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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: 546

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  • Jul 31

    I'm not an ACNP, but I did go from an inner city ICU where all the patients had every major comorbidity in the book... to a suburban, high volume ER where the patients are overall much, much less sick.

    The ER nurses at my hospital, with a couple of exceptions (those being the nurses that also worked ICU and, to a lesser extent, those that have worked in major trauma center ERs) do not have the experience with hemodynamics and management of really sick patients that I had working in a CVICU/SICU. Many of my ER coworkers have between 3 and 10 years of experience and can't/don't titrate drips or coordinate ventilator readings and what's going on with the patient. On the other hand, they are still more proficient than I am with initial reception of STEMIs, strokes, and things I saw less of in ICU.

    You will learn things in ER that you won't in ICU and vice versa. I do think that having a strong background in respiratory, cardiovascular, neuro, and renal issues, which I feel you'd probably get more of in ICU that takes truly critical patients, is going to be really valuable experience if you're going to work in a critical care environment as a provider. If I were in the ICU as a patient, I don't think I would want an ACNP taking care of me that had never worked ICU before.

  • May 31

    I'm a psych NP, employed in an outpatient community (=not high-paying) psychiatric setting, one year of experience, and make 6 figures..

    More than just a few of the psych NPs I know in private practice make between $200,000-$300,000 a year. At least one significantly out-earns both of her psychiatrist partners. I'm looking into starting a telepsychiatry practice, and factoring current reimbursements, no-show rates, etc., working 35-40 hours a week and earning in the $200s is definitely doable looking at the longer term if all goes well with the practice.

    Money isn't everything, but, since that's what we're talking about... it's all about how aggressively you market yourself, your business sense, and what kind of market, practice, and practice climate you're in.

  • Jan 31

    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.

  • Jan 26

    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.

  • Oct 15 '16

    OB rotation *is* hell, and it certainly hasn't been my experience that there's no modesty in labor. When I did L+D two weeks ago, I was prevented from seeing ANY births at all because neither of the two moms giving birth that evening would tolerate a male nursing student. It was really humiliating and boring.

    I don't think there should be OB rotations in the first place, nor do I think maternity should be tested on the NCLEX. Not unless they start making students do a semester or half-semester of oncology, cardiology, critical care, etc. etc., which in the long run would probably be far more worthwhile.

  • Sep 13 '16

    Hi all.

    I got my RN license at about this time last year, right after I started working as a GN at a downtown San Antonio ICU. It's a SICU but we see a wide variety of medical/surgical/cardiothoracic patients. We generally have very high patient acuity. Lots of drug abuse, non-compliance in the face of multiple comorbidities, repeat offenders leaving AMA and coming back a day or two later, etc.

    In some ways and on some days, I love working as an ICU nurse. I'm finally able to more or less independently care for the sickest patients that we get. Vented patients, balloon pumps, septic shock pts, CABGs, managing multiple drips, CRRT, RRTs and code blues, I do it all and the rush keeps me going.

    But although I do my best when it comes to particular patients, I feel like I generally just don't care anymore. Without even going into the issue of how hospital administration and doctors' attitudes get me WAY down... patient-wise, I see the same things day after day after day. People who don't want to learn, don't care about their health, don't care that our team snatched them from the jaws of death. And then I read about the pertussis outbreak way over there in California. And then I think about my dad, who has years of untreated HTN and refuses to see a doctor and is probably gonna end up as a STEMI on a balloon pump.

    And then I think, why do I bother? Why am I busting my ass and breaking my back for you, mister 34 year old, 800 pound, 6 cigarette pack a day CABGx5, when you're gonna go to the nearest McDonald's immediately upon discharge and eat 8 big macs? Or you, the violent, intubated 22 year old heroin overdose with seizures and anoxic brain damage, with a history of being intubated following heroin overdose and hemodialysis since the age of 15, whose insane mom is sneaking in opiates behind my back and screaming that the benzos we're giving him for sedation are killing him.

    I feel like I used to care about my patients. Sometimes I still feel like I do. No matter my attitude on any given day, the job always gets done. Some days I go home and I'm proud of my work. I said goodbye to my alert/oriented patients in the morning and wished them well, and I really meant it.

    But then there are the bad days where I go home, have a beer, put my head in my hands. And I feel like an empty human being because I don't care about people anymore, entirely dread having to go back to work tomorrow, and wonder what the point of all this crap is.

    Sorry, I just had to vent. Thanks for reading.



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