU (at a different hospital), standard orders and hospital policy were 1) rehydrate, 2) insulin drip, 3) start KCl IV as you begin the insulin drip, even in the presence of elevated serum K+ levels, which is most likely transitory. DKA patients are significantly potassium-deficient as well as profoundly dehydrated, and as insulin is administered, K+ will influx back into the cell.

    I said all this and the RN looked at me like I was from bizarro world. Several of the other ER RNs seemed not to be aware of this, and the fact that the ER physician ordered Kayexalate was really hard for me to fathom. I shipped the patient to ICU not long after, so I don't know what happened.

    What do y'all think? I feel like maybe I should talk to our unit educator. We don't see nearly as much DKA in my suburban ER as we did in my nasty dirty central-city ICU... I feel like it's important that our RNs be competent in the pathophysiology and treatment of DKA, which is pretty significant as far as emergencies go.



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